Samenvatting Omgaan met urgenties - gezondheid en maatschappij
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Course
Gezondheid En Maatschappij 3, MA2
Institution
Universiteit Gent (UGent)
Dit is een samenvatting van de lessen en PPT, alles dat je moet kennen staat er in. Als je tight-budget bent, mag je mij altijd sturen via FB en dan kunnen we een aangepaste prijs bespreken (Liana Kirkov)!
Omgaan met urgenties - gerechtelijke
geneeskunde
Inhoud
1. Algemene aanpak van urgenties ..................................................................................................... 3
1.1 ABCDE ...................................................................................................................................... 3
1.1.1 A = airway ........................................................................................................................ 3
1.1.2 B = breathing ................................................................................................................... 4
1.1.3 C = circulatie .................................................................................................................... 4
1.1.4 D = disability = neuroprotectief ....................................................................................... 5
1.1.5 E = environment, exposure ............................................................................................. 5
1.2 Monitoring en testen............................................................................................................... 5
1.3 Cruciale vragen ........................................................................................................................ 6
2. Casussen .......................................................................................................................................... 6
2.1 Septische shock ....................................................................................................................... 6
2.1.1 Casus ................................................................................................................................ 6
2.1.2 Shock ............................................................................................................................... 7
2.1.3 Take home messages shock ............................................................................................ 7
2.2 Dyspnoe dr longembolie ......................................................................................................... 8
2.2.1 Casus ................................................................................................................................ 8
2.2.2 Aanpak longembolen....................................................................................................... 9
2.2.3 Wanneer behandelen vr longembool ............................................................................. 9
2.3 CVA .......................................................................................................................................... 9
2.3.1 Casus ................................................................................................................................ 9
2.3.2 CVA ................................................................................................................................ 10
2.3.3 Take home messages CVA ............................................................................................. 10
2.4 Bell’s palsy ............................................................................................................................. 11
2.5 AO dissectie ........................................................................................................................... 11
2.5.1 Casus .............................................................................................................................. 11
2.5.2 AO dissectie ................................................................................................................... 12
2.6 Take home messages ............................................................................................................ 12
3. Intoxicatie en anafylaxie................................................................................................................ 13
3.1 Intoxicaties ............................................................................................................................ 13
3.1.1 Aanpak acute intoxicatie ............................................................................................... 13
A. Algemeen........................................................................................................................... 13
1
, B. Toxidromen ....................................................................................................................... 14
C. Toxicologische testen ........................................................................................................ 15
3.1.2 Pathofysiologie coma .................................................................................................... 15
3.1.3 Paracetamol intoxicatie ................................................................................................. 15
A. Casus .................................................................................................................................. 15
B. Antidote paracetamol ....................................................................................................... 16
C. Kliniek paracetamol intoxicatie ......................................................................................... 16
3.1.4 CO intoxicatie ................................................................................................................ 16
A. Casus .................................................................................................................................. 16
B. Pathofysiologie CO intoxicatie........................................................................................... 17
C. Kliniek CO intoxicatie ......................................................................................................... 17
D. Behandeling CO intoxicatie ............................................................................................... 17
3.1.5 Toxidroom obv opioïden ............................................................................................... 17
A. Casus .................................................................................................................................. 17
B. Typische toxische syndromen ........................................................................................... 18
3.1.6 Alcohol intoxicatie ......................................................................................................... 18
A. Casus .................................................................................................................................. 18
B. Opmerkingen alcohol ........................................................................................................ 18
3.1.7 Hypoglycemie ................................................................................................................ 19
A. Casus .................................................................................................................................. 19
B. Opmerkingen hypoglycemie.............................................................................................. 19
3.1.8 Stimulerend/sympaticomimetisch toxidroom .............................................................. 19
A. Casus .................................................................................................................................. 19
B. Behandeling stimulerend toxidroom................................................................................. 20
3.1.9 Take home messages: coma door intoxicaties .............................................................. 20
3.2 Anafylaxie .............................................................................................................................. 20
3.2.1 Symptomen anafylaxie .................................................................................................. 20
3.2.2 Differentiaal diagnose angio-oedeem ........................................................................... 21
3.2.3 Behandeling anafylaxie.................................................................................................. 21
A. Adrenaline ......................................................................................................................... 21
B. Andere ............................................................................................................................... 22
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, 1. Algemene aanpak van urgenties
• Casus: man 67j, koorts en slappe stoelgang 2d, toenemend kortademig
o VG: Crohn, totale collectomie, interstitiële pneumoniereis met residueel restrictief
longlijden, herhaalde ZH opnames
o GM: Pulimocort turbohaler, acetylcysteïne, Lasix, Emconor, Moxon
• Niet pluis gevoel
• Aanpak: ABCDEF
o Cave type 2 respiratoir falen: chronische hypercapnie → bloedstaal
o RSP = retrosternale pijn
• Vervolg
o Ph: acidemie
o Geen argumenten vr chronische metabole compensatie vr respiratoire acidose → je
mag O2 geven
o Biochemie= hyperK kan wijzen op acute nierinsuf
• Aanpak
o Slechte perfusie met redelijk goede pompfunctie → vulling 0.5l/u
▪ Voorkeur vr kleine hoeveelheden en evaluatie
▪ Fysiologisch NaCl 0.9%
• Cave hyperCl → acidose
• Bevat enkel NaCl, dus geen bloed, stollingsfactoren, andere
bloedproducten
▪ Hartmann (gebalanceerde kristalloïden met samenstelling dat meer overeen
komt met extra/intra cellulair circulerend vol)
▪ NOOIT met glucose (enkel bij hypoglycemie): osmotische diurese
o Je moet hypoglycemie en hyperK actief behandelen! De circulatie herstellen zal deze
problemen niet vanzelf oplossen!
1.1 ABCDE
• Eerste inschatting niet-pluis gevoel
o AH inspanning, bewustzijn/voorkomen en circulatie
o Triage: inschatting ernst + hoe snel moeten we reageren
• Urgentie → denk ABCDE
o Evalueren → actie → herevaluatie
o Arrest → reanimatie
1.1.1 A = airway
• Controle
3
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