CURS 2-Conduita Medicala

8/18/2019 CURS 2-Conduita Medicala

1/25

Toxicologie clinica

curs nr. 2


2/25

CONDUITA MEDICALA IN INTOXICATIILE ACUTE

1. STABILIZAREA:

EXAMINARE “SCREENING” PENTRUIDENTIFICAREA MASURILOR DE

PREVENIRE A AGRAVARII STARII

INTOXICATULUI

2. EVALUAREA COMPLETA A PACIENTULUI :

ISTORIC, EXAMEN FIZIC, TESTE DE

LABORATOR

Gaz c!"a#!$a%

GC

S&'c#!"'#( )'

"a*a + MS

Mc!ca-c(-a#!

I#'%a#a )' c(&-a'

Chromatogram Plot

File: c:\saturnws_old\data\prbio\insecticide\c. e.sms

Sample: C. E. perator: !ihai

Scan "ange: # $ %&'' Time "ange: '.'' $ ().)*.

+ate: #,(,'# ##:')

Sample -otes: rina salon CF / P01

#'' 2'' %'' 3'' ('' m,4

'5

2(5

('5

6(5

#''5

&%

*6

#2(

#6#

2#2

%22

Spect # #*.)(#min. Scan: ##%* Chan:# 7on:%'* us "7C:8P *6 9#((26(#''5; c. e.sms

#'

2'

%'

3'

minutes

'

#

2

%

!Counts

"7C all c. e. sms

metoat

!etamido


3/25

/. MASURI DE SCADERE A ABSORBTIEI TOXICULUI :

DECONTAMINARE PIELE, OC0I

DECONTAMINARE INTERNA

VOMA, SPALATURA GASTRICA

CARBUNE ACTIVAT

PURGATIVE SALINE

. MASURI PENTRU CRESTEREA ELIMINARII TOXICULUI

!+7F7C0"E0 p1 P>0S!0T7C si "7-0"

+7"E?0 F"T0T0

1E!+70>7?01E!PE"F?7E

C0"8-E 0CT7@0T SE"70T

17PE"A780"7S!

EAS0-B@7-T"0-SF?7E

P>0S!0FE"E?0

5. ANTIDOT SPECIFIC : ≈ (5 din intoxicatii

NALOXON GLUCOZA 34 TIAMINA la toti intoxicatii cu deprimare S-C

6. TERAPIE DE SUSTINERE

8SE"@0T7E

E@0>0"E PS7170T"7C0


4/25

STABILIZAREA INITIALA

08"+0"E0 S7 C"ECT0"E0

F-CT77>" @7T0>E

C07 0E"7E-E= "ESP7"0T70

C7"C>0T70

+EP"7!0"E S-C P"7- TA7CE


5/25


PRIORITATEA IC07 0E"7E-E "ESP7"0T70

@E-T7>0T7E

A7BE-0"E

8ST"CT7E:

C-BEST70 !C0SE>"= SEC"ET77

+EP>0S0"E0 PSTE"70"0 0 >7!877

C"P7 ST"07-7

SIMPTOME: C70-?0= T017P-EE= +7SP-EE=

+70F"E?0= 0>TE"0"E0 ST0"77 !E-T0>E


6/25


PRIORITATEA IISOC: CONSTIENTA ↓

TA ↓

VASOCONSTRICTIE PERIFERICA ACIDOZA METABOLICA

OLIGURIE

MECANISME:+ ↓CONTRACTILITATE, FORTA DE CONTRACTIE

$ 0IPOVOLEMIE

+ ↓PRESARCINA, ↑POSTSARCINA


7/25


PRIORITATEA IIISTAREA SNC

PUPILE

COMA

PRIORITATEA IVDECONTAMINAREA


8/25

PREVENIREA ABSORBTIEI TOXICULUI 1. DECONTAMINAREA EXTERNA

$ P7E>E: C0ST7CE= C"?7@E 0P0

7-SECT7C7+E 08-+E-T

$ C17: S>T7E S0>7-0 3$& l 2. DECONTAMINAREA INTERNA

2.1. DILUTIE: C0ST7CE= C"?7@E

%'' ml >0PTE= 0P0

CI: -ET"0>7?0"E0 C S>T77 0C7+E= "ESPECT7@

0>C0>7-E 9"E0CT7E EATE"!0;

PE-T" 0>TE T7P"7 +E TA7CE: D 08S"8T70


9/25

PREVENIREA ABSORBTIEI TOXICULUI

2.2 E!E?0 $ S7"P +E 7PEC0 $ 0P!"F7-0

$ +ETE"BE-T >7C17+ %' !>

INDICATII, EFICIENTA: >0 !0A. 3$& "E +P0 7-BEST7E7-TA7C0T> T"E0?

