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    Iacob Elena Alina
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    This document discusses the clinical examination of critically ill coronary patients. It emphasizes the importance of conducting a thorough examination of the patient and all related devices/tubes, as well as monitoring both clinical and machine-based signs. The patient's status should be dynamically evaluated based on initial status and changes over time. The examination involves gathering information from EMS, the emergency department, family, as well as directly examining the patient and related equipment/tubes. A multidisciplinary team approach is needed. Hemodynamic profiles and rapid hemodynamic status assessment are also reviewed.

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    This document discusses the clinical examination of critically ill coronary patients. It emphasizes the importance of conducting a thorough examination of the patient and all related devices/tubes, as well as monitoring both clinical and machine-based signs. The patient's status should be dynamically evaluated based on initial status and changes over time. The examination involves gathering information from EMS, the emergency department, family, as well as directly examining the patient and related equipment/tubes. A multidisciplinary team approach is needed. Hemodynamic profiles and rapid hemodynamic status assessment are also reviewed.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    9 views12 pages

    Examinarea Clinica

    Uploaded by

    Iacob Elena Alina
    This document discusses the clinical examination of critically ill coronary patients. It emphasizes the importance of conducting a thorough examination of the patient and all related devices/tubes, as well as monitoring both clinical and machine-based signs. The patient's status should be dynamically evaluated based on initial status and changes over time. The examination involves gathering information from EMS, the emergency department, family, as well as directly examining the patient and related equipment/tubes. A multidisciplinary team approach is needed. Hemodynamic profiles and rapid hemodynamic status assessment are also reviewed.

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    of 12

    Examinarea clinic a pacientului coronarian critic

    Antoniu Petris MD, PhD


    St. Spiridon Hospital Iasi, Romania UMF Gr. T. Popa Iasi, Romania

    Devicemania Devicefilia

    We repeatedly enlarge our instrumentalities without improving our purpose.


    Will Durant

    1. Pacientul nu este un preparat cord cord-pulmon!

    2. Examineaza tot ! Inclusiv sondele, tuburile, cablurile, drenurile ce vin sau pleaca din pacient pacient. .

    3.

    Echilibrul pacientului depinde de echilibrul medicului: medicului : asigura un raport just intre monitorizarea cu masina si cea clinica!

    4. Evaluarea va fi dinamica dinamica: : statusul initial si modificarile ulterioare ulterioare. .


    More is missed by not looking than by not knowing
    Anonim, din Hillman K et al, 2002

    5. Pacientul nu este un sumar de numere pe un ecran!

    6. E o munca de echipa!

    Armstrong BP et al Emerg Med J 2008: 25: 790-791

    ANAMNEZA

    Date de pe ambulanta Date din UPU Date de la familie/ martori

    DIFICILA
    Evolutia bolii Rezerva functionala

    Severitatea comorbiditatilor Punga cu medicamente QL inainte de internare Atitudinea referitoare la final

    EXAMINARE

    mediata (ochelari, manusi) pacient si anexe diagnostic nonnon-verbal

    DIFICILA

    SEMNE

    SIMPTOME

    Examineaza tot ce intra (lichide, alimente medi medicamente) si tot ce iese (urina, scaun, secretii, sputa etc) din pacient !

    ABECEDAR ICCU

    (Cai) Aeriene

    Gut (Tub digestiv)

    B
    C D E F

    Breathing

    H
    I L M N

    Hematologie

    Circulatie

    Infectie

    Disabilitati

    Linii venoase

    Electroliti

    Medicatie

    Fluide

    Neamuri (contact zilnic)


    Hillman K et al, 2002

    Profiluri hemodinamice in SCA

    TAS (mmHg) Normodinamic Hiperdinamic Hipertonie vagala Hipovolemie IMA de VD Insuficienta VS Soc cardiogen N (> 140) (< 95) (< 95) (< 95) N / (< 95) (< 95)

    FC (bpm) N (> 100) (> 60) (> 100) (> 100) (> 100) (> 100)

    Tegumente calde calde calde calde reci reci reci

    Cianoza +++ -/+ +++

    Jugulare N N N

    Evaluarea rapida a statusului hemodinamic


    o evaluare de 2 minute la patul bolnavului
    SUBSETURI HEMODINAMICE IN ICA
    PERFUZIA IN REPAUS

    A
    W-D

    B
    W-W

    L (low)
    C-D

    C (complex)
    C-W

    CONGESTIE IN REPAUS

    Clasificarea Stevenson

    dupa Nohria A et al. J Cardiac Failure 2000;6:64

    The secret in the care of patient is in caring for the patient.


    Peaboy FW

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