a Me VORONEANU ALEXANDRU BUCUR CARMEN VICOL DINESCU NEDIM NICOLAE ACTUALITATI PRIVIND RISCUL URGENTELOR MEDICALE iN CABINETUL DE MEDICINA DENTARA In cabinetul de medicina dentard pot aparea urgente medicale in care rapiditatea si exactitatea _masurilor eficiente este esentiala pentru salvarea vietii pacientului . (© buna cunoastere a lucrurilor ce trebule facute in cabinet , ca primi reprezentanti ai sscutului? medical in apararea fata de inexorabil, asigura cagtigarea de secunde pretioase. [RCTUATITATIPRIVIND RISCUU URGENTELOR MEDICALE iN CABINETULDEMEDICINA DENTARA edu omACTUALITATI PRIVIND RISCUL URGENTELOR MEDICALE IN CABINETUL DE MEDICINA DENTARA Coordonator : MARIA VORONEANU. Autor: MARIA VORONEANU ALEXANDRU BUCUR CARMEN VICOL, DINESCU NEDIM NICOLAEAutor: MARIA VORONEANU Prot. Universtar Ds atvertaten de Medi Formac rT Popa ALEXANDRU BUCUR Prot: Univeraitar Dr. DINESCU NEDIM NICOLAE Medic stomatolog Doctor in Medicin’ Dentard “Targovste Pree In argent ema ult dest inde in medic tines si tine tebe ab fe pase ia sluba sav igh efi alate vn 9 awe freemen actual in ae aspecral medic ogal least de fecare segmental ingore medial u devent © prezeis fstseia ie areal maseedia sau chor nial JRdectest conser sara apiia uni ci cre ‘fos is evaliren i enfieares paces c een special Te pacica medic dente dar la eto dei cae fe tinpctstl apres sau cia eel ston arse ‘Get pent deans uni eveniment medial previ. Ices apt. a moist oven autor Ste ‘actuate subechu urfrnd eompletaren cu date de Ut ort pecblematl impact tlle wenerale. Ta pracica de medicing desta In tats conplexiavea lor, Fre taunt de management cae se impun In (A. gene edicale UUgette medial pin pl lich fncile vitle ale Cult conse O pint de ceca pen pete si promptidines medcubl pain car 8 ‘acts prosacice @ frpil specie, webie st asigue Sigwast pacient stoves! neve popu Ej aor mcode sca care au dep sop entice acon cu tse matical ar i a faconor de ric cae ottaacort evolu inraoperaoi preci 5 profi Ghampementul gene meicle coniet cd son gwar chi lores per rata de cabinet ena (Coen treed sprinaeste cA ete poss consi wn nc de refeim tetra de specinia y cae repeat Grvgiid de orenre practic, extrem de ul poction ‘Seen de medio dettara.Feit ofr coxjugate ale ator In elaborres ace fi complete complete cae. rprerind opis ‘ipericnflor pep, acum pe. pcr nor cree ‘medial de ances pe cate o comidetladspesabl In rege oka actcon de medi deta, Prof, Univestar Dr. Dr.Aleandr Rotara Universite de Medices Farmace «ta agegaaa” Cj {IMPLICATILLE URGENTELOR MEDICALE IN PRACTICA DE MEDICINA DENTARE ASPECTE PARTICULARE IN PRACTICA DDE MEDICINA DENTARA PARTICULARITATL PRIVIND BYALUARE | DENTARA 1 Raa Urn Medel 52 amare oil tee pastor LURGENTA CARDIO-VASCULARA 15. Gen de pettus teat ‘Cb Aeterna uae ‘eimpege some ‘Sasa tacevane ct (8) oie ES Napa ns 9 s462, Palace "Pece Maker” adie URGENTA RESPIRATORIE ‘52 Tevet Rprtre Aci (RA) 21 Tatsten ermine ‘nce nersepoale {223-Reaeiaterge ae 523, Anpentin erplloe ita 1 cate respirator 53. Edemal pulmonar ce¥(EPA) LURGENT4 ALERGICA Ty STOMATOLOGIE 61 Socl mata (62 Een nora nea eden) © eam ge URGENT4 TOXICA DETERMINATA DE ‘SURSTANTE ANESTEZICE LOCO REGIONALE URGENTE NBURO-PSIICE {saa pil a pana ny (CRE anc pit ere mal caro) us w 10 7 ni ma 1” 18 18 18 16 URGENT CEREBRALE eat tear eral (AWC) Cree mtb 2 am tom rami) tata at netlgce inpesitn procs de men etn S41 Ctea ese each 9.42 Cafes in ree (trench) 943, Cott ae sompaaat 0 sti pene LURGENTE sasoRE cu DEZNODAMANT DRAMATIC IN CABINETUL DE MEDICINA DENTARA RECOMANDARI PRIVIND ALGORITMUL PROFILACTICSI TERAPEUTIC ALURGENTELOR MEDICALE in CaBinert De MEDICINA DENTARA ILOGRAFIE us 19 181 188 ry 194 17 19 an as ne 2s 267Capitolul 8 IMPLICATIILE URGENTELOR MEDICALE IN PRACTICA DE MEDICINA DENTARA {thor miguel efclate este csenfiall pentra salvar ett patent (O'bund casoascre a tucrurior ce trebule fleate tn cabinet ex print reprezentan(t at ssewalal” med Spirares fata de lnexorabll agora clyigares de stounde prefiose. tn cote actulntormstion tn cate dia pune ‘cena males pe pola aerunsorptlogoe da Sminartncdenlr, aceidentelor$-compleilor tehmioe cruel, exe ‘mperos neceark reaches Dofiunilor ct conte ln redueen rac a teat omatoogiel yd chirp dento-aieaart, Asistind in ula! decent 9 explo infrmatonst gio ‘perchncizare i cra ox pevese modaltle de diagnostic {do abord shige, cree ch 0 wtndine meer omplesd poate oer mediate pracicin.somolog un cent eam, coopean, ceo ian maim de conor ‘sigur cu reducers laminin psieProblems intrveatior de stomsolgie si chirurgie deo: alveolar practi fun eabiet de medi dott pea aspect gi never mule Ip context creer ‘Sse! Stomuiolopc in Romina pata privat su de Fracicea intervene de chirurgie dentoslveolat ete problems care implioh mull reports din paren ‘nec practcan reposablite mera, pofesonls ‘in lial nd mee egal, cos ce comport sborare. di urmitowele pence de" vedce! dren cra, lnvestparen dn pune de vere generals pint precu Filmi acestor erent In prac bind eine. Feral medical ta micna dentartcuptnde dou especie ‘parent fete = unl tes bine dint de atic, ‘pecialitae alal ai ppin delimit care ici tn mod Paci, toate porteulntile paces ce se preind Pentre ng dente Orit de precisa ebsicastomatologis 9 ndeminaca medical practictan dat ou sat ate i considera fondle speefice fica pacent esiia medial Se poate idea In un nivel speror reat final putin fi Compromis pia spurs nor compli cu scar tebe, Vite sistem agra cui linc et send pene inclegerca partcalartior pe care le peste pace, DPermiind. depitfea factor poeta! care a pate ‘keermin cpariia argent cabinend omaoogic “Ainainesterapeuted bute india ponte ficore fm pare, orld dace obinte prin anamnerd x ele ‘ince paracinice Ot vederea bin or reat ct Ima exci, corepursioare tatu pace ‘ord interdcpiny permite cmejerea palogek Sstemice soci a medical wma precim fa Parclaritjlor pe care matamenta ermal limps, Frogressio Inegisrae tn domenilfoptloge pert Injlpeen procslor gt mecniameor inne "ee apar la nivel dif purate i sisteme its, i pl ps Interven chiral 0 etapa exrom de important abirdarea problematic! \wsenflor mediate "din cabinend somal ete ‘epretntatd de ivestigaree amt states general 1 pacient,blan preoperator ansicic charge) {alegere ev dscerndmnt lau momenta we ve a dexfura manporasometolgid aude cht den sheolard In pene orc act modico-ciugalpreupune asa sor esc dar cose po imine cosisrbl pats tamen general focal covet l patents, pin respecte ‘cho de nr pin tren rap esc teape ‘azul spars une urge medial oti mt ste 4 snp sunt aie y deacon oe trebuie fe alse ‘lscertmat pent diagnos. eaion i compe statist goer paiet. Propiies cominas a mediclsi paste, dub de xprioa acuta inp, repent premise ue! attain ‘modclejeloase , mst les insti mt, reed lal resolver nor caren ise apes LUrgena medicals represiatt 0 smal clinics compent ‘are necosit ointerventle prompt rapida direct, entra afiona at acl mal scart mp posb. In cael de medicins dears, reais poate spur ioice ‘moment cosa ce nce 9 senie sport cont cia Up medic experiment exe capabil sh aniipece instabies ‘wpeni, find mn prompt ie hres deiilorterapewtioe adeovate. Canoes catzclor cae ab determina argos ‘aficald est eon in stable conde ie does ‘bine uebue sf corepundt sandal In vig,Pearu a putea dispune de tte sustanjele 9 materisle {In teatamentl net arpefe modicle ete ital atiudines ‘mela care trbute ad aionene rapid erie seeundt find preionsa. Decale fate pot tncing. alana, i {avoarea restabile sti pacenall sau dimpetrv pot agri sitwatia. Clrtates qt sigeranaactunor ‘edict pracdclan sant ndipensabie pera resolvaren ‘rgefel meatal. ue preeperatorie te iperioe necearé penta Cimoatiea, pacions, erkeres Tock “anerete ‘Ses thc deans roca 3 pour 0 regis (peor corsair af med on pene ids de ped prea mult Sip i dsc pact pe 8 oe ct a ap a Ings dents props enews scldote cr savin in cabin de medina Senet san impos foam Sn ekenee,pemest Scere nope decom aE Exon! pce iat la coven ont ese wa ult Geena ents eet, aon gece Siege ete Pace cae mesh sh fe psi unl inerventi de Sharpe demo-sivebr, auto pan combine de poems gentle ponte inst sa Din pe ives pce i medi desta de shea se oproge at it supa lnc feu etolpte cre sada pe pack conmigo Dispute vdeo ual cnn onan od big ‘prc oar mur vbr pls ie pest Daj In condi de ambulabe efectuare unui examen ema complet ete ret dif, tebe adopt ut stem raional ficient prin intrebir pete yi examen ‘metal, tn scope! obfinel datclor mceare 3 rilente Dana prcierea tren yin grad eee In staiirea deci erapetie , in mod special deciia lerapewie de nated chiwrgieala, medial +e otenteacd ‘dela la ca rebut ai in vedere 1 amploarea erent de exeeuat 1 Afeeriuneagenerala $1 masura tn care exte sou poate BE compentata ast! brit atl operator 80 se ‘fecteze fr scan pena pacion! In cabinet dente pein event pace por neich Ssomatlogice de uit, iterveni de crc oral cu sre feral apurent bus" darunaor eco sfciane generals bra manifest ich 2gtos(ipeesane ati, bolt fercoxrant, diabet zat te), fe 8 pce I ascunde ‘bert bola find rest de rere. Pairs score matin se pune am coal modal cline tee 9h competent a singiomelr # semnelor principale fev pot apse ct a aes aor ‘Apwratal cardio-vascalr, spice, ges, renal, sistema servos cena pee, pun investi lice complete 2 deotebit pit de obrvae gh dicemimsnn deoarece Stomsiologia post rerezata © “espe” pentru medi Sper, Proccarea stomaologii nu ieape cu tama de acidete at complicti, coat ri pun de ageje mediale ie prom ale puis proven tela ofc acoes trbuise oscute st cinpnosicat rapid cost 9 cu ul ‘dace‘Urgeta prin dette rectamd o maxima opertvitte a abordaren ei impune clea cea mal directa mat Scud ‘ire resvare Domi vast gi complet al medicine! destire face ea ‘gee se presi mb spect variate iar media it ‘erat elie poten monih gt medeotel de gnost atament {nha une urgeafe matical stmataog shui si precizeze ‘n tn ul gcompetent duc exe vorba deo sie exe pune Im peckol vinta pcientlu sau numa deo rare cli Sopstoa, alamaats Din ace ponct de vedere vai ctl pots pelt ied un perspec in srl do maxim ergent up inte vit moarte umird to secunde, de_actea w intervenia stl ‘alvatorseimpune prompt competent eficent Unie muifsacclnice darmantetrehuie comidete de semen! gene, dara pon aftr dash medi fetid vile. ek