TA7CE +7?>@0TE 7- 17+"C0"8"7

CONTRAINDICATII: 7+"7= C70-= -7T"0T +E 0"B7-T= 0>C0>7-E= 0C7?7=17+"C0"8"7

0>TE"0"E0 C-ST7E-TE7

C-@>S77= 1E!"0B7E= 1E!0TE!E?0

TA7CE C EFECTE "0P7+E 90+T= 17-= ST"7C-7-0;

DOZA: %' ml

EFECT: #( %' min


10/25


2.% SP0>0T"0 B0ST"7C0

INDICATII: C-T"07-+7C0T77>E E!E?E7

9C!0= C-@>S77= +EP"7!0"E "0P7+0;

T7!P !0A7! 3 & "E PST7-BEST7E

S>T7E S0>7-0 2'' 2(' ml= # min= +"E-0

CONTRAINDICATII: C"?7@E

1E!"0B7E


11/25


2.3 C0"8-E 0CT7@0T 0"B!E-TE: EF7C7E-T0 "E>0T7@0 E!E?0= >0@0

EF7C7E-T0 C"ESCT0 7- P"7!0 "0

P0TE F7 P"7!0 PT7-E

INDICATII: FE-80"87T0>= TEF7>7-0= +7BA7-= -"T"7PT7>7-0=

0!7T"7PT7>7-0= !EP"80!0T= S0>7C7>0T7= -0+>>=C0"80!0?EP7-0= FE-7>8T0?-0= 8E-?+70?EP7-E=

FE-7T7-0

INEFICIENT: !ET0>E 9Fe= >i= 8o;= 0C7+ 8"7C= !0>0T7-= ++T=

C0"80!0T7= C70-"7= 0C7?7= 0>C0>7

ET0->= !ET0->= E>ECT">7T7= B>7C>7=

+7ST7>0TE +E PET">

DOZA: /5 6 155 $ 9 #' x +?0 +E TA7C;

"EPET0T= +?E SE"70TE


12/25

CRESTEREA ELIMINARII DIGESTIVE

@7TE?0 E>7!7-0"E C"ESTE: PURGATIVE OSMOTICE

SORBITOL 754, 23' ml= >0TE-T0 #.% "E

CITRAT DE MAGNEZIU 2' %' g S>.#'5= >0TE-T0 3 "E

SULFAT DE MAGNEZIU S> #'5= #( 2' g= >0TE-T0 #6 "E


13/25

CRESTEREA ELIMINARII TOXICULUI

#. !+7F7C0"E0 p1$ului P>0S!0T7C= "7-0"

2. +7"E?0 F"T0T0

%. 1E!+70>7?0

3. 1E!PE"F?70

(. C0"8-E 0CT7@0T "EPET0T

&. 17PE"A780"7S!

6. EAS0-B@7-T"0-SF?70

*. P>0S!0FE"E?0


14/25


1. MODIFICAREA pH

* 0>C0>7-7?0"E0 p1 "7-0" 7,3 6 8 87C0"8-0T +E S+7 # 2 mEG,Hg

80"87T"7CE= S0>7C7>0T7

* 0C7+7F7E"E0 p1 "7-0" 3,3 + 9

C>""0 +E 0!-7 6(mg,Hg,23 ore

p.o.= i.I. 925;

0C7+ 0SC"87C

EF7C7E-T0 !+E"0T0: FE-C7C>7+7-0= 0!FET0!7-E= C17-7+7-0=ST"7C-7-0


15/25

SNC

B0E

SANGE ALCALNIARE PLASMATICA

(BICARBONAT DE SODIU i.v.)

