Secvlili cnobierebis done

Dr. Christy Keyes and Dr. Satta Massaquoi

Emory University Department of Emergency Medicine
Slightly modified by N. Kvachadze
miznebi
1.Secvlili cnobierebis gansazRvra;
2.paTfiziologiuri safuZvlebis gadaxedva;
3.cnobierebis cvlilebis mizezebis
gadaxedva;
4.aseTi pacientebisadmi sistematizirebuli
midgomis Camoyalibeba;
5.SemTxvevebis ganxilva;
gansazRvreba

• cnobiereba Sedgeba RviZilisa da

kognitiuri funqciebisagan
• Secvlili cnobierebis done gulisxmobs
cnobierebis ama Tu im xarisxiT
daTrgunvas
cnobierebis doneebi
• Zilianoba
• ara-paTologiuri mdgomareobaa, pacienti iRviZebs, cnobiereba naTelia
• leTargiuloba
• iRviZebs CaZaxilze, yuradReba daqveiTebulia
• stupori
• iRviZebs Zlieri gaRizianebis sapasuxod, magram sityvieri da motoruli
aqtivoba Zlier Semcirebulia;
• koma
• ar aRiniSneba pasuxi sityvier da mtkivneul gaRizianebze (dazianebulia
tvinis Rero an orive hemisfero);
• fsiqogenuri koma
• ara kontaqturia, magram normaluri EEG Ti da fizikuri gasinjviT. Aaris
gamoricxvis diagnozi;
 aRmavali retikuluri gamaaqtivebeli
sistema (ARAS)
• ARAS pasuxismgebelia
RviZilis doneze
• ARAS atarebs impulsebs
Tavis tvinis qerqamde;
• ARAS -is disfunqciis dros
impulseბi ver aRweვს
Tavis tvinis qerqamde;
 Secvlili mentaluri statusis mizezebi
• “TIPS/AEIOU”
• T:
• trauma, toxins, tumor,temperature
• I:
• infection, intussuception, insulin
• P:
• Psychiatric, Pain (ischemic), porphyria
• S:
• seizure, stroke, subarachnoid, snake bite,
space occupying
• A:
• alcohol, , acid-base disorders, arrythmia
• E:
• endocrine, exocrine, electrolytes,
encephalopathy
• I:
• insulin, intracerebral vascular disorders
• O:
• Opiates, overdose
• U:
• uremia
 Secvlili mentaluri statusis mizezebi

1. sasicocxlo parametrebis
darRvevebi (ABC’s)
2. toqsiuri
3. metaboluri
4. infeqciuri
5. struqturuli
6. fsiqiatriuli
 miznebi

• swrafi Sefaseba da stabilizacia

• sicocxlisaTvis saSiSi Seqcevadi mizezebis
identificireba da mkurnaloba
 Yyvela pacientTan
• rogor gamoiyureba?
• ABC (C cirkulacia da c-collar)
• NGT? ( Naloxone, Glucose, Thiamine)
• 5 sasicocxlo parametri: BP, HR, RR,
Temp, O2 sat
• The Opener: IV, O2, O2 sat, monitorze
SeerTeba, EKG
• moaxdineT sasicocxlo parametrebis
koreqcia!
AMPLE
• Allergies
• Medications
• PMH: Past Medical History
• Last oral intake
• Events leading up to presentation
 swrafi Sefaseba da stabilizacia
• ABCDE
• Naloxone, Glucose, Thiamine
• saWiroa Tu ara opener? IV, O2, O2 sat,
monitoringi;
• gasinjva
• anamnezis Ddetaluri Segroveba;
• Lლab. da rადიologiuri gamokvlevebi
 istoria
• Tavis tkivili, gulyra, cxeleba, mxedvelobis
gauaresეba, alkoholis da medikmentebis
gamoyeneba, travma;
• PMHx.- Saqriani diabeti, gulyra, hipertenzia,
Tiroiduli daavadeba, insulti, simsivne,
RviZlisa da Tirkmelebis daavadebebi;
• Mmedikamentebi, alergiebi, axლაd
gadatanili operaciuli Careva;
 gasinjva
• sasicocxlo parametrebi
• travmis niSnebi
• sunTqva: amonasunTq haerSi alkoholis suni
• respiracia: xixini, krepitacia
• guli: Suili, xaxuni
• muceli: asciti, masefeqti
• neiro: GCS, gugebi, metyveleba, mxareoba; kisris
kunTebis rigidoba, araTanabari gugebi
• kani: diaforezi, sifermkrTale, siyviTle, peteqiebi, post.op.
iara, nemsis naCxvleti;
 GCS
Tvalebi verbaluri pasuxi motoruli funqcia

Spontaneously-4 Oriented-5 Obeys-6

To verbal-3 Confused/disoriented-4 Localizes pain-5

To pain-2 Inappropriate or Withdraws from

nonsensical-3 pain -4
No response-1 Moans/Incomprehensible Decorticate
sounds-2 (flexion) –3
No response-1 Decerebrate
(extenstion) –2
No response-1
 diagnostikuri kvlevებi
diagnostikuri kvlevebi emyareba gasinjvis
monacemebs da mdgomareobis gamomwvev
savaraudo mizezs