pia eampiaile grave » previ eli (waumatinmescvredent- snc sop ake Jojelorprotinde ales or-manio-fiil ee) Dia ec im practi stomutologck wngeta medical nu = Indie fecven in cabinet deta dar dat cas pouce sei crt apa esi bush salveze vi pciatl, Pour a eliza acess ere major, moti pactcin ae ove deo ou in coca ce privet diagnostic Si teria urgenet insyiodos ca mula continconate Pci bord patent nasa tae caer Conduits obligatorte care trebule splcat de edt ore ‘mele practician In fafa uel wrgente re impune a rap ‘ett rt ete au ori, fr Ine! justice prin explora paraclince nese in acer tea ‘Un patent in sare deren, ou poste f sandonnt chiar tpl resucitven neil Wala: Inobligaile medical Jind asigurarea anspor interien pace aan servic de terapc incasiva,supavegheres permanent & ‘eesti pa ead se vaconfra fniures aru perio Medicina modem oft solutii vate de sbordre a ciel In aport cu renal acertn mo’ pon care sii wrapeatie ebuie antih ca gi ene Rise x [npr omul ind owls bine determina. Mada stomatolog et obits evalu cul pe cae i Imps manopeel cleat nam pci cutee oni Specie dar 5158 cuoned"mtodete de profit de Combe a ureaflor medial ce ot apr in sbi de facies dear Prete generals practich « mediullcuen, apices ne premacai ads © tebticor sigue de analgesic general local ae pn efucerea ans vor race frets percepts de paces in lil rnd stables lout igh afectve on aeevtn pen sels incederen, ‘nt doar cfteva slenete cre magus preter Special dr 9 paint "apres ak e sca ‘Manoperelor tomatlogie sau de chirrpiedeno-lvolrs Indvidalsrea torapet ete premisa unl Pept ariel ‘area verona pacenatat tase ahora ov mare Seriastte, impale cnc ind fare variate ‘Abe implica eats de aeea dsr practi ere realized o vestiape‘minuioad 4 wreul pein ‘Bomacetiguoud, examen clini comple examene ‘waclince, va putea deze coets va eu tee farina focarecaz cu poten des a declangaten ne ugene metal In sabize deci’ chinagiale , medial pasician tebuie Sait in vedere eters aspects extrem de iprare + Amploutes intevenie de erect Hohl unde se SP Afecfen general prem (compensa “compensate linia decompo)+ Bvahuren comple anamnerst medio chingicle Piru apreciererscal une fen generle Flenouse™ eae ‘stb inact agresini saterico ‘hirucle pot even mane + Evaluren salut imervenl chrwgicale i scopl Pegi! medicamestose' patent poten Hac ‘Pentru a prevent npn mal 1 In cazurte in care medical specaint de. medias Genta denied sau doar are splines problemeee de tare generally acsta ste obligate nformezn, onsulte eu spain! de mediied generals despre natura sl sveritate afeetinilpacenulal stu , ds Sadia 'deeolui, sa ceard aval de ‘aprabare Intervent peopuse, 1 Medical specialist de meicing general exe de fap el ‘are stable gravitatenafeclull generale» apreciard Flcurle anestetl gale set ch ontim at interven egies te ean die eden. carant ol dents, door i cal Ia ie ehlbrat general primey ave ‘Srortipetr intervene ene 1 Considerineha moment sna 2007 - you uma in “meatena"dentrk, ebuie ak aie a cara Sentracronomeira ptr deoltiresabliiior Dacian tn detecarea pain ca iy eps Sementar st indpensbil igri produce terapeatc a urpenflor medeale Nu rer medi stomatlog sunt dict implica din pant Ae vedere medical micoegl mora as de pate ‘ea delat o urgent moll acursl anor proce ‘hurpcle an de nr deme entra fi iach. vor fori nce asemenesiatogeni, ‘mediit prtcen) webu st priveacd cu sean, ‘competent i poesonli oe anes Ser care Shure eieumtane, se pote complica cu un eveueat ‘medial nepeviztCapitatel 2 ASPECTE PARTICULARE IN PRACTICA DE MEDICINA DENTARA Modal de via, de alimentaie gi de mined 4 om omtemporan genéreazl numeri factor! de apresane Scjloneaz en comalatvarpra organism una Daoria.suesslul, isco poten al acldentslor in bint stomatologc anu de cing deio-alvelart est ‘mul cescu pin 3 stiease ~angoie Senta Insommi, limentaie defctart dat de. dares dear, fttomedicala aevontolats i iseal steacpunlor Urgenta medical tm stomatolgie _survine sare patlogictimprevil, neapteptat in St durats, sesceptilt ta unele cazurt s4 compromita Beyer vat pteniet pena er In evalares urgent medical ea In consider cel teh ‘nt vials atume aren de ony rpiai g iteuljia Previa de la Incopot cd Gece tuburae ‘iagonict au bute consti context int, ci od ‘blgmoriyrobuie avah ia vodere lterdependena Funchilor vale, © deficenl agnd dup sine in core icios 0 decompensare a clot fancti care dak eterapid. combirua si ceils, poate sage moarsn pen ‘Traduceres elinied a wal stuati de argentd ms exact de suerin a furetilorviale, trebeie cht Invetigatl exact i precoe a lvl neurologic, ven st cardiovascular, deoarece gesturile medica Frebutese instil sunt de mating important, de fapt esupravetre imeliat Responabiiarea decir #1 a consecnflor in cal ‘peri! une! gente meicle tn somatologe, comet ‘etl mee practicon Ings de practcsstomatogilcurent dey ayonesza ct an tama supra parieplor,resurele nergtce Fincioaie slo organismelss sunt fn. general sufciente ents preven t come rail nodrte stu enageratc ‘sternite desea asin operator" Ta pacieni "care ish presi tae orgtice iatiney importante rato crultny esl tmeablice, 0 inerven}e stonatolgies minim cist, poate detemina un ric dowebit de" av te pene In Deicol ia paint, rgenia medicald pena a ff preven” tratats ficient, trebuie recunoeutt gl lagoestiats rapid. orect jiu mutt ascermant. Lupts inte vat 3 re dares pufine miaute sau se sam chiar 10 Secunde In urgenta. mediesl, de aceea medic In medisina de urgena,functie vitae cae reprezits taza raionamentlss meds sunt: conga, epial Pentru reeunoaslerea rgentei_medicae, medical Somatelog trcbule ak xpreceze ‘cu competent ¥ plane arn cerbrla + teu respira: + probleme cardio-reulatri Sebliniem fined cA inafcents sau chiar oprren uneia ia cele 3 fume ital, nu va ft nici incerpretath Tenet et intotdeauna in sensu interdependent tor Sinplomele de ~ simi” ale uci urgene mice sunt ‘union: compartment modi stare de eit ‘+ tufurin ale congbenul (Stare de cote, tube) tel, senate reas, vata ‘deep espitor looe rie extreme, wasp ub ifr, TA iseadee rp fn vederen une! ovens rapide. Ia ca, recomandan Ceasar Lisel de contol penta srgenfa medialt tiara de Ahmed scare copeinde examen "nt ‘chor vie > Conptientat + Deed paciental eacnet I simi vera + Dace realest uma sili dro 2 Sistema respirator +> Mig epiatr + Dishncile esprit 2 Open renaget> Sistema cardiostcaatr Modi pula aren ‘Modif se tens serie Cots pesto pera» path ugha ‘Rese papillr a amide ‘Succes terape in czar acute depinde de: + Resunoatrea pi cor nit de pes + Prmelemisur de essa spite Cole mi multe urgenfe constaw in combinares anor pertrbist "ale stir de content, ale fonefilor Fspirarit ‘sau. ale aparatlalcardi-circaltor, Dereglrie eestor tunel Wale trebles. Metieate "apd; masin 30-90 de secande, de aeea au ne puter permite un diagnose deta Cu stot viet, auzaet 9 palpatri, puter otine informa centile, reali, neces Pomel sur ‘erate fn cable stamatoogie in agent medial, Scopul pscigal al medic pactcan ete de a nlcal ‘mening supeveghen cele 2 neh wine: tpi reali entra realzancintrvat cu maxim de ecient acste lout deaiderate, medial ete necear "sh vadh 6k ‘ceretee, adie. st albi, sf acfionere gis slat Scones”. Lapta pentru supravituire. se muir in ‘mina fn oprizenrespirafiel(STOPUL RESPIRATOR) 1 in "Seeunde In oprirea cardo-crcalator(STOPUL, CARDIAC) + Stopal respirator iia, fick pcre cond dei cu ‘reenact, permite ca f-an Interval vrei de 3-10 mioue = iaam 12 mite, estsciizesrvpmore si ucces™ + Sop cardia inital et mt ms gray, sesctares mai “igen, progestical mat intuncest Interval opti de Tessie ge preci de 0 Sc. pn Ia mi. 30s. Stopul cardiac th deca de cites reside (20-30 soe) fs urmat invariably de Hop sapaton Din punt de vedore pace, exit reanimar respite feb carne fark respenfie ateals, deosrece oda ct ‘opal cardia se opreyte rapid respira + Seopa prow 9 Sinalalreunctri_ carder Simi ‘onienares suis 4 soarel cobraledeorece tnvea eonar, se pre lesan dstctive, averse la eesti + Medel de revorcitarecard-respiratorit sun splice In prema ip lumen isp. Corners seeps ‘tcodeor cae a cacert flgrtorlmbea medal, cost a Fpl ef as aces apa, dare mera connor, ‘metcament rare ~ cel poi a prime secande sau minute Salvo, ae based pe sore paces ct, ‘timmnopre cre ust a demna oc. Pacienul care a prezenato urgena medical in cabinet sl medinddentra. va f rupravegheat cu cea mai mare ‘grag responsblltate de cde medical practicion, nd 1 imerarca ur clined de speciale” terple Intend cardlogie ou mediind interns Sutiniom afl cd roll medic practic ee crucial recamatrea abordara cored 9 urgene! medio paral n cabinet ‘ane sop el eb posed wn arsenal bose de ofan, terrace practice» arvenal care 18 sontinds motor‘rect sale rapide font fa erentmen medical ‘npr cor post anni vee pte, Desflgurarea in condi optime a cratameataal Somatoloie in-an "cabinet de medica deatars Drevapone sincronizaren anor factor cee Intil fst ompleteart, urmivindase moaltriaren stents s ‘redrordezechltre. ‘Acet factor fm de per arate ul medal, de patent 9 de 2 Factoral personst oecesit o instar stent supra alu pacifier dent 9 voz pete model conduit dingo dary cuore ‘Sojuilor flame de scone + primi at, In ‘ul apa una eveniment medial noreviz Este Important ca ment echipssoatlogioe atm bap tosst de cunginusteretce space, elev It willzrea meta specifics feel sectunt pre ire para dary a manevelor de wget ee Ty Situs clinie specie. Perecetea conta a Peronauhul soasolgic ta ces ce pies sofas {eoretice precum fi ebjieea unc be intuit ae dep ‘ni sep mbansitien sell made, lemental de bazkce pune in mitcae factor >enonal ‘ste echipa, in cal een nord, roxunangtese to Sect apeciren gt respec, crear lime ett ‘et bune comumcin, co reps’ fvorbe sap icine! interven teapot, Randamental echipelsomablogicedepinde de panna 50 creer Tne membeit acess in concern ne ‘slunile de ‘compartment si omncu compet $i Acjunea in tandem nd conde acer read ene ‘management ball pcietl Comunicaren in cada echipet omstoloice se bazsad primal pe legen respeearen nolan de ship ‘ue to cet ina dar rebuilt ca pe a ‘lstogli qi paint, permifiod tanto ines pecepie mess ‘2 Factorlpacient et ol mai vari inconstnt tr dinge cet ue, et Sad Singur! ee se modes te Goce inlerventie somisigich Activates clon ftr ee (Gnd eodsa ancl de ces, Fecare