Summary
Samenvatting week 6 Opmaat
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Samenvatting van week 6 van het blok Opmaat naar de praktijk. Bevat zowel college-aantekeningen als studiestof vanuit de ZSA's.
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By: tyrama-ajong • 6 months ago
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Week 6 – OpmaatPC Tweede lijn trauma-opvang
Epidemiologie letsels
- 2 miljoen SEH-bezoeken
o 659.000 in verband met letsel
▪ 95% ongeval (prive, sport, werk)
▪ 5% geweld of zelfbeschafiging
o 8671 personen overleden tgv letsel
- Van de ongevalsletsels:
o 3560.000 prive-ongevallen
o 124.000 verkeersongevallen
o 112.000 sport
o 46.000 arbeid
- Bij potentieel gevaarlijk letsel proberen deze zo gestructureerd mogelijk op te vangen.
o ATLS = advanced trauma life support
▪ Initial assessment
▪ Preparation and triage
▪ Primary survey
▪ Resuscitatoin
▪ Adjuncts to primary survery and resuscitation
▪ Condiser need for patient transfer
▪ Secondary survey
▪ Adjuncts to secondary survey
▪ Continued postresuscitatoin monit oring and reevaluatoin
▪ Definitive care
Primary survey
A= airway & CWK immobilisatie
- Geen chin lift bij CWK-letsel
- Bewustzijn, braken, bloeding: aspiratie
- Aangezichts-halsletsel, CWK-letsel, traumamechanisme
, - LO: agitatie (hypoxie), sufheid (hypercapnie), ademhalingsarbeid, geluiden bij ademhaling,
trachea midline, uitwendig letsel, CWK-drukpijn
B= breathing en ventilation
- Thorax uitwendig letsel, drukpijn, crepiteren, ademgeruis symmetrisch, kleur
- Big five= acuut levensbedreigende thoraxletsels
o Open Pneumothorax
o Spanningspneumothorax (thoraxdrain)
o Fladderthorax (met longcontusie)
▪ Behandeling is ondersteunend
▪ Pijnstilling, zuurstof, non-invasieve ventilatie
▪ Eventueel beademing of operatief herstel
o Massale hematothorax
▪ Tachycardie, hypotensie, hypoxie, verminderd AG
▪ Behandeling: traunsfusie, thoracotomie
▪ Wit op de foto is geen lucht, dus vocht (niet te zien welk vocht, wel
beredeneren)
o Harttamponade
▪ Zachte cortonen, hypotensie, uitgezette halsvenen
▪ Pericardeffusie/effusie → tentvormig hart op x-thorax
▪ Behandeling: vloeistofresuscitatie, pericardiocentese, thoracotomie met
operatief herstel
▪ Te zien met echo-fast
C= circulation with hemorrhage control
- Externe verwondingen
o Directe druk altijd eerst
o Zo mogelijk tourniquet
o Opstoppen wond (pachking, gaas)
o Meeste bloedverlies uit bekken (>2000
mL), daarna humerus (1500 ml)
- Organen meest frequent:
o Milt: 40-50%
o Lever: 35-45%
o Dunne darm: 5-10%
o Retroperitoneaal hematoom: 15%
- Trauma mechanisme
o Stomp: direct/ crush/ verscheuring
o Penetrerend: lever 40%, dunne darm 30%,
diafragma 20%, colon 15%
- Shock:
o Obstructief= spanningspneumothorax, harttamponade
o Cardiogeen= myocardcontusie
o Neurogeen= ruggenmergletsel
o Septisch= preexistent
D= diasability
- Uitwendig letsel hoofd, EMV-score, pupillen (PEARL), kort neurologisch onderzoek
E= exposure/ environment
,Adjuncts to primary survey and resuscitation
- X-thorax, dan X-bekken en echo-fast
- CT-blanco hoofd (CT-brein) → bloed hyperdens
o Epiduraal/subduraal hematoom
o Massawerking, ventrikelsysteem, sulci
- CT-CWK
- CT-whole body
- (ECG)
Damage control surgery
Vloeistoffen bij trauma
- Permissive hypotension tot definitieve behandeling
- Bloedproducten 1:1:1
o Erytrocyten
o FFP (fresh frozen plasma)
o Trombocyten
- Geen of minimaal cristalloid/ colloïd toediening
Secundary survey
- Zo nodig aanvullende onderzoeken
, Take home
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