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DEFINI IE LEZIUNI CU O FIZIOPATOLOGIE PARTICULAR CE SE INFLUEN EAZ I SE AGRAVEAZ RECIPROC SINDROMUL INFLAMATOR SISTEMIC EFECTUL GLOBAL ASUPRA ORGANISMULUI MULT MAI SEVER DECT NSUMAREA SIMPL A EFECTELOR IZOLATE ALE FIEC REI LEZIUNI
POLITRAUMATISMELE
POLITRAUMATISMELE
POLITRAUMATISMELE
DEFINI IE LEZIUNI A DOU SAU MAI MULTE DIN CELE 5 sau 6 REGIUNI ALE CORPULUI, DINTRE CARE UNA SAU COMBINA IA ACESTORA PUNE N PERICOL VIA A PACIENTUI SCOR ISS MAI MARE DE 16
REGIUNILE CORPULUI
1. Head or Neck injuries - include any injury of the cervical spine, cervical spinal cord, skull, brain and ears. 2. Injury to the Face- include mouth, eye, nose and facial bone injuries. Injures listed under AIS region `Head' and followed by the letter `F' in the trauma chart are scored as ISS Face. 3. Chest injuries - include injuries to all of the internal chest cavity organs, the diaphragm, thoracic spine and rib cage. 4. Abdominal or pelvic content injuries- include injuries to all of the internal abdominal and pelvic cavity organs and the lumbar spine. 5. Injuries to the extremities or pelvic girdle- include all sprains, fractures, amputations and dislocations except those to the skull, spinal column and rib cage. 6. External injuries- include all contusions, abrasions, burns and lacerations independent of their location.
ISS
Evaluation of Multiple Trauma Patient Injury Severity Score (ISS)
ABBREVIATED INJURY SCALE DEFINED BODY AREAS
1. 2. 3. 4. 5. Soft tissue Head and neck Chest Abdomen Extremity and/or pelvis
SEVERITY CODE
1. 2. 3. 4. 5. 6. Minor Moderate Severe (non-life threatening) Severe (life threatening) Critical (survival uncertain) Fatal (dead on arrival)
ISS = A2 + B2 + C2
INCIDEN A
APANAJUL VIE II MODERNE PRIMELE DOU ACCIDENTE MORTALE AU AVUT LOC N ANGLIA 1896 DATORATE EXCESULUI DE VITEZ : legal 12 /accident 17 km/h
Costurile sociale
PRINCIPALA CAUZ DE MORTALITATE SUB 50 DE ANI IN SUA, ANUAL MOR 150.000 INDIVIZI 400.000, R MN CU SECHELE IN R ZBOAIE AU MURIT 280.000 DE AMERICANI N ULTIMII 60 DE ANI LA NIVELUL ANULUI 1965, POLITRAUMATISMELE AU COSTAT DE 28 ORI MAI MULT DECT R ZBOIUL DIN VIETNAM COST APROX. 50 MILIARDE $ ANUAL
CLASIFICARE
POLITRAUMATISME CU LEZIUNI CRANIO ENCEFALICE ASOCIATE CU LEZIUNI VISCERALE I/SAU PERIFERICE POLITRAUMATISME VISCERALE I PERIFERICE F R LEZIUNI CRANIO ENCEFALICE POLITRAUMATISME CU LEZIUNI PERIFERICE MULTIPLE POLIFRACTURI
MECANISM DE PRODUCERE
PIETONII - PROIECTARE PE SOL,BARA ANTI OC FRACTURI ALE MEMBRELOR, DE BAZIN, LEZIUNI CRANIO ENCEFALICE MOTOCICLI TII TRAUMATISME CRANIO CEREBRALE, FRACTURI ALE MEMBRELOR, FRACTURA CLAVICULEI CU AFECTAREA PLEXULUI BRAHIAL
MECANISM DE PRODUCERE
SINDROMUL TABLOULUI DE BORD -leziuni la nivelul rotulei, genunchiului, colului femural, acetabulului MECANISMUL DE WHIP LASH - leziuni de coloan cervical CEA MAI GRAV ESTE EFRAC IA DIN VEHICOL
MECANISM DE PRODUCERE
OCUL DIRECT
R SPUNSUL METABOLIC
Faza Reflux Flux Catabolic 3-10 zile Men inerea energiei nlocuirea esuturilor pierdute Cresc: glucagonul, Cresc: met. bazal, temperatura, insulina cortisol, consumul de O2, balan azotat catecolaminele dar cu negativ rezisten la insulin Balan azotat pozitiv Hormonul de cre tere, Insulin Growth Factor Durata <24ore Rolul Men inerea volumului sangvin; catecolamine Fiziologic Hormoni
Scad: met. Bazal, temperatura, consumul de O2; vasoconstric ie, Catecolamine, Cortisol, cre te frecven a cardiac , debitul Aldosteron cardiac, proteine de faz acut
Anabolic
10-60 zile
EVOLU II NEFASTE
ARDS tulbur rile membranei capilare la nivelul alveolelor pulmonare, cu cre terea permeabilit ii i transvazarea intersti ial EMBOLIA GR SOAS tulburarea stabilit ii lichidelor circulante MSOF
TRATAMENT
ORGANIZAREA NGRIJIRILOR PRIMUL AJUTOR I TRANSPORTUL R NITULUI: SCOOP & RUN sau STAY & PLAY ORGANIZAREA CENTRULUI DE NGRIJIRE
TRATAMENT
NGRIJIRILE PROPRIUZISE:
APRECIEREA CORECT A VOLUMELOR LICHIDIENE DETERMINAREA GAZELOR RESPIRATORII APARI IA TEHNICILOR DE HIPERALIMENTA IE
AIRWAY
BREATHING
C CIRCULATION - OCUL
u or 1 Pierderea de snge (ml) / % Pulsul Tensiunea arterial Reumplerea capilar Frecven a respiratorie Starea mental Lichidul de perfuzie necesar <750 15% moderat 2 7501500 >100 Normal 30% grav 3 15002000 >120 Sc zut 40% sever 4 >2000 >40%
<100 Normal
>140 Sc zut
Normal
Pozitiv
Pozitiv
Pozitiv
14-20
20-30
30-40
>35
Anxios Cristaloid
Anxios Coloid
Confuz Snge
Letargic Snge
D DISABILITY
LEZIUNI CEREBRO SPINALE
HEMATOM SUBDURAL GLASGOW COMA SCALE INTUBA IE ORO TRAHEAL PENTRU A MINIMALIZA HIPOXIA
E EXPOSURE
MESS
Skeletal/soft tissue injury 1 Low energy (stab, simple fracture, low-velocity gunshot wound) 2 Medium energy (open or multiple fractures, dislocation 3 High-energy (close-range shotgun or high-velocity gunshot wound, crush injury) 4 Very high energy (above plus gross contamination, soft tissue avulsion) B. Limb ischemia 1 Pulse reduced or absent but perfusion normal 2 Pulseless; paresthesias, diminished capillary refill 3 Cool, paralyzed, insensate *score doubled for ischemia >6 hours C. Shock 0 Systolic blood pressure always >90 mm Hg 1 Hypotension transiently 2 Persistent hypotension D. Age 0 <30 y 1 30-50 y 2 >50 y A.