pacientes 0 ena bo-pso-scial care pine co tauren at Se adept feces bolt in pane ‘Sigurinde-se aslo opiizae a tapi stomatlose. Din momen arin cabinet! de medicind denn, paciea va fi ghdat de che echia somatlogich vf fonpcazt tn legiturs cu ru activ pe cae f'xe Ia renal trpeuie Reliant patent echip se brea eu clmat de Inceere gi pe cooperate ar dialogs ne "Seti ar dbl rl des congent pace in legis fb walaizaren acl trspeut de infra chip ‘Supra stasull pci! gia mdr neprevaae otapsre. Pacintal represinth slemental seapra cireia cola factor! sunt focal pe prion safionri In eabinetl dle medicing entara. BI va ica condita terapesteh ‘olul stu important de a duce informa sublectve cu Drive ln stare a este ncontestabl. > Dotarea gl inrastructura cabinctuat de mediing dentarh te eld al tele factor al inom jue us fol escupilpin Spl el tees sau permit tens precoce stun url sau de urgens Este necoarh att dotrea corspunttowe cu apart prfonmanis ct 3t funcjonars Ta pcemetr opin Spartelor. Aces pt pete mau montanes st tently stabien cu erate «moma oide intervene. Orce micas niveisi optim de funciona a aprsiclor medial va conde lao nflrmate onl 4 echipel somitologice "i reprcursun aps ‘ire diagnose g's dedi trapentce. Mody pom, ‘are calraren parodies a permetior apattelor ste Impesios nec ‘2 Monitorizareapactentulu dar gosta slat inpuse ‘xis a cabal stmatoloie mu ama ue rane de Uwgeail dai a wor aparateulllnte expres Ty Imomitorizare sul preperstor pe dust ltervenel Posopestor a aceon Conform ordinal mamdrat 151 2003 al Minseraai ‘Sind 9? Famili Untunee National socalor 200s, arice unitate omatologcd tebe [ad in dotare in raced urge rman 1 Apara de tein. 2. Sttoscep. 3. Garou : 4 Seringl de une flsing Ace sterle de wae L108 1. Comprese trite 8. Val sterliats de we medica. 9. Banda aden. 10, A061 70% 1H. Aleootiodat 1% 12 Apt oxigenats 3% 15. Tavih renal 14 Peete seth 18. Ser glucan 5% perfazabNQ8 1-2 png 16 Ser folie pertazabil 031 nee punt 17. Lecoplast es 1. Mina tre penn prec 19. Geaspon vet ehe 2.VieK (tomenadion) avec 23. Ser failoge 9% 2, Salfat de magnet 20% Be 25, Glacona cle 10% enn 26, Hemisucint de hidrocortzon (subst Activin solvent) 7. Miottia a 30, Algal. 31. Alcan{3,Fenob att 10% nnn le 34 Furosemid 10% nf le papaverine 36, Adrenalin 11000, 37-Amplling sas Ertomicad 38. Nitosiering th, 28. ifdipn th. 0. XI 2 41, iin ow adeealing ‘ruse de primajutor ste orgaint In valk din alumina andiat eu iter neater pas ce poe 8 ernie. Este idea pent centre dep joe ‘permet de ugert spas. Confine: ‘+ lon respirator de fanimare penta adult su pentru «pl anima, Amba). 1 ale Goede! diverse mimi 1 Setlaringoseop (4 ame} ati oxigen deschictorde gut + spitor pent prim stor. (1) Fiat Montrizares constant cariosasule exe sealizt cu sora! apertelor de tip txsomer, pulsoximety, ‘leorocardiograt sau apannra complex cue iegieas Simclan tose consanile cardiovaseslre Monitor paca (Dragger, Cann, Cadiogp, Dash 3000) “eesimetra lia pects inepistae valor presi steal est indspeasindilvent de pul sou smplowes inerveniet simile, find folostoblgnaiu Ia ‘tama! cline ener al pacientul Pubosimetrele joacS un dul ode indica satura de ‘oxigen in singel anol dea dtu seal dels uct ind acest parame emotes. (05.2)Fig2 Aca! 3 factor’ se af tn inerraie, modiicres trike dltre ef dlpminded’ apart varailor lt tetra do 36 Nise pate spune ef wl din ace factor prime ci dour ei bie canna cansau fo mod ea chris ‘dee webuind sat tore porn ave Nami poniro alist = ficorlor persona, pemirtgacieat #1 petun tnod de pine Medicale Conple echlibat flonase va feu peor Fee ul et epee ndepline condi de sigur Pentru a. prevenith sf trata recunoscutd #1 dlagnsteats rapid rakmant. te dureazd pune minute sa ‘medical, de © recamoasterea ta timp wil a gravitas Simptomelor yi semnelor de “arma” © asiguraren una gest salvator prompt, competent 9 ‘tientCapitotel 3 PARTOULARITAT! PRIVIND EVALUAREA PACIENTULE IW PRACTICA DE MEDICINA DENTARA 34, Evaluares paciontla pe taza Chestlonarulal do dontitcare = Risculal Urgonfl Medlente Medicina destard este un domenia care imple malts Fesponsablaie in partea medical practiclan, ‘esponsabilate moral profesional ju i lima nd Imedicodegala cca" comportdabordarea sh multactoral © nestigares din pes pacientlt 2 Canoagires factor turgeneor medicle © limite de vedere general a rise tm fstlaren Orit de preci af tenic tomatoloie i Indeminarea Imola pactcian deh nu sunt fate Im considerate onl speiie Recta pacien prea medicals me $e ponte ridics a un nivel stperio ela ial put ‘eompromisOrie aet_medic-chirurgcal_prevopune ssmares wnor curt dar aestea pot dimingate considera print ‘samen coret al paclntalu prin respectare thai de fecal pein instiaen cor torapil i cra rl urgeate. ote atin asl de suai sane die acca ee tbat fle covet sindie pot 3 chia sata fal ‘al poceanlulreitiecontnai 4 mica Ftc, dbl de exper seumulats fn in, repent Frenne atin medline, a as suai [En reugind in acest mod relate or cate peed Per sceste mative, 2¢ impune un contol medical elnie ser competent al sipomelor i semnelr primal ‘Sra penta o specie lt mal bisa «Rn ‘pwn estio-vaselr, respite, ges, renal sistema revo cena pier, impan nesta ince eu spi 4 chsenate Hi dacensaintdeoarecesomaslga pews teeta ocean peta med superica, gi Di coi de anbulatrefeunct un exe pera onple ee ela iil, euler fol ‘iefcet pn ine: rece examen meade, sepa Cts oe oesgare sulin peu peecaes ‘seg gc er : In stabilirea decizii terapeutice , ia mod special in Aci terapentch de naters cirurgicls, medial Se trinteza de la ca nea rebui sh aibain vedere = 2 Special _pacienti Mttiuni generate 2 Specific intervene de exscutat ‘> Misura in cae sunt st ptf compensate afeciuile coral ste inct sol operator se eects Sia dieu, Pentru aii o specialiate medicals, problems terns 3 Inalvduatzateaterapiet i raport cue, at de Sringent a pentru media dentard, “Metoda de snetei, Interna cirurpcasconstitue © sgresune care dact igrorh partcuartie reactive le Dolnavulat respect, pote aduce mal multe deesvantaje ect bene operator. Anamneza_medicochirargcal, examenul general pe aparate, Investigaile parsclisice, eaamencle bilogle generale au rolal des depista” uncle deficente sa Insufcenefunctionae sau organice,latete uncon Imanleste ater dar intotdeauns de fin chat de ee Medici prcticint recone Ik moment ani 2006, ck smetin de vrt in contin etre a pacinior, deta ‘ejires sums sever bollor gentle sty pet care se conse neces blipsione evaluate [reopertre ern packenu a cl chiral {eweie* operon). Fos de sul vem teen de “tren” at i see foe varat Ifa conte asupra teealui au fost dominate de eacile indie Gs deo nurs Sat reais ‘duets id’ ipa in spocal cu eoptngeia Ue, tere «fost infrprea pin componena propos cxpeimindebcens villa rent x asp ‘rei. in present, terenal poate defini ea “totatitateafctorior care conferd organismal ‘aspunsurile sale ‘arnetere partcelare™Pais core confrd orgoromat calle mofo incon gBocimice ce condone react ‘fee alopti. nt reprecent pit oat element area court ladevllara eolla pace pd ‘eon espe 2 Nar geet > me 1 polo preeisten i acmalt * Facile continfional, mobili 2 ates honda! eal si a “= In medicnt imporana practic rel se sev males sunci end spans uaa pola fafa deo apestune ‘areca dif de norma canon in patlogia eget Cunoapea paietull presipne un ltropsos pets un examen oDlgora al Stas clini eto some Interogatral pote se dealers partial prin completarca ‘reala'a chestionar mal dar erro rele ont nal neaparat ub control meta caren Del tm condi de medicink dentars_ambulatorc, ssgurares une CConsideram ot acest Cestionar de Tdentieate Rica Urgentet Medial ete deo de valores dooce tinge btectvele ute cunt complexe a pct + suamncza medico- chiang ‘alae cline paraclinice 2 veers score snneafdentare ta opal Dreclarl pull comportamental al paietalat + “iagnosticl de stare general * ingnstical deat parodonta, ide" tratment stomatugie psa Faptal ed paciental este pus si semnere acest. formalar ‘omples, 2 demosatrat ch at asgurd, intotdenina, © ‘esponsabzare cert prvind wsmarea datelordeclarateDEFICIENT ALE METABOLISMULUI CALCIULUL CCHESTIONAR de Identicare a Ricci Urgenfet ‘TULRURARL suc: ‘SELCTIUNIABOPLAZICE © DATE DE IDENTITATE CARDIOP ATE WHEMICACRONICS Israncr suocanbte I ANTECEDENT Tita pear cate SECTIUNEA I Evalue AFECTIMCONGENTTAI PACuENTI CU BYPASS oe PACIENTI CU PEACE MAKER | | | | NUMA DE mESinATu ne MIT Mebieamte CONSTANTestan plare neat: reat spn c(t. Tae 1): aren plot tet perp cron 1 arent arial rit “THPULDE PREMDICATIE {Si omni Ci pam de cia de vents fleciralntrebrt, fedral spans deoarece ate sproplindwne de pacieat,citiginda inerederes, vo a cominuae, reomanin cxaminaren ou stnio « spect generd al pacieau pi sprecires colors Diels ga mucin lena de loo wun et ie eon alin peste ‘alin i grease reba studi obictvdeoaoce obits Sau deni sun contrat are npn dose bof Apart candiowascular, espirtor, digs, real, sistema ‘evos_cemtal j penfene,inpon investi clince ci eoveit pint ds Obsvaie deoaece somatologin repreazus' “spent” peat med supertiial, ec ‘sah preps encralfn cabinet dentar se prenthtrecventpacenthpestrw Ingle stomatlopice de rating, tnervenfit de chirurge alc stare generals apareat baad” dar wneori fe co ectone genera uu va manifesta net rpomotan, ech paces ascnde delberat boas Pru aceste move, reomandim vn conl medical clinic ent gi competent a simplomelr # semelr principale fo pn ose ta bie coma [EXAMENUL CLINIC SOMATIC > Aspectal generat ce, ln (loot, us) ti green colori piel ya conser olen peso * colori pera * colori peizalsauiulss angel 1 Spec ante tempore sepericle 1 csteni venlrntero-corvile 1 sdemal gabe inferoare ‘ntsc hloror pls, pein aerials 1 Respirator *dipnce 7 ase ia, se eu xpecoaie + ale + regurpia + ate ‘> Sistem nervon centr erent atin 9 opaia 1 Soordoararefeelr motor > Cavtaten ort ‘+ Tucrt pottice mobile 1 obturap dears ur details deine Pentru a aven 0 imagine cit mal competi asupra ‘rcientull, medical ebute smal examinee ev gi 2 Colonna vertbralt cervcalh deoarece uncori se viene arto In acest vel sa In ale casa aa ied “pit scar, ctor de difclate in msnoperse de esse sepatone 2 Starea sitemaluh venos in apical la_menbrele Supercar, mal ales dad se consi of va neve ‘nsalaren nei prt scopul admins premediael Sau peat aiguarea line parenteral in eventalies uel rect cardiorespiatoc 2 Cavitaten oral se explore cu desebith temic ent dpiatarn de macroslon, ndeirres eventalshe Froteze mobile, Were) oteice decent, obi ‘Erujble, cause posible do compote ier eor > _Testeleeutanate se po fect apie cu Neen” Slegie dar peta _depntrea aegis pe in “ered 8 {recat ale osezioee leo regione recomandim 4 1 ghidate cle culese de anamnera modico-s iol parametrilr veratri!