Dit document is een volledig uitgetypt document van de lessen van Prof. Sabbe gegeven in . Het bevat ook de info uit de slides. Met dit document, hoef je niet meer naar de les te gaan en slaag je zeker voor het examen!
Inhoud
Examen...................................................................................................................................................6
Wat is EHBO?..........................................................................................................................................6
Oorzaken van de mortaliteit van de cel..................................................................................................7
1. Door een direct efect op de cel.....................................................................................................7
2. Zuurstofschuld (zie verder).............................................................................................................7
3. Signalisate......................................................................................................................................7
Hoe komt de zuurstof uit de lucht in de longen?....................................................................................7
1. Zuurstof in de atmosfeer................................................................................................................7
2. De vrije luchtweg............................................................................................................................8
3. Difusie O2: van longblaasjes naar capillair.....................................................................................9
4. Zuurstof in de alveolen of longblaasjes..........................................................................................9
5. O2 in het bloed: Hemoglobine.........................................................................................................9
6. De circulate..................................................................................................................................11
7. Difusie naar en in de cel...............................................................................................................11
Evaluate van de noodsituate..............................................................................................................12
1. Verkenning van de omgeving.......................................................................................................12
1.1. Read the scenery...................................................................................................................12
2. Beoordelen van het slachtofer of de ziekte.................................................................................12
2.1. De eerste beoordeling...........................................................................................................12
2.2. De tweede beoordeling.........................................................................................................14
Medische urgentes door ziekten of omgevingsfactoren......................................................................16
1. Stoornissen van het bewustzijn....................................................................................................16
1.1. Algemeen O2-verlies...............................................................................................................16
1.2. Hypoglycemie........................................................................................................................16
1.3. Syncope.................................................................................................................................16
1.4. Epilepsie.................................................................................................................................17
1.5. Cerebro-vasculair accident (CVA)...........................................................................................18
2. Stoornissen van de ademhaling....................................................................................................19
2.1. Problemen bij het inademen.................................................................................................19
2.2. Problemen bij het uitademen................................................................................................19
2.3. Respiratoir falen....................................................................................................................20
2.4. Ventlatoir falen.....................................................................................................................20
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3. Stoornissen van de circulate........................................................................................................21
3.1. Longembool...........................................................................................................................21
3.2. Angor en acuut myocardinfarct.............................................................................................22
4. Bloeding........................................................................................................................................23
4.1. Inwendig................................................................................................................................23
4.2. Uitwendig..............................................................................................................................23
5. Brandwonden...............................................................................................................................24
5.1. Thermische brandwonden.....................................................................................................24
5.2. Chemische brandwonden.....................................................................................................24
6. Verdrinking...................................................................................................................................25
6.1. De nate verdrinking..............................................................................................................25
7. Elektrocute...................................................................................................................................26
8. Allergische reactes.......................................................................................................................26
9. Pijn................................................................................................................................................27
Wonden en verbandmaterialen...........................................................................................................29
1. Soorten verwondingen.................................................................................................................29
1.1. De schaafwonde....................................................................................................................29
1.2. De snijwonde.........................................................................................................................29
1.3. Een scheurwonde..................................................................................................................29
1.4. Een steekwonde....................................................................................................................29
1.5. Een schotwonde....................................................................................................................29
1.6. Een bijtwonde........................................................................................................................30
1.7. Een injectewonde door vloeistofen onder hoge druk..........................................................30
2. Wondheling..................................................................................................................................30
2.1. Hemostase en coagulatefase................................................................................................30
2.2. Infammate............................................................................................................................30
2.3. Angiogenese..........................................................................................................................30
2.4. Fibroproliferate.....................................................................................................................31
2.5. Litekenvorming.....................................................................................................................31
2.6. Epithelialisate........................................................................................................................31
2.7. Liteken remodeling...............................................................................................................31
3. Ontsmetngsmiddelen.................................................................................................................31
3.1. Defnites................................................................................................................................31
3.2. De factoren die de kracht van het antseptcum bepalen......................................................31
, 3
3.3. Ontsmetngsmiddelen..........................................................................................................32
4. Verbandmateriaal: wondverbanden.............................................................................................32
4.1. Kompressen...........................................................................................................................33
4.2. Wondverbanden die niet in de wonde kleven.......................................................................33
4.3. Wondverbanden met actef bestanddeel..............................................................................33
5. Verbandmateriaal: beschermende en absorberende (tussen)lagen.............................................34