•sasicocxlo parametrebis darRvevebi

•toqsiur/metboluri
•infeqciuri
•struqturuli
 marTva
• ABC
• moaxdineT metabolurი mizezების-acidozis
koreqcia; ivaraudeT Tiroiduli Stormi, adrenerguli
ukmarisoba, miqsedemuri koma
• moaxdineT toqsinebis eliminacia, mieciT antidoti
• infeqciis dros adreul etapze gamoiyeneT antibiotiki
• qirurgiuli Careva – saWiroebis mixedviT
 dispozicia
• pacientTa umetesoba saWiroebs hospitalizacias
• gamonakliss warmoadgens: isulin inducirebuli
hipoglikemia, mcire intoqsikaciebi, gulyra
epilefsiis mqone pacientSi
• normaluri cnobierebis donis dabrunebis Semdeg,
Tu gamomwvevi substanciis moqmedebis
xangrZlivoba aRemateba antidotisas (mag.
metadoni, oraluri hipoglikemiuri saSualebებi),
pacienti saWiroebs hospitalizacias;
 kiTxva #1
• tyian adgilas naxeT 56w ugono mamakaci, mis gverdiT
SeniSneT mkvdari ZaRli; pacientis daTvalierebisas mis
sxeulze SeamCnieT Semdegi kvali da varaudobT, rom
mdgomareobis gamomwvevi mizezi aris:
 . kiTxva #1
• a.       cianidi
• b.       mJava xsnari
• c.       mcenareTa sasuqis mofrqveva
• d.       mexis dacema

Mmexis dacemis Semdeg kanis dazianebisaTvis

paTognomuria e.w. lixtenbergis figuris arseboba. es aris
kanis zedapiruli dazianebis Sedegi da ukuviTardeba
24sT-is ganmavlobaSi. lixtenbergis figuriT komatozur
mdgomareobaSi myof pacients unda vumkurnaloT,
rogorc mexiT dazianebuls.
 avtosagzao SemTxveva
• 65 w mamakaci moyvanil iqna 112-is
mier avtosagzao SemTxvevis adgilidan,
kisris malebi imobilizirebulia, ugonoa;
sasicocxlo niSnebia: BP=155/100, P=55,
RR=18, T=36.9, O2 =100% niRbiT
 SemTxveva #1
• A:gamavalia, sekretis gareSe
• B: Rrma, neli respiraciebi
• C: pulsi normaluri avsebis
• D: gugebi zomieri, fotoreaqcia+;
Tvalebs ar axels, gamRizianebels
iSorebs, Rmuis, GCS?
• E: patara hematoma marj
frontalur areSi
 ras gaakeTebT?
• IV
• O2
• monitorze: sinusuri taqikardia - 110
• Accucheck: 42, 1 amp D50W –
pacients cnobiereba ubrundeba;
• Semdeg?
 gasinjviT
• VS: BP=155/100, P=55, RR=18, T=36.8
• ზeდა sasunTqi gzebi gamavalia
• kiseri imobilizirebulia-deformaciis gareSe
• gulmkerdi-travmis niSnebis gareSe
• guli – normis farglebSi
• muceli – rbili, daWimulobisa da
mtkivneulobis gareSe
• kidurebi – travmisa da deformaciis gareSe
 dif diagnozi
• sasicocxlo parametrebis • infeqcia
gadaxrebi • struqturuli
• Aაriტmia • subaraq, subdur, epidur
• toqsinebi hematomebi
• alkoholi • insulti
• medikamentebi
• fsiqiatriuli
• metaboluri
• ar aris gamoricxuli
• hipoglikemia
ra gamokvlevebs
vakeTebT?
 diagnozi
• epiduruli hematoma
• qmedebebi?
• intubacia, sawolSi
Tavis wamoweva,
manitoli, n/qirurgis
konsultacia
• mkurnaloba
• qirurgiuli Careva
 SemTxveva #2
• 85w qali moyvanilia
ojaxis wevrebis mier;
maTi gadmocemiT,
pacienti ar iqceva
normalurad; av-fi zis
mSvidad, distresi
gamoxatuli ar aris.
sasicocxlo parametrebia:
BP 100/75, P=100,
RR=14, T=38.2, O2 sat
93%
 SemTxveva #2
• A= gesalmebaT,
ambobs, rom araferi
awuxebs;
• B= norma
• C= kargi avsebis pulsi
• D= kontaqturia
 anamnezi
• axloblebis gadmocemiT, dRes pacients
aReniSneboda uneblie Sardvis kvali, iyo
leTargiuli, uxalisod pasuxobda kiTxvebs;
elaparakeboda gardacvlil das; amJamad
acxadebs, rom araferi awuxebs.
 gasinjva
• BP=100/75, P=100,
RR=14, T=38.2
• zogadad: kontaqturia,
GCS 14 kani Tbili da
mSralia, gamonayari ar
aRiniSneba
• gulmkerdi da muceli - N
 dif diagnozi
• sasicocxlo parametrebis • infeqcia
darRvevebi • pnevmonia
• toqsiuri • meningiti
• alkoholi • saSarde gzebis
• medikamentebi • struqturuli
• metaboluri • simsivne
• acidozi
• tvinis abscesi
• Eეleqtr. disbalansi
• insulti

ra testebi CavataroT?
 diagnozi da mkurnaloba
• Ua= nitriti dadebiTi, eriTtocitebi, WBC=20-30
• Chem= BUN-30, Cr-1.5
• CXR= uaryofiTi
• WBC=12, formulaSi marcxniv gadaxriT;

diagnozi?
• saSarde gzebis infeqcia
• mkurnaloba?
• i/v siTxeebi, antibiotikebi, hospitalizacia
kiTxvebi?