— explores fncionls Pulmont ralioscoa plnonard te, mu ene recomandat ect det din anata refit 0 ineresarepolgi a pant por 1 paclentl peste 4San aru se stoma deoeoce ‘cor jut Ta stblien uel ei diagowtie de ser ‘asm xamencle parade de ttorator vin sh completexe ‘ramen lie penenl. le slit In apr cu nse ‘bjt de acest st eos de ancsteie pron ch ‘hr eal de desire nerve chica ‘Single ve corcstesk laurie tpl de singer 51 Soaps, moving hematocrit, -nomirorea "de emt tomboct, formula leucocta, Ugl de conse lpravombin, ier de edimenar a emai, ‘Unodpeot’ peste unui iay mat complete recrmundt 9 ale eumene ole: lem, cleofoers ‘lesteaaltighcerd, HDL, LDL, “pies tole, cea, ‘Sle ator fsa sealing et ring ee vera rin examen uma (lbuin,gacoed, Sedimen) sin wood poe f necosrd © investiga tah ‘mis dia pone Se vedere fine, chim, ciologie bcesobogic Consider 4 tn abordarea manoperelor de dogrjri Gdeatare se. impunecunoajerea etal complet {erenual” pacientdeldeourece numa ew perme ‘ajar “explorer, 2 indietilor de pregtire preanstesil, 2 fermulirlor prognostic 9 bincinees Sritaren remand ronate stor seis l uel boli webu incorporate date de ‘seporanfa medical in vis painl, Dak store boi fst consemnat ip ovine conoid, cn mi mare stefe ‘rebui acordahcveimentlorrcete. Tat acest od dacs fe Gloag 0 shore nent pe acelepecieul Desens cit in dine te Soca Priel In mod del, deere impostor seu semncor {rb lat flosnd avin aoe ‘ote, pn pate sv eapacten de observ sa de ‘epomorre neces penny a oe un itr boli i 0 ‘hia dn paren mate, care webu 6 fe tet 8 ma ‘gue rapunnle ln iniebile aden Deseo on Sirpom cre ingore pagent ar omic insomnia, fx tmp ce tlbcin ape mito pot sven import ‘onside Pon urmare, mevicul ebuic st fe vig, deoarece un iment relat de lite acit,chinr hal su part Indepirat, “poute fl cea spe” soluiones problemes 32, Evaluaroa riscull anesteric si operator fn Anamneza medical riguroast,examenul complet organi, ‘examenee biolgice generale clsctucark de fap evloares terenulalpalenall nw un dagnene de bola propel Dect din ierpeten actor dite apa een oe dev emnfctve de la tonal, roma vestige at Complete is cini on laborstoe despite malo © coaborre sui istscpinart (medi! teri, ‘arog, disbetolg,slerglog et.) se stably conduits de ‘este, impale amplowes itv rusia 6Din punct de vedere mec dar gi din punt de vedere smeicrlegal, conan pence et Olgnove “au nt eirurglaltrebule st asigue nttdenean sex mal ‘bunt prestai,adapat ctrl suai a pare” rice ingle detrtae om carr traumatic cia pats tu pine ppt ate coset snag, cat mt lt ich ste caval una paciet ot feel ia Sond aogie rica (brny, op, ene ravi) soon ate eae lsutuliiatereat prin Ingres stomata, Inportana actull neste = ehirurgieal nu treba x4 “Areer in nal 1965 fo prim cre fiat 9 sasificare limit a gradelr devise ya 3 dovedt prope de sepa ‘tll pele de is aps Archer sunt + Good RISKS: pci ine §-40 a cu sre generals to 1+ Paty RISKS: pci ne 35.50 ai ct tse sufcinte ‘pice rin general cu stare de sittin ‘Poor RISKS: pace sfrin organic importante. a moicina americans, Soktaten de Anetecie din SUA (Q977 evaluenalrscl operate pe basa dou ements Andamente:amplouee merengue yi coniia ‘teen pace ied) ret eee C7 L a sfc gerale ceatte (isc ntarene iae Pacietcu afte meals > coms dr car pete inane store \\ fener rn Pc pina son dere. + ener de ren Paci aia ise. In prernt gradte de rnc unanimn accepate fn practicn chirurgie; dup Soeitaten de Aneterie SUA(I998 sunt es:Mins. Sera omtnent deltaic» clonal sat ese ln in consider pe ings eens pict, ‘plore intervene, vss fuze Pe Mngt acesteclmente de matematizare risculultn praca dentard mal Intern factort specif care ‘aut la evaluarenescula operator (03.0% a ‘prea poner “Tine esttor ‘etoroger Moeroensitatats Fie [fecturea examenull genera af pacienlad cit mai congincos, ma comple mol cect are dept sop) ‘eleres matoareor obi > cwtuarea ical anestie > Spreciraa print preanestece $3 moment opin @imerveni crural > bites metodet “de anesese variants ceo. mai fovea In fuetc de starea generalpshologil organic, de Alentard trdele st ve orentere up wrmdtoarse rupe ert+ Carurte une “Good Risk” Ia car scl snes 51 ‘peratr pat conser ca nga Acria sun ace ‘tse gene bun iar lectins pstlogc oem ae sine gener ‘+ Canute grave “Poor Rik” I cate eran acl ete Saint de sever eats & padi fete gence promis St care predn atingee impos & ini sa Ilr orpne wile: de exemple infetmiocde reat ub 3" lun hipetensiune areal oscilanh auch ‘esprtote sever, dahe abt dil de ecb ure etrgae cota ete, + Ingo scete dows grup se sect tooth seri de eau intermedire “Tnermedate Ris" care tere tebule ‘van eta eae pos ‘Problema eval risculul operator este departe de » pair, Difealitumerose provia win wrma ‘lun de ene hlrurgleae substansaneteie 9 ‘socieripobile,plipragmaz te Intervenfia unui raflonamment ronan indica, eb chirargiala prot slash sau electuaty suprovegheres Incompetent rats condionaren direct raul de ‘orile medical stomatolog, de gradul sau de prgitre Doeanfa de matediicae atoll att de malt dri de tre speci apa cand practi posh din enue ‘malian factortor ear reuse latin considerate, fn przent tri une vie denebit de ate, probleme ffumini sociale i economie, attic de ota mt Gr fi moral, profesional sow fall, deine limenti corcte imi, uur ner Srion eta seuro-pstic, eurevegetatv al pcienilor care se prea nr agi dente, acest fit altrinuse ementlor asic dese opetar. (Cutest aestea cu sjtn uni eal crete tel ‘gatulu desc, teape slonatlogiea su de cng ‘eno-alveoi poate fe clit, sigh conrad acd ‘te fica de eae un medi eo aden cla xa, ‘x caocte de scent, cu opate cunts dion ‘hire cu un sin cle devi. CCredem ch interventile denture de pratch carnth au ‘comport moralate dar dacs acest total ext le se ltorese al multnecunojter art geneale 3 aclenta nt anereredect chirurgie deateavealare, Prelunges i calituea vii, mist de odeae snack presoc, ects tratamensior medio dit moderne in {nastucar eabipetlor dntae, pert ingen een In siguan a pacino. Exactimtes si eompetnja medics praca in efecures tamenahi cline” genel, In intrretrcs severigtior Paractnice, claborares eu tdi din. ae apecliti Presatvespropestre corspanaioare ron fealiates tence de anestenie teal chia vrai preasat egies verses chino in oii de nue Benfciel eval risa atestnco ~ shinee tbuie omident su uma prin rele obit dr pin ‘edueren numa comtiniaie i justice oe ont date uncon. In fata acestor eventual, medical nu tabu se ‘elit spre atadinen righ a contrnndiatilor de Principia, cl pe buza explritlor » « colabartor Interalcpioare «Juste tratamentlr preperstor1 crotrtexperintel st ajung textarea rezouabi 1 indeaior 9 In entegrile de pent cu um roe mah tare, dar cu rezltate contra, satstitoare. in experien,capcaneleitricl evn vile, Cosa ce ‘elias pach de ocr aut Poeun sieve colon ‘de expenenele ecu Evident pein difert mult ‘iva mecaism de ec Ia esa sim - Ain Toret divers inf de ema dealt ide most (Chcodtsacuraeesstoriclu esate prin batere Tbs sau socolope, pin degrades. inion intlectale ‘ae interfer cu memoss shu pia alr ale sit de engin caret fe st mi peep comet boas. No este ‘epinsator po umare meld, cir te cl ste, tuner af pur pean in abprea de date concrete fat Be fora st operon cu aut care repels pul {ha mult ded proinare a aevar ‘Medel “de obinere al itoricula scot in evident Iademinareacunoyafle st experena mediculul Stopll ct smmmeet Cle fcc ports doa stabil sm de a scent leptir spciall care este aca ‘eat medi pect, Considram cd eb feat un efit pnt cea paccaa ‘sn confor, indeent de ctcumsarjele tm care sea Picea ebiie run abut moment sb posite Sf relteze pops povete expe onl fr inept Scveute tind exe ca, webu st eepbonere 0 expec eters, ici smpae dn pares mee Sar putea sh part tals sublines of medial weble od horde paccai mu deep cma sau boll, cl ca individual ale gor problems in tte fours ade ‘Epigere moiee cre au ao bs speci «Majoras Petia sat asi 9 spe: Dscon fc mar ric Pena se autoconinge cd oala py exist sau in mod SReoopent, pnts pet april labore pet 8 Indep sr de vinta tems, pe a 0m post (Gu rset de + me repeta dori sk sbliniem ol gnararn Istorculul medical = pe deo parte sia stiritpabiee x Paclentalt Ia momentul”abordulal Su chirurgul dentalvelar = prin necunoastere sa tegen, pot transforma terapa de igre dentate In fatrogenie mal grav pot purta culpa median de menintare' vei pacietul I. Considerim ef supericlaltate bora una pacteat Spareati sinsoe” poate duce Ia sedparea unor aspeste Important cu rol predity ta delangarea une argente maicale - Un trie informatiy trebote sh fe mal malt ‘cedt 0 ecumerare ordonatt de simplome, Totdeausa se tftignyceva”ascalnd pactenfllobservind ful ere Sorbesc dare implomdl lr Infestanie voc, expres facial attudinen pot confine indict importante privind semmifcaiasimptomelor pentru paclent.Prie ascultarea [Striata, medical descopers au sumat dla despre ‘all deta despre patent. Simpl et acl medico-chirurgicale oles mmedicalul portunttea de a stabil sau de accoatua [egatara special are est baa lai medi paces Un aspest extrem de important in oinia noastr estacela ch sofa” ji au tn ultimul rind joes, delayed Imecaisme complene vegetative umrale- Ast pace fu, angie dese” pot dervols lou clinics verte Ps sala desta fic exprcnl durease ela 1, ‘majoras pacer in nmatlope e ncades nse 3In orice conti smtamentul stomalope ee 0 experi seplicu, anaes avind 0 nae pepsi asp acelor cent care vor Isimpins probleme fy unor stat ‘Un control cores al percep ureons Inn pint cae 3¢ presint pets Ing somatelosce se cbjine pin floss [loads premedeat in cdr uel bun pens Ulan compeente shail de apes foo eon Dareres et pric ene aubiectv su ca o perce nor expen emoionae ua Sosive epic seas ‘un injur ectual su pote. Daren poate percepts {Su experiments de un individ doar sine! clad pul ere jungle ell "mi compen santa find dureroace Practica stomstolopl ee Ign Ge dc djl _durrea oso sinpiomul care luce pacientl i Shine omatnogs, tot sx indepen de ace “deri o mare pte 9 popula sf evite su sae ‘rare afte prone, Milonele taeda oft wei © image exaget Imncinitoare« medicals somaolog sa actions, once eplich cam an pacen chit pi, spn pe ‘esc ul emoae, peas devel anos, aca, supcos ‘apa, defining condi de ers improper Somatlogie de eit de dur sau de me fate Dureea ete defiatca. 