SNC

BHE

SANGE

FE-80"87T0> 7-7?0T -E7-7?0T

-E7-7?0T

7-7?0T-E7-7?0T

-E7-7?0T


16/25


. DIUREZA FORTATA

* 7-C0"C0"E0 C F>7+E

* +7"ET7CE: F"SE!7+=!0-7T>

*

F>A "7-0" % ( ml,Hg,ora

INDICATII: 80"87T"7CE= 8"!"7= >i=

S0>7C7>0T7= 0!FET0!7-E


17/25


!. HEMODIALIZA

* C-+7T77: $ B! J ('' +altoni $ 17+"S>87>7T0TE C"ESCT0

$ >EB0"E +E 0>8!7-E>E P>0S!0T7CE SC0?T0

$ @>! +E +7ST"78T7E !7C

* TA7CE +70>7?087>E:8"!"7= C>"0>17+"0T

ET0->= !ET0->= ET7>E-B>7C>=

0>C> 7?P"P7>7C= >i= 0C7+ S0>7C7>7C


18/25


". HEMOPERFUZIA

"EST"7CT77 J

7-+7C0T77: $ SE+0T7@ 17P-T7CE -E80"87T"7CE

$ 80"87T"7CE +E SC"T0 +"0T0

$ C>"0!FE-7C>= FE-7T7-0

$ P0"0K0T= S0>7C7>0T7= ETC>"@7->


19/25


3. CARBUNE ACTIVAT SERIAT

- "EC7"C>0T7E E-TE"1EP0T7C0 C>"0>17+"0T= FE-T70?7-E= C>C17C7-0= FE-7T7-0= +7B7TA7-0= S0>7C7>0T7= +7BA7-0= 0.+.

T"7C7C>7CE= 17+"C0"8"7 10>BE-0TE= ++T= 7?-70?7+0

&. 0IPEROXIBARISM: !-A7+ +E C0"8-= C70-"7

T#,2 C0"8A71E!B>87-0:

7- 0E" 0T!SFE"7C: 2(' min

>0 C-C.#''5 A7BE-: 36 min

17PE"A780"7S! $2=( atm : 22 min

6. EXSANGVINOTRANSFUZIA

8. PLASMAFEREZA


20/25

Clasificarea antidoturilor in functie de

mecanismul de actiune

MECANISM EXEMPLE UTILIZARE CINICA

#.0ntagonism competitiIla niIelul "

0tropina 9". muscarinic;

-aloxona 9". opiacei;

-oradrenalina 9". al


21/25

as carea an o ur or n unc e e

mecanismul de actiune

MECANISM EXEMPLE UTILIZARE CINICA

%. Chimic

c; "educerea

d; Electrostatic

0lbastru de metilen

Protamina

!ethemoglobinemie

1eparina

3. Fi4ic: dilutie 0pa 0lcaline= aci4i:ingestie

(. Fi4ico$chimic:adsorbtia Carbune actiIat Fenobarbital= etc.

&. -eutrali4are tip antigen$anticorpi

0ntiIenin Trat muscaturi de serpiIeninosi= scorpioni

6. "eactiIare en4imatica Pralidoxima=obidoxima

rgano


22/25

TE"0P70 +E SST7-E"E

SUPRAVEG0ERE CLINICA MONITORIZAREA

DEPRIMAREA RESPIRATIEI, COMA 7-T80T70 PEEP 9P"ES7-E P?7T7@0 EAP7";

P-E!-70 +E 0SP7"0T7E 0-T787TE"0P7E

EDEM CEREBRAL PRESIUNEA INTRACRANIANAD;0IPOXIE, CO<

MASURI: 0IPERVENTILATIE

TERAPIE 0IPEROSMOLARA ;MANITOL 254 5.3 6 1$=>$=/5 "< CORTICOTERAPIE FUROSEMID ;INCARCARE CU FLUIDE<

CONVULSII

DIAZEPAM 3 + 15 "$ .?.


23/25

TE"0P70 +E SST7-E"E

"EST0"0"E0 EC17>78">7 0C7+$

80?7C= E>ECT">7T7C S7 S!T7C

CIRCULATIA: C0TETE" @E-S !E-T7-E"E0 T0: C"7ST0>7?7=

S8ST7T7E-T7 P>0S!0= @0SP"ES0"E 1T0 : -7T"P"S70T '.( 2 Mg,Hg,min

+7"ET7CE


24/25

TE"0P70 +E SST7-E"E

0IPOTERMIA

TA7C0 B"0@7T0TE !E+7E N O 0"7T!77 C0"+70CE $ >7+C07-0 "E7-C0>?7"E P0S7@0= 0CT7@0

0IPERTERMIA

0-T7C>7-E"B7CE

17PE"TE"!70 !0>7B-0 7!0= 0+"E-E"B7CE

MASURI: "0C7"E A7BE- "EEC17>78"0"E E>ECT">7T7C0= 0C7+$80?7C0 T"0T0!E-T> C-@>S77>"

SINDROMUL NEUROLEPTIC 0IPERTERMIC "E>0A0"E !SC>0"0 +7"ECT0 +0-T">E- -a # mg,Hg

8"!C"7PT7-0 2.( #' mg x%,?7


25/25

TE"0P70 +E SST7-E"E

EVALUAREA PSI0IATRICA SUICIDUL EPISODIC

SINDROMUL DEPRESIV ENDOGEN

STRESS EMOTIONAL

ECONOMIC

FIZIC 6 BOLI INCURABILE

ALCOOLISM

TRATAMENT PSI0IATRIC

Documents

CURS 2-Conduita Medicala