5.1. Doel.......................................................................................................................................34
5.2. Waten...................................................................................................................................34
6. Verbandmateriaal: zwachtels.......................................................................................................34
6.1. Fixatezwachtels.....................................................................................................................34
6.2. Drukzwachtels........................................................................................................................34
6.3. Tubulaire verbanden..............................................................................................................34
6.4. Immobilisatezwachtels.........................................................................................................34
7. Verbandmateriaal: gipsverbanden...............................................................................................35
7.1. Gehydrateerde calciumsulfaat zwachtels (klassiek)...............................................................35
7.2. Synthetsche gipsverbanden..................................................................................................35
8. Verbandmateriaal: kleefpleisters..................................................................................................35
8.1. Textelstofen.........................................................................................................................35
8.2. Nonwoven kleefpleisters.......................................................................................................35
8.3. Kunststof kleefpleister...........................................................................................................35
8.4. Nonwoven fxatepleister.......................................................................................................35
8.5. Synthetsche fxatefolie.........................................................................................................35
8.6. Wondhechtende pleisters......................................................................................................36
9. Verbandmateriaal: speciale verbanden........................................................................................36
9.1. Wondzorg..............................................................................................................................36
9.2. Alginaatverbanden.................................................................................................................36
9.3. Hydroacteve verbanden........................................................................................................36
Intoxicates en vergifigingen................................................................................................................37
1. Inleiding........................................................................................................................................37
1.1. Aard van de intoxicate..........................................................................................................37
1.2. Een medicateoverdosis.........................................................................................................37
1.3. Incidente...............................................................................................................................37
1.4. Toxische stofen.....................................................................................................................37
1.5. Intoxicates die een metabole acidose veroorzaken..............................................................37
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1.6. Een toxidroom.......................................................................................................................37
1.7. Indicates voor een intoxicate...............................................................................................37
2. Klinisch onderzoek........................................................................................................................38
2.1. Centraal zenuwstelsel............................................................................................................38
2.2. Pupildiameter........................................................................................................................38
2.3. Ademhaling............................................................................................................................39
3. De verschillende toxidromen........................................................................................................41
3.1. Het antcholinerge toxidroom................................................................................................41
3.2. Het cholinerge toxidroom (↔ antcholinerg toxidroom)......................................................41
3.3. Het extrapyramidale toxidroom............................................................................................42
3.4. Het sympathomimetsche toxidroom....................................................................................42
3.5. Morfnomimetsch toxidroom................................................................................................42
3.6. Sedatva en hypnotca............................................................................................................42
3.7. Derving op alcohol of sedatva...............................................................................................42
3.8. Het salicylaat toxidroom........................................................................................................42
3.9. Het serotonerg toxidroom.....................................................................................................42
4. Toxidroom pitalls.........................................................................................................................43
4.1. Geen toxidroom ≠ geen intoxicatee......................................................................................43
4.2. Meerdere toxines ingenomen...............................................................................................43
4.3. Ongeval of ziekte in combinate met toxine..........................................................................44
4.4. Toxidroom maar we missen een symptoom of er is een tegenstrijdig symptoom................44
5. Diagnostsch protocol...................................................................................................................44
5.1. Biochemische evaluate.........................................................................................................44
5.2. Beeldvorming.........................................................................................................................46
5.3. Elektrofysiologie....................................................................................................................47
6. Het therapeutsche protocol.........................................................................................................47
6.1. Supporteve therapie.............................................................................................................47
6.2. Reducte van absorpte..........................................................................................................47
6.3. Eliminate bevorderen...........................................................................................................49
6.4. Antdota.................................................................................................................................49
6.5. Psychosociale bijstand...........................................................................................................50
Casussen...............................................................................................................................................51
1. CASUS 1........................................................................................................................................51
2. CASUS 2........................................................................................................................................51
Examen
Mondeling, max 6-7 min, zonder schrifelijke voorbereiding
Praktsche kennis e (bv: stuipen, zak met drugs (wat is het?), tante met pijn op borst
(snuif lijntjes),…)
Wat is EHBO?
Eerste hulp is de urgente-geneeskunde
Indien we niet onmiddellijk zouden behandelen treden 1 of meerdere van volgende
zaken op:
o Morbiditeit
o Invaliditeit
o Mortaliteit
↓
Het is belangrijk dat we snel weten waarover het gaat.
, 7
Oorzaken van de mortaliteit van de cel
1. Door een direct effect op de cel
a. Mechanisch
Bv. een crush syndroom wanneer iemand bedolven zit onder het puin na een
zware aardbeving, een been breken bij het skiën
Miljoenen cellen van het menselijke lichaam sterven af.
b. Toxisch
Bv. Meer water drinken dan men kan urineren, het eten van een bepaald gif
c. CBRNE : chemisch biologisch radiologisch nucleair efecc
2. Zuurstofschuld (zie verder)
De balans tussen zuurstofvraag en zuurstofaanbod is verstoord : vraag >>> aanbod
Cumulateve zuurstofschuld : de zuurstofschuld wordt steeds erger aangezien vraag
>>> aanbod
↓
Leidt mogelijks tot een “punt of no return” ( dan gaat de cel dood) het is belangrijk
dat de zuurstofschuld tjdig herkend wordt.
De hersenen en het hard kunnen geen zuurstofschuld aan.
3. Signalisatie
Het ontstaan van kankercellen door het wegvallen van de signalisate tussen de
cellen.
Signalisate rond infammate
Hormoonsignalisate
De zuurstofschuld
aeroob metabolisme
( aanwezigheid O2)
ATP :
homeostase
biosynthese
cellen met specifeke functe
anaeroob metabolisme
(tjdelijke afwezigheid van O2)
Hoe komt de zuurstof uit de lucht in de longen?
1. Zuurstof in de atmosfeer
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