0 expeven senza 9 mona erage” in una toot jun ulare vere Sa ‘otenpile - Sonia dxreoush geeracd un de ifn’ indvcule cep inf comportmenil cea tn fine dep itn drat apa aumatizant. De afl, perepin dre ea sel ‘te dele inpltore Tnteoitatea tiem aparielflburdlororganice inde de duvere.depad de pul de personaitte al pace, xperientadureronstantrioars xpactatea de adaptare ‘organist a ses, reactviaten a, acer istemice sana meet rane Prvitdin asus perspec orcs tatamet somatic ete luke 9 indidutoat Besa az pate, medical ated Alicia stein de pune in alan crabs dele bite fin anarnert. clic pre informal dees Stren genralt albur dein cade, burs de ‘onducere cara in cast ingrilor stomawlopice (exmeti_ dene lveoopatice pupectomt,Indepartarea Iu protec, Prep ale sion In vedoes protein ete) y xl 8 Toon bunds aparat carder dad psec tn Time normale prestuen arerit i re reluezi © ‘oxigen bn incnrwpa geerlt sale satisic au arta le blnait cart compensa care au ser interven chiral de ‘lear, moraliate lp de acl operator a fast cu pti fia iat cit Ia toll fd bot canosscoare fn schind in bolnavit cani-vasculai_ decompensti_. oct de motaltate one malt ma eset, el popes i ‘sport i grviaieadeeompensiei. (American Heart ‘Asean, 200). Din fei siti njore apr rar tn cabinet dest dat toca se foe faecal Somaya prin Sarpindere dic nu chia complet ape Devaceea ta faa orictrl paint cardio-vascular asupra ‘iaieintervine este neces Canam riwroad {+ Ghexamen clint general een complet 1 Byars cored arta operator 4 Alegerea indeajet de ametecie gi telnicd ‘haga et mal pin nc. Din date de somneztculese, medica omtolag deduce uma wejanea deca sfert pact cel ponte primi {nfo a lgatua cu eden pe care oot seat (Conicarécs, disete, vaniatatore » stcopaans). Tn cet fl pot vit intreenfle eu ale medicament pe ae umes she presere pce Compltarea anamnece ante dite obectvesmare ese foarte important Aufl dig ese desea de 0 ‘nsfcenaverricuars ating dare” precordial Contin sem clin al crdopatet chemi canoes tnavlor su a macoase! orale exprind pote» inp ce lance acid cu edema member erioare rena spre o agin cad Bia plete medi stomatolog un cha eu expen 6 rmaumese St fomulese br eairl anamneat mals © $aguetarcare de ri sinters sts sve Inte mioeatic in amacedns”? Deck rises Memativ, medical renin la sbetna vsoeotore (area) din sol anes loco-regioml eu seas ‘Soir la termites genes Modul de sboriare a acest probleme este Hash mult ma ‘omplet pin de mar respon medicolegal deoarecs ‘rit itn de variant ale sue! caerscalre Tecate’ sviad "un mod partcular “de rasp Is acta ominoge in destiguarea une interventi de chirurgie devo si paint ou teen cardio tas, modal somsolog ‘lft eu ule probleme deorbide complet ct mae ‘esponabiate medio ez. [Act probleme san. ‘ Diaguoste corel, grade de compensate al afin corace + Risa! neaopertor+ Local de desgrare 2 ecu trae (ambultor, sonar) + vetignitepropertr’ = + Premed corespunioa teen pacintl $ ‘pall nerve + Atl ntopeator 9 ampioarascesain 1 Astars int postopersogs ade. Jn prvings pacintor care se presinth pent Ingrid Stomatologicesaieing dou catego 20 Paclentul cardowasculr’ care il canvas Afeciunea,este-Investigat gt aft sub tratament. Tn ‘mapritaten ezurlorel ete gpesaraat partment neato” Packie ris lento” sunt aceaeatogore de paca care mu ii eunoseafectunen cardiosascalard te fomecia(h nu sont ‘agnosia EL nu preach Imaniestirt ‘eldente_ceeace face ca boala si teach heabservats lao etaminare mal superficial, are ‘minimalizeact importante factor de rie Peau majorite pacinilor eu probleme canioaseulise ‘typ in uatment omatlopc in-an cabinet piv in {ful sau clit de charge dento-ivolar. sng Invegisuare a isorcelst modal mv exe suse jet sresia sul predict al une arene medial» In aces ‘hn colaborea vial medic pea cartoog ete fanisone Incbinet de medicnd deotrt , made praccan poste iis un consult peeliinar, elomonar al pater seta ‘ardo-vscaar, Reoomundisn medical stomaoog stn ees sh ou fac amaze pe care ou le pout interes ch core Indesprospe cu madicl cardiologist CCunoarterea implicilr in samaloge « bole eardioe ‘asculare ee seal pnts enicea pacenr eu ise Cirdiowaralar — slagwostcarea corel 4 Schl tp de Sfejiupe in scopdreupter misutlor profiacice care Teebuiese lume In vedotea unit watament dent pel de Det paca care se preins pens Ingrid dentare exe ‘amost ca pnoral ute! toll adi vaseulae pent cae fost imeratsvertgt, Waa dipensret mu 30 Pune Frise Seon dor cut fa unt pace cu simptome i seman de suing cardinck su vascular de ip dspace pla due recone einer perio, tupescena venlor jepsare lgatoneo investgfe umount i servi de spesiniane (oven ister, eroloe) ‘Aprecieca pall arterit #avalrilor presi ares, ‘onsite pre interandinexamoace pe care oie mete Somatlog uebue st le practice qi at le. ‘orespnatr In eatinetal stamatolgi de chirrie Seno ook Prlpareaareri cate sax mile oft date importante espe oevenfs tml dust 9 eaten pu feral. "Fectena peste “90 de ‘pled Sxpa [ohio iar sub 0 pubis brad. Ex sk nee forme parce de pul ae fd a palogpamonce ‘ot const un sms erent ule feu care sk 2 Sal or de ech, Masuraren valor preinll artersle aduee indi prefionse care nu rarert descoperd un tren hiperteasy, ‘antes manifertiilor cline. Practices uel elrtocardiograme inane intervenor de chirurgie deo-alvcolars mal lef pie ese 43 treba fesematcd deauece unos a tables Pim dupes de uteri cardio-acelar. (ig)Motode de Investigatie ale aparatulul cardiowascular “Anamneza medicals riguronsh Prestunes srtriats Petoul arterial otana nce ame Ecogratia cardiac (Capacttatenvitala ‘Timput de circulaie sngvind Metabolism barat Fig? Dupi cum se observi, metadsle de investigate ale aparatalat cardio-vascular sunt momeroae dar emaiale fn aprecterea fnctiel st ‘alo-vascular sun snamneza medica sl masurarea valarlr pala ale Dresanll arteriae Examendle ice de lnbortorcompleta2t examen clinic general Ete solicit in apr cs ndefil obint [cet cu metoda de ansteve prcraanty ea ha tcl Seevitiststl emotional iliac ansteisor leo regione cu dan de subetnjraso-cnetictare (rena care sunt dessbt de pesca i pin ‘ct malas coronene. Ee fvorizezh spanner § vaoconstcia conarand pa creas anti do ‘colin ndogre exogene| ‘2 Infact! miocac i ultimele 23 luni constinie ‘anaincfe formal pour ce walanest somatologc ‘> Medial canolog ese mat s-g dea tau peta Ingle stommolgie chiar pen pace in gape Tall dense ‘> Metical storstolog ies ai rts retin gist eric ca ace picts lb angen for medica ‘bi aniangince vasdilatatoure ‘© Chin peta intervene dentare de in piel ete ‘blgats bine premediest cu anual sedative Traeilzanemipore pent dimioures stewull motional meas Scot mlsardfl,fests prin: + detutbese 4 rr retsteral a aie spre ai, prs lr, ‘teal sting. et maniac dram de aleve Tamaim 20 ate 47 sezte de presune st constr oa dapnce *plpt (fburet de rm earine) 1 Rare danse venta Atiudinen de urgent in cainetal Se ajews—facenat im poe semipcindt cu ‘cone parallels orzontlt pat pea inna” te9) Oxigenteraple O; 4-6 Limin pe mad sm cant a + Laie pacinrtl (pstotrpie) Montorizaren tens teats pul Administra de Nirolcring slg sub fom Aecapsulede 0,3 mgs spay iropceriaa se va adminis door died tenance rte stolid ete mal mare de 100 mm Tig. Se ‘dminstetza 0 eapsla‘Su 2” put apo eo asp § Dac simptomtoiogia nu se remit dar tensa atrial siti se meni pase 10mm lg se pose epee Se va alminiara Aspiring 100-250 mg (0 Woe de ar aloe sau leh bia) care v H msteca sa Lai se topeascd sublngua- Administer de sepia fste contundiea is pace cate a aiendene de Kemorage digesiva supercar sau de ulcer asic sa Shiodcal- Acetttament mae indie le pate care ‘smena un ttameatcronie cu apirinh sa a ange Pacha 4.2. INFARCTUL DE MIOCARD Perstentadurerior peste 20. dé mite in_cuda Teatamentaal pleat sugerazh Gasalares aul farce ‘miscand ‘cca producert infect micardl sigtomatologia ‘pect angie! pectoral ma pot dag sez de monte mien 1 argent jogulaelor+ space grvt cu prezejasalulor ce pot 6 sute (eae pulmonar aca) 2 eae I cal in care avem suspicianes fondatd demiocard,teatamental de urgent este ater 4 Caimars deri cu Mla 0-100 mg intravenous dat {210m soluje se slopes ean tama 4 Teamadol, Ketorolac inramaar dock pent ce fala 10min, eetal 30 per or 1 Adeinisures de Sitrogherindsobingual si form de Sapmle de 0.5 mp sau stay. ln braicari sub 60 de bat pe nat Atropind 5 Sols Inxavenou sn | fot intamasiar ‘in traticale severe, sub 30 de pula pe mim se free Alupent 0.5, Saprarennd {ms su Hol Tet ssevenoe + Plo a sosiea Ambulfel ver fi monitor file Viale espe pul, teasune aerials) 1 Tacazal apurife’ Spel eae se vr lua api primete ‘sur de reswctare care orf connate pla Iso. intent In formete foarte grave lfarctel miacaric acut se poate tla sub forma * ycull eardogen™ sau pri = soars eb In yocalcarlogen teatamenta de masimd urgent = Memisucinat de hlrocartana 300 400mg nrvenoe Adrenaling 1/1000 sbouan © iin 2% a abicadie fe nravenos 4.3. CRIZA DE HIPERTENSIUNEA ARTERIALA [Numero pacing cu MIA se ered sbeatol, find tn ‘canon de boa lr ‘Aproximiiy 1% diawe pacienti pi dessoperd iperensines areas indmplifr, cy. acae tor ftamint de rulat (examen de condactor no, ge im, parma ere» ona nme Crepe resin arerieete dat de creterenrezisente Stile perce prin spam prekagit supa leon Iipereonee si degenerave ae perce vascular Tn prima a2 procera ete cl pin in pate roves e clad ins does cazest deni LTA.ste dfn clase ca cry a prsané arterale ‘n ciculpa scenic, diferent de ean ear 0 green HA ese. comunt camenlor ia vars repent sproxnat 75% din boi poser post 50a Hiperensiana ners ese una din eal ma fecvente ‘probleme medical in SUA, ude fotze 25.30% din, Popul: Ce ai enult camen fers de HTA met ( 70%), Imoders (20%) 910% de fonne severe. (American Heart ‘Asiocatin, 2008) pl detain datt de OMS (Geneva, 1978) HA spare in ‘aml ne esi sterile stice de 160 cam Ug 9 oa ‘nol yu Ino fensune areas dastolics de 95 men Hg ‘aslo igs Germans de Combatere x HTA (199) ecomand a ‘alone maxime normale it tlds) dal she Interpeett funte de vrs pint + Presnea ssid: 140 mm Hg pat 40a, 150 Heine 0-0 an 1 nH pss 60 on+ Presume dinstotck; 90 mm Hg pons orice vw. In air de cele dus det, cat dj, piviod concep ‘valor de peensene ane conideech ete important eit Claire tenia arrine dupa" Pith Repoct = SI WHONSH dovad s preoeuplor in oes privet rest ‘slecune eriosacilr caste cen on espn pe ob sicare dail ees demu wisp senna. 3) ‘ab. 2 Cintra tgs arere dap Fath Repet a \WilOASH Ward Hei Orpen Intron oe at ‘iypetenen), | CCASIRICARE | TA sotcd | EA dase comp He) ‘OPFINK =e =o RORMALK [also a8 TIGHNORMAL | 130-139 sn =e ‘STADIULT | 140.159 aw mo BTA ujart ‘STADUL? | T6079 ww we ITA wyoarh STADIOLS =a sie ITA wound TTA watoied | =100 3 isc opertor este variail in functc mal als de "isunetl pe cae Ware mperetesianesasupes dere itr ature. ‘rgenta leg de stl operator poate prise it prin xejces ct prin coborrea exces presale Sire hipeensive pot determinate de team, emo, shrre acest prelangi, t eapetice Urgent importante care se pot produce dups o erik dehipetestane arterials” 2 pesena vascular cecil Grete de amp pectoral Sea de ioc 5 loa pamonar aot amit "ucigsul sens” deoarece a taxa anual a efile mlloanlor de samen, HA Ta mod surprineton, Donte adesea descoperté de medic rtmatlog, Stomatologl ese unic im profess medical viata rutin profesional de aga num "paca aparent log ete Incurajat sk imdsoare de cae dat resumen arterial anal paient Decare lia in tatament ‘Toft bona cu prestane arterials egal sau mal mare de 120 man ig, trie Indrumatt spre medical internist, pentru laren in evident si preserierea une media oresponiteare AGimarea dignosiculi de HTA neces mini 2 ‘nis ale TA, Ta dou coma dete fo pesca Valoror tasuil areale se vor ha. inde onsierabe icon! ca stessul, ea, inordrenfch, ‘rere, foalRisurile waor urgente apar mal recent a pacientit 2 ‘itor HTTA nu tte canons sam ale cre valor st prost replate peintron tatament medicaments eadecrat volais clini aceMentebr determinate de HTA, 2 fiat ch de cole oat tlle oe ete mal portcaaesd freytere mic preslunl arersie dar bres, dcit ‘retere mat_mare a. predunil arterlale dar’ ent, petungll in np CCrizle de hiperteasiunearteriald nu sant eveniment rare a cabinet de medicing denart find anima ‘eeunosct rola not factor delanatri al eri asia psitica * inondrea ‘anopere arerose ‘ea suisse vacsconsiceae din solu SestecihIoeotevionala al aes ck din eae 9 Toate nimvascla te ‘Simptomele “rae de HEA” 2 Cregrea bret 2 lor presunit striae ‘ensunen doit dep linia de 140 mn Hg ‘2 Enefnlopaie ipertensirt cu che, senza de scsi $1 vom, eboubie, somsolens, uber de vedere 7 2 lnmafincoronarins cardiac 2 Olguae 2 Atectrea retin prin edem papier, hemor Cran de HAY se destigoars in general bruse, ex trmiri ramatice uneor. Prous cri de TA tn Practica stomatologiel are In vedere urmitearele ‘esti: 2 Panini o HA eb dip prin wn etortc Imaal competent preca f pin mdswares ‘hligatorie "a valoror pres arial, males a ciel tec de 45 ant 2 Pcie x MTA trebuleecilibrap medicaments ‘de cre medical carlo mim dap o pregare ‘srs er far © Clnoastrea mada pe care oka pctentul permite ‘lara grail Dol perenve. Ba mele Inwerpié nanos texamentlordentare. © exept medcamentelr antag 2 Bvtarea sess, e direri, a manpereor tale maton > Entre saoconectrior dn slile anescice Ico-eponale 2 Teint de anesteie corecte, cu verlcarea permanent prin spirale Tac de ifort ‘eset ete ier jectarea htranascoard In aneseile la ‘terest spina Spl, gor Dalatind postericaré) > Dota cantor cx gparate moderse de masurat 1A san montorzir’ ale pacentorSuprevghersa continu valrlor presi arterial apa, ‘at at tama acd la maserares tensinllarteile sistolice se obtin valor cu peste 2030 mmflg mal mari dect valoaren de Tat, Se ta pane alngndea depose oe ipertnstane ‘rerialé se vor lua uematonrle avai de urgent> Masur generale: + Inceareattmcetall stomstolgie + -Adminsares de O2 prin sods na ‘cron + Asezrea pacemuui pe jumsiate ridicat gi ce ‘chur at or det empl + Mostrar permanent TA pia ple. 2 Terapia mediamentosd: + Nifeipin (Adan capsule - 10 mg sibling, epee dud 15 rine, 20 mg sublingual + Nitrogierintsblingual sau Miromint spay I-t Jt epi + Parosemid 14 fol inravena sa intramuscular, ot + Diazepam 510mg nen sitar * Se'cheamt salvarea space va fiers fico ‘linked de eanlose Premedicatinsedativd, ansoties, abigatorie ex franchlzante minoe, controll durert rite aneteie eoreponalt de caliate, urmirres oigenird opine, Ssitaren unel stmenfre agitate incordatey manopers scale bliade 3 puin traumtirant, apes ola ‘CUTTTA de cedente x compliat svere Uutlzarea substan vaso-consrctare in solin favescrch nu este categorie ‘contraindiath, ttm oncetraia oe recomandt 4 fe ub limita obgauit$ ‘na als, tehalca de injectare se pefeth,veriflelndese 4.4, INSUFICIENTA HIPOTONA ACUTA In practica de al ew 2i urgent con fecvend dla ‘bint siomatologic este sacopa vvo-vagal lo, Uipotimia pasagert 9 [En dures de acters soci pd le jumsate de of Powe Boi de mii! force le muyeor eet ¥ ‘membelr. Conta simctrelor ee stat ope dose ‘i conralaiy Prt este sla, neo pereptibil doar It nivel anrelr ‘mai (ekroh sa femal). Presanes aril est coborda ‘peu ce masuat incor, respeapa supe ape plone ‘aed pacientes ajeat in pote orzonalt x psioace ‘ma ss deck cpa, pls se amples, presiney areal free, pour fe dispare, espana se itensied onstnts vine Der bic siacopa exe preci de un scrt_prodom (oresincop care cupeine! ama, iecaren ver pak IE'oebe geatate im membre, Pro lps in ard Sacopelor generat deur ta croc Dup Inosaensincope rami sechel, dar siacops poe reapre dd pion erie bse su pened, ‘Tipur de siacops:pf oar. Se one pi ap pene pace Se ecomandh capac eae declaet epsaae de sincope ‘gale nantocedene st ise aminsreze tm anole de ‘ample Midazolam, Diszepam. nnn cu 20 de inte de Ineeperea tamer sb age bat snalgsce #9 smote cana 2. Sincope determined de hiptesiaes ortostaics pte delangat de ridcarea Branch» pci din Eliosatsn Tn orosuism Ease rome ln rsiarea ‘lino, ‘Apa is pesomele'cu fetes reflerlor vasomotor (Gpotesune ortosbcs fils, sufi. pomart tana vegttiy, det nearopsi abe, cick ec) Powe evita rind lent paces de pe fll outage 3. _Sincopa cardiac exe i fecent pneu de spritia inuscd une! tuburl reverie de tm cardiac. Ace fulbuare “detemink fe sores focvenf!suace sub 9 ‘alee de 35-40 ati int (be ato ential, bal de ‘od snusalyfuncfonsea defectash a ual "pace maker” ine), Se crejlerea sa peste 160 bi mi, acai prnisice venture su wupravenicls). “Aufl de Scope a rein prado alia sincopelor cardlgene exten general benignd. Slncopa vato-vagalt este forma minord din galer Sncopelor, deoumt i Upownie su lyn trad like bia 6 perder iecomplet stride content su ti ‘rao stare de oboe pron. Fneile vitale'ma sat disptrue et doar diminuste , comtaindu'se totus rae contact candace i mig ‘espstori, Aceasa’deeglae poate sven 9 dma de Ia hist I 30 de minute sau ‘1d Stara este aproape Inttdesuna versa Lptimia. se diferejiacs de sinoph pin intensitata sermeloe, piereren cunogtnj cae exe paral ‘eantori,ritmul tesptor sardine exept Inet. Dien xen ft de sincopd ee devi pesistenta Tntean anumit grad al cenogtnjey dar buat Mente pens cele dow ae. Ea pete consideratt Drodromulsincopelvat-sagaeproprase. actch de fat, sincopa vaso-vagalt i tpatimia se confunds, cle mu se excled cl we coniauh ana ce rap, evoluia de slncopi find ‘esta de de inti fn cauzele general incriminate i etiopatogeni iptinie sunt tate momentele pribogenc. teen de! medic, Fespectiv de actul operator eare urmeszd, acfiuae ‘teat medicament patra odorant la iatrares in cabin! ‘vederea stagelat Ix incepual_ Intervent, vedere ‘ering, agomoralaparateior cu tarai nate. iia yon an ub a an et privtes fx, anus lpr foal cunostiet sea piel fn ail ommoogis ‘Anemia cotebrals port via in acest coelai, find ndiionats de nflvente pstice case rob covsie ‘excita! ponte cone vasomotn fa Hpi simp $i colapstl eros exo tulbree seth ciclaeh enfence prin sabres cent vasomotor. Paciet "stigmata ca_vegetatvt ay 0 puternicd ‘vasolatale trecrent ma le later, bet feteDerloada puberty astenil, vasodiatatie determina fe factor uneori minor. EN sunt ceca fa ‘majoritate ipotinior. (Cott vasomor nu este capable pont eglarea ‘neces momenan de sings, al presacral opine al repr sang ‘atl lipotiie simple, cena vasomotor se seface in poafie cole Im tinge cel ma scat la fipotimical se ‘teat In insalaen pon! apace sotto bi tun imporaat il jock pubic, socal prbeb ‘motieten venoast din zona splsnicula care fe pare, posed un anumi grad de independent In mod special i pacen trai, arent poate fi cazul ‘nui tons scat al neve visceral ia sta vasomotor {Ste prea sab pon cx scot singe dn scx eon 9 Si chip teste eceare » Deseor pate vaso Init aeuzi ch Ta cidinren din poats col vd sponta epi senza nd. ‘Vert (ameteaia) ete prodromal sincopel vaso-vagale. ‘Apu eimpune open anesteriei sau a cult open panera in ponte decliva. cu capul. mai Jon deck Festal corpulut, adminsrreaasepeelor cardio: ‘seule Sincople produse prin mecanim central nervos sunt sincopa cardiac (lb), sincopa respirateie abate) Sncopa totalt, Orica ar 8 incepl,netaa sino Donte deveni repede totals deoarece fanfile viele, Feipiai i cirulapa ma pot persia Indl Independent, nn ikea Sincopete prin mecanisn perferie, de orgine cardlacd po ft produse Ia rindal Yor pen tp ear, fae ‘enwcalar sa pein isuetena contcilorinimi cate Sn eregulate, slabs, free propul Sincopsle propriate se manifesté tease tn age fel Inch rode tee adesea nebserat mada bid a comporamentull ea umare sexsi coral efor Tavursublect tact plod tunel sin’ cones somnolengdInus apa. Simptomatotoga sincoped se poate clases pe aparate ite 2 Simptome nervoae ‘Taburdri ale cunoyinels somo, ,pieneren motel, coma ‘Talburirl sensitive: cefloe, vrij, anal, zgomore urechi, organ vizul side ect find cele mat seatileln anoe ‘Tlburaet motor sant fecvente prominin’ dese ‘abou clini sub Tom de convaliSat mod bigrit ‘serait sau de ip Jacksonian, 2 Simptome respirators Respraia este mai fot accclrat, repultd, devine ‘spot seeps, nctin last sbren > Simptome cardiowaseutare Bute cariace sunt accelerate, nergute, Extaisolee sunt fecvete. Preis arterial exe dima incepat ‘poi mu se poate mts. Pll exe Inet nese din lund dspare, Uneor pate apare o rere precordial. Opies inim pose Rimetiath anu sscundrt opi £2 Simptome neuro- vegetative Acestea suat intricate ov simptomele respirator ‘ardio-vasculare,ansarbll for reli adeta tablade cola perf. Principle sinptome newo-vegetative fine puouen masts a tepumentlor 9 cor sa linger canoes, mide eanmpiat pong ee, ‘La aparia uel sacope -ndferent de cates rebuie Iaateuemaoarelmasurt de urgent ta cabiaetal stomatologe: + lngenperes rataetll somata + Agente pons nclinesttisn cu piss wor ‘adic deasepra nivel capa 2 Curjien ea ore fia faingsui de ngs, fommpese, rts dette, matrale de npren, protere mobie, obra aorSetgaile ee > Desfcrea iunelor sau onror ale. acer ‘esientare site cea, cravat et) 2 Avamen, thi pectania tn poziie de ‘Serj (ot lara pea a elibera ce eine eiperei eee, lat riage gi pres fvemaeoe str ' Montoriares paramesilor cardio-vascular + pul, prove areal 2 Smale perc (spite cu ap recep amie. 4,5. TULBURARILE DE RITM CARDIAC. Indiferent de aspectl clini , de etiologic de cadrul Meinl ta care par ,tlburlele de rtm cardine se ‘seamda prin problemele clinic diagnostics pe care le ‘ides prin euburirie hemodinsuice pe cae le produ 9 Prin atudina erapeutica pe care o mpl Riseal operator ta olan ce descra ulberisi de rtm ‘arlae’ este ula, comparativ cw ace pace cu ri orma (band prestize prpertai prin seer crc in tahiti rapide scout, creyerea cela in Tuburele do" condicerestnosenticlare sunt condi ‘senile vedrea score ep de atl operator Pen medial somatlog este ior sneeze prezens arimilor nt adapere manoperle terse ta func ‘ese ura, De senerlist ere problema inert puasinpatice tn regimen crommuniofaiat” “Aceata peso ae Imporayaindeosebi peuru braicant ta blocs ir ‘wenicub care pot favre pin stimulaves perampai in cus magaperdor somatlogie Pe dealt pane ‘Soules parsimpsied poate 8 ulliza ca rma wea Sale hirer sa elias Sm ‘Bue cadiace considerate normale 1s adult 4 stuazi Ine 600 iat ar a cop noe 40-120" Medical stomatolog are oblgaia ex alsin de presines attr, 61 examineze pl poietor eae a pet Powe ingritstomaolgie. Astel el trebuie sh determine Freven pls existe wei hs radcrdi, vote Pusu» dst cae sab ptemic, bis» dace regula su nega,‘Manifestirie etinice ale tuburdritor de itm cardiac cunt general patogeomonice. Un diagnars corect raw te podbll AERC. Deregirlertmata cardine pat determinate de; + supedoes de sbsant vio consti in sla ster lone tea de. Ingrinle dems, anesterin. inguin, cj pe as 9 Re, manele inane 1 txiai rnie cu loo coin init mediante ca antideeesive, vain beabloant di, digle bra metabolic, bomonale,espirtor + afc eariace” bola "cornarind, fen ‘alvule miocadie, ecient, ‘abrir de om cardiac pot sven atl pacino mind sino ed 3a eo eu afc proven, Un ‘rore medal rigwar detcoprd In anmnece peter tneort ba ind ere, tabard Iie de lnaletate. secaie de potnve sou opie de moment “Medica stomatolog nu este obliga sf punt un diagnostic 2 tipalal Dreeeaa eh de efectte posible aspen paciental Dest este bine pretzat eu "pul opt ete un hax $m cenit" 9 mut pace ne 4-30 a9 peste dco iad normal tn etude armieconcltafia Itrdcpinard (x media carlo Impure preter. ‘Conduit eapeucs de peers prsnescictreeomandim Sallesubi de re mail cadcog, pat eb vee ou ta a re sapiens wang bcos ‘ratameatului de urgent, “ edna sal pio el er cae ‘copia trys a ara ope Mai semis ees in cow mop ‘typ sme ee ee seeptlne ep Finks vnc sen undo feet Au Cn tonne na ae Sapa abCDtat ean cn waa Aliana de urgent in cabinet stomatolope: 4 Sevalmreripe tate somstolone ‘Seva administa 02 pe cal taal sou mac or-ozalb Se va asigua 0 bunk analgezcy “dnc on lpect (sptimenanea anes! local, snigetice pe eae generals) ‘Daca ia ciira mine pull se toma’ 5h Simplomisioga spre # dock na resales ‘manoperlarsiomatologis tment poate cnt! ‘Dict simporstoiogn nu pre, ss rape In eat de tein tatament, eva apela a Servi Ge Ambulat pears tamper pica lo unite spiced (Gingrsteal pt taumentl boric de ram eae ‘hse mi mse ECG ete baa!) "gp cal inravenoas! su intrmsculr saAlupent 025-030 mg inraveos. 1 Tahieardia declangat de cateolmine a pie cu cond siniioy se combate pen admiasuaea unt betablocsat pele navenoss, ica: Propranoel Se su Visken 0.04 mg, ancaiice ~ Disaepam 3-10 me4.6. ALTE AFECTIUNI CARDIO-VASCULARE CU RASUNET IN PRACTICA DE MEDICINA DENTARA 4.6.1. LEZIUNILE VALVULARE CRONICE Acformare organiet permanent ‘mal multor vale cardiace. Ace afctvnt at eta vers dar cl ni seaen sunt de {sume valve oeopa un loe ‘Meinl eado-asalre, "cu a preci) crept a ‘moral gf morbdtat Aces ip de lesun soctenc nia de spup » alvelr corde pane din xepoi sHenoele sau 9 inne cage, mulfestindsse a oma utor: eae, sec. inlsmati sade Zonele cole mal nite sunt value, ill vale, ‘upc poplar, core teatinense,Afetrea poate Iocan ft extnvavule deieminod sparta akor bol ‘ace de ipl boll vatvalare dfn. recveats, 36 60% ain 2 ie abate some. 30% din 2 erie vararewcusidene 10% ain Lene de ipl sttozcor, determin spars wn peso sngine micte a vel caviar (at, venieal) ce fu in fa for valula asc Digares doe I ipetoia ‘vit sch pulmonard ipreosine aera fal a Insufiin caica “Marfestite clinic carters st gore (sulle) cardiac, Majoriaten bolnailor cu lent vatvuare se aft sub ‘monitrizarea ani medi specilistcardolg x eral aie Imsoft de schema de terape medieamentost exe cligatore nants oriedrel itv chirurgiale. Inifrent dat sce abc se manifest so fora iste fcienelor au stenozelo, ele ot reson ne ch 1a bavi ca to congenial sudo in tjtaen ceo, fet manifest eves clnce rodents ft poz cae sep aver meds stration Cen mai frecentd comple a lexiuailor valvlare ‘rani ste endocardit baceriand subacith,deorece ‘ex impli, Tntean grad Small, reepootabitaten ‘edictlel Homolog, Datoritl acess fap, investiga paclentulul da pune de sesdere general pint-oanamavatrguroash 9 coroborat ‘st examene paraclinice,impreend en med cara ‘Su internist Se impune cao regu, omplesilor tonbo-enbsic), + fn ant protezcior valve mecanice, declines iil Gini exami, thir prostie, fiat venticuae) xap8 observe medculat accent crtte sep tin eal+ Decangren prin manoper stomoogice a acest ccna ange poctrale iainfrtu mieaie rice sft supimenar sau sedee & valor presuait ‘stevia sb ita de leans ddl actiecl opin Ugenfelor. Se sincopale nu mit exh deaetrace pi Seadetea bin eer mails inal stonoe! ane, Duck pacientul prezinth «bead mitald sau aortic (Gnclzdnd att Isufcenta cit st stenora), precaile Mate de medica stomatolog treba ot fe tai mat a fl de cazat,avzal medicaat carat inert sa ardilog apare ca 9 mivura bigtri. ste imporant erent fp leit forme sore de Blt songentil carince (valvule) sre sit bine tls 5 ‘min peobscrate pind cind 0 Sal eaceae, ne cane pte figura get slomatlop; deeango complica 3 “alvulopti esto manifers. Best apue cette ‘sna iteroguora stent in problema cao vasular, el pain a prima pezetare a pacienta medic somatlog 4.6.1.1. IMPLICATILE STOMATOLOGICE ALE ENDOCARDITE! BACTERIANE SUBACUTE (e8s) Deg aw ne putem refer ta endocardita bacerand sacut cla urgent medial decanyata tn tp Fel, ‘ceasta merit ont tenia deoare ou poate decangat in arma ngrijiir dentare Endocardia bacterin este © bond infections grav ta care gree sept loalste pe endo valvular saa pe tke sStrucar cardiace normale sau patalogice, prodec lecuai vegstante sau alcero-veetante care determin eteriorii structurale gi fancionle locale si embolt ‘stemice-(Ameriean Dental Avtcation 198) In pofida progecior objnite in canilogie gi a uni ‘raiment anibotc tn doz impresonate (30-100 mane Fenlelag UL ', endocritatactsind subocut pres 9 volute grav, cu un procent mare de ocala pn Ia 29% inca dupa MALL fi 42.9 sips FALACE (ca ROTARU 192), Coste mari de diagnostic tratament,prognestc ‘efavorabil yi moraltata eat orien cumoayeres ft area cunoytnfelor legate deacet vast capitol al ardo-ascalae ai de care medic stomatlag (eebule si den dovada de pruden(a dar yi de conduit opting, exact efients Originen dentark a endocartlbacterone subacute exe spreciat in procente variable tee 20-74%), majorities lor sinindu-se in jural 555% Aparfa yi dervoltaren [EBS se face ea urmare «unor Daterieml portant; ca Aiteriteovigial arago-smigalian, snare, eae fale aparataa geil, urea, desis tc) dar cen mal important bateriene in reais ct EBS. se ‘omsiera cea de origin tomatoes ‘Launcrpaism satos, bacteremia ented bic! airs, rt wn cinicedeoarece ex et desl de epee com Arial alergi. Se at nme eines atop. tro lt bach react alrgicd + Glpvall lan igen fezan in mes embit exogen). > Asimal nealergc Na ar a bach o elie bine defini 5 ‘ct an mecanism palogeniccunoscut fa eters emus Uwonsic ‘neler mun cle: anal endogenous Gninseo), stalin fitch ci, ‘smal provoeat de efor ("exer dndsed st") # fame de ass cu genes serena de fina tn smal infects fos iceimiaut un means seg nae “endolergea” san represen de rd de diapers a {Ge toxine ale baserilor, vistors prairie da Foearcte de info suena ernie, site inspect In lle resistor spew, susan sa amiga Probebiltaten de imboldvite ete eeu into sie de ‘si gi ctcumstnjepuologi, cae repeal au actor ders a ama bong Dia acento soe mal imports sit + anecodentle aie de str bone 1 existnj uo fin lrpc cul an anteeedenie * Sipura esol Gensler gs ner In evident a unl sensiilini, mel un legen {hale + reac de boahopscuopti infin crnice + Gisteta unr factor psi (tecnica, waume Phe, «use aeeoze us unr tet newt,‘ste de int cd persousele eu polpor nasal ris de Inbolnioize pein tat rence Crest dash aces a3 (© hpeweactiviate brongct pemardconstsonals fp “eclanjaren crit de brnborpam intevin 9 sere deft ‘ae aconaztpitsn enim de ac nage), Uni ie ace = case pol tap ttc pein tube sau vis, se compo ca ina care declan ‘rothoconstiia elie pe clea acrvul as tn asema lel, moist chic scion det ssupra ‘scaltr ete 5 brio, arups glndlo nics 3 & endatlilorexpieorbragice,produciod ebstutia ca rocker a brollr mic Mediator chin in aces Ep de sm, pot scons gi imvstprint-un mec when, rodcnd obstruct i. asia infects, eosin oni pati a ei ‘tate ilar especie cl ener orate imo Alec. Locliarea exon beri engi nace Tom de aso, depie de opera nama mons, nasi ra sim provoact reac oayce med pin ner vag. sau prin. desta de meditod fronhoconstricton. Uni sult av cum sunt pase ‘oxoe, determi sprape ls ecae person un sess de Sefer, al stim sat (pa, fam. tempers ste ‘9:) declanjeaa un brosorpsem ls pci cn sie ‘rons hipeeatv prcum la Blea rons cone. Tinscoip de atm tron, csttia pedo veal ‘rohilor mari In asa Brome indus prin eft sau sri emofonale Iingenia este tal comple, bronhoena putin fi ‘cunt hiperenlae, hipocspni peace Vagal cliberrea de mediator! speanogen) dar side Tabara ctrl die activate, eptonoralft- rene betadenrct Concentra. srestt + medatorlor chmici prima (istmian te, a plasm boinevilor eu et ip am, recum si fap, cromopicaal ds revin ase de ‘Sun indus pin exes, indica partcipues medisioroe ‘Simic, cu tit ma mul, cu edt a const ch stim ‘emi pot inde degranulaes mao, Paneren dngnosticull de astm brome nu comport sata earanle pice sa cae evlues ace de ‘tape parxistia. Diagnostica elope te Ins diel, ‘roars denirea cael deslagtore se lor ma ‘ste otdeauna posta Pentru natura ley astmutat brome pedencts + ntecedenee alee familial pean + pant accselor repetitive in condi asmnioare de ‘imp (periods de polenizr), de lo Beclanare rizr {noel detuned, In anunite ieSper in cabinet Somatologic, et) itn coi de coat cu scl ‘hice generar de alergeat + teste tants tele de provocre ogi porte Precis 8 anarpezt minufoas ete obligate, mete Pet cae is servicie de alergologie se floes hesonae Speckle sandarite,Diagnorteul purty alata Tome iaimce se pune pe iss tblul clinic 9 pe cramensl de spi, x 41 pe sbucnla onctor doves Ge pencil In ie alergen imal bronsic web ferenpiat de axa cardiac Aroma cron ex spam bong am de dere de ‘alten! Dronk-pulmonar care pods dpe fulesiowre pene care sana aig comp st Intabrnsic, mone maligne 9 Senighe’ ale abe 4 tronhlor, guja cu dezvolare recosersi (plonans) fi Sino! mediastinal (in care se peu compres pe boc rabeo boa)ceamnretene se ‘Unerihipervensaa tna in acide metbaie de ivene catze 91 din sindromal de hiperveatlaic de cane ‘von, pote confi stl rok (Cra de astm brow _reallzeart insficentt respirators scat de tp obstruct prin broayarstenerd (epatm + hipersereie eden. Prien devin. asin, cisotic gi prefork topes ‘Bronhspasmal determin spi dspcel de ip exis cx spur de alr slant, heesing tee Aceta rate pet ution sa “Tn pci simatic eanonct (era de astm) ‘lan pie fit ut care avo ¢-mmifestae lege, tn wceteaz broospasn fad toot he feomene alice de Up leit (rie et ruined, dame, oc nailstic) ‘Se vorindepirta to eventual lrg ‘Atezare peu tpi yen “Otigeserpie 0, per mamch sau cand mazald (2-3 nina 1S vor adminises 2 puta dinten spray x pbstant ‘mime (din tras de gents cabinets in madieia ‘opt apace) ‘Diet dp ted 3 minus, dapnees ay ae remite se ie ania Amita (Mba) 240-230" mag {inves fare len Ga cea 10 minis). Montrzaree Psa packs exe randitarie a apria de nial a va Inrenge ied ijectaen Seva apla Sservcial de Ambulns pena tenor asisat al ecco io unitate splint, Diet boabowpusmal ti apace in conextal wach ‘nsuficincardace se ecomandsaminstore e *"Hrecortizon Hemisucinat 200 mg itvenos tn tote + Clemastioum ( Tavegl Romergan) 24g 5.2. INSUFICIENTA RESPIRATORIE ACUTA cama) Desi_ in literturt au fost mai multe incereiri de et IRA , Schwenzer 1995( stat de TRA de orgie centals TRA de oie peiferca TRA derma de dre fn mecanic respi TA prin fbr ale schimbulu de ge faves Dine cauzele care pot dclana IRA, mica somaolog se “atlast in practio igjiriordentae ma fecvet cu 2 TRA de originepertercs 2 Ingres imbilia pacentaliconytent 2 Aspiraia de corpi sri 2 Spasmal laragian persistent 23 Criza de asim bronle 2 Edeml QuackeDiagnostica precoce al drier respirator fn urgent fe relizemt de cite medi! stomatolog ch 0 ate ‘ttn pe baz smut: yel vee, aude pagent” {in sitnia ‘care pacienul este consent ene fosste ‘mportat dacs ecules sk obinem i cite date de Ssoamnest medical, mates cin scesea ou a fox uate Snteror deciansri urgent Se recomandt tori sau se plardS un timp pretios entra precizaen Gingnoseal, ncepinds-se de sent onto! print al repeat Simpromatologia TRA exe impresionant, compless gi ‘ariabilt Es depinde de eopatogenie gi gravitate, de ageing hoax th «ecto presi Dinpaees este de regult primal {col mat important sem eine. Se manifest taal pen poipne, spot prt fufbuaren simular repping iar tn forte grave pra bradipnes yt apnce. Informe supeancte grave, spaces ‘se pouenual brs chia dade Dey i cabinet stomaialogic IRA se poate d brase, uncort pentru tn timp foarte reart detect seme pl simptome de aertismeat sa > Semnete i simptomlede avertsment in IRA: + opnes, hiperpnes,hipopnee (ture respon Ar amplitadie 8 pone) + bradipnee, “tahipore (burt; de teeveas irate) Sano resprtorptoloice ‘Spar repro pelos, > Semace de alarm inTRA: 2 ora) + Blcarea respira apace 4 respratieivers, send + dspneeimportnit su coms, seidor 2 Simptome de insotire Stemi agiae etnin,ata + deregie ale compat In aprecierea grav manifetirlor _ungontl respiatorth medieul somatolog. treble shia in Conideratc urmatoarlelemente cline! “recvena pal respira 2 Rttmad reopirel 2 Zeomotle respira “* Breatualle spe cerebral vegetative 5.24. INTOXICATIL CU SUBSTANTE ANESTEZICE LOCO-REGIONALE Aces direct, defvorabilt a substanslor fnestevice In dozele une asupra apart empire Criowarcalar esto rat Rescfile.declangus.bruse, Devculs gl care pun i peicol fanetile isle sunt 3° ‘at toed sau alec Reale tice pot apse fe Ia 0 donire ronan concen i caniataspestercse loco region), fe a famare a tei admiisrari greta (de exempl intravaseal){in cazulacestor supradoze de substanftaneteic loso- regionals se poste prodace intoxcake = SNC sau a ‘micardlintouicafie care ete uma apd de tour) ever car esptaton Simptomile 5 semnele ita cu mbetanesnetzice loco-eioaleevolueas in Se (8g. 19) Derplirle (orice ale acesor func sunt atit de bratale gi grave Inet dacd au sunt diagnostiate $8 (Gata caret por duce la stp cardiac 4 respirator 5.2.2, REACTII ALERGICE ACUTE Reale alegice ate prin severe lor pot produce IMA caun prognostic sever. Cau cn mal de nit tt declnjaredatestor rene alice o conus subanta svestezicd loco-egionalé (Novocain, Xin) In alte ‘ircumstanf, sunt acuzate uncle medicament Penis ‘Alpocmis, Antisera, dan ee Compromites fnci epitr In eal lege acute ‘ponte feria "2 Cea de atm brongie ‘2 Bdemul Quincke 3 Socl anf Recunoarea sf diagnostial manifeatislor grave ale reacllor sate lergie trebule hse fact media sigur Pentre teatamental specie se apiat cu mare 5.2.3. ASPIRATIA CORPILOR STRAINI IN CAILE RESPIRATORIL fn od acidental aspirin compile stn determina 0 Insulin respirtode acu, prvi, cu prognostic rezeevat Ea se" datreat hpercypaii_ Way hposiel Cerebral prodst de obtrujit calor selene supeioare fate se poate complica ew ani. Simptomattogin in aspirin de corpt stil exe ramata sof de seman de moar ine y bse ‘0 ineceomigctnlor respirator, citooh Suit xceponale siuatie in care acest aocieat ae rel $ponta, cel mai adesea fad necnars interven pomp ‘odie stomatolog indepirarea corpolat strkin duce la remiterea ‘manifctiier elie Perssenfa corpull seta duce ta agravaren stiri generale stop care-espirstor smarts, {Cle aciene rebut elie cit tal api, deoaoce ‘Npowa penis duce a len coral eine.a practic ingiictor dentare_percollobsrectis acedentale a elor respirator au ste 0 variate eoarece exit sere de condi specifice manapersor omatalgie: ‘9 Poa paccaai to sauna stnatotogic ( spa tn exten) 12 isco proce ecient ta cava eal tuzx mi, riage) eansecui eile respi wnor cheagut Ge sags, fragment. de ‘coroane dear, ‘bud ace d ama compeese ‘> Aspraa scien a una ab de seings dest fn ‘pel defunct de mesic Atiudinea de urgent cabinet stomataogie Purundres acid compiler sti in tle repo, petra af urgent Mota strat, neces eure Sie defn a procedunlor de sare spine 8 picoable woe Depgiarea cilor respirator — hipeextnsia cipit cient pe git oto mi exe pak sub repnea ‘cpt cu coal te impinge ino 9 nape eps Frontal. 11) Uapyli Fig tt Verfoarea welatet — acclates itu sexpinioe concomilent cu viaunlizaea mig trace (fg 1) Degdlrea elor respirators ~ mamal (See, pene ct Seng re Mai spn epee «ips cous 1)Manca Safar dei oxgenare-s pli concoritet cu ‘err oti Sel in an ‘aml peso | tapdil Iaivll unghlt = ‘élaseas manu hese Cincom! cour apd deschide gua cu esl degli) Fig. 12 Fig ia Verfcarca epiraiet Ventiaearifciald (6g 15)Mig 15 Dect limba est nua obstruct acene, nanevrledessie ‘unt ein i scents penta savrea vei pace, (Get) Dect ‘acest prosedu an ft realrte nwet ta Simplomaioiog de obrusisrespinon ne, eile lant n considerate postilitea ca obsarll selena akavel (6518.5) ‘= CORPIL STRAIN LOCALIZATI LARINGEAN oul cline pote deste © sinptomioloie dif in ‘port cx dimensune oral apie, orp stain vohmingt = apg ia sive gash pot ‘eterna 0 obs complet tall clio nevine ‘ind Is mare sub pei ie a oop. ne get se mani antl (17) 2 Agia phe motore evident 1 Dispoce accel sou fies tall & zgomotlor ropratr, Fig.t7 Corp sr mil lcs determi a bat PDs ba{2 Tig coms chine detase 2 Dart vilente provocate de marine are ale corpuli sin : (@CORPII STRAIN LOCALIZATLTRAHEAL tn mijoratea cane sunt mobil ota. La sur simp opt debut drama cancer inort, dgoee, aac tho-motoe) simpromstologa acres La asalaic 5 poate detec un woot dep drape tart a vt 2‘ CORPIT STRAINILOCALIZATEBRONSIC or rimane fais mobi in arbor ng psf 4e Simplommologa aso asp decom te ‘eens sue spare real complsilor infoione ‘mona gave detente de patent oa Desieratul major al conduitel de urges in aspratia de ‘orp strint cll respirators const tn realares ‘xigendel mediate Protedrle de realizar a exigent de urges presupun ca as esenial deaobstuca eilor aio lar din pune che ‘Us pact cu otra parall ic se cp 3 gens ful Bet sateoeae cna wba sm fck eh Sg supreme, sca tel tne {neta obstacle tale, a general pal wet iii sivoentt, al so vcun zpos jes as pee £1 amine contra Gp ct vel O sanguin ote ste ei 23 mit) Procaarle poninvaze de demi ile rept st Ear > Bala pespate 3 Presnes manual: ey Stones 2 Caries cvs rae cu dept [Bétaia po spate ‘Aces manera ete consist dito seid ptr ath ‘asmice ou pol plmeite omopl Ele pot oleae ‘eit npr, pose end su aa Pacient consent - poi edad saan pore: ‘+ Metical se sgl n pt pict sproape dee + Sepia ming jurul lis pl eure Sport + Dred st psi se mpl cp pint, entra se ‘tne borate man oreo + "Seaplct calvin Paces incongtet pest cast Piel ea fi mabe Motil sh lal ine oso (18) Fig 8.