AATTEENNDDIIMMEENNTTOO IINNIICCIIAALL 
AAOO PPOOLLIITTRRAAUUMMAATTIIZZAADDOO 
Dr. PEDRO CUELLAR 
MESTRE EM CIRURGIA 
UFT-2...
AAtteennddiimmeennttoo IInniicciiaall aaoo 
PPoolliittrraauummaattiizzaaddoo 
O TRAUMA É UMA DOENÇA DE 
GRAVIDADE VARIÁVEL...
AAtteennddiimmeennttoo IInniicciiaall aaoo 
PPoolliittrraauummaattiizzaaddoo 
A BUSCA DA QUALIDADE NA ASSISTÊNCIA 
AO POLI...
Atendimento Inicial ao 
Politraumatizado 
PPOOLLIITTRRAAUUMMAATTIIZZAADDOO 
O traumatizado deve ser considerado como 
um p...
Atendimento IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo 
MMoorrttaalliiddaaddee 
 PRIMEIRA GUERRA MUNDIAL(TRANSP...
Atendimento Inicial ao Politraumatizado 
Distribuição Trimodal da Mortalidade 
400 
350 
300 
250 
200 
150 
100 
50 
0 
M...
Distribuição TTrriimmooddaall ddaa MMoorrttaalliiddaaddee 
MMoorrtteess iimmeeddiiaattaass:: TTCCEE 
ttrraauummaa rraaqquu...
OO IInníícciioo 
““AA ppaarrttiirr ddoo mmoommeennttoo eemm qquuee oo aatteennddiimmeennttoo pprreessttaaddoo nnoo 
lloocc...
TTrraauummaa 
Principal causa de morte nnaass pprriimmeeiirraass 4 
ddééccaaddaass 
ddee vviiddaa 
EEUUAA:: 6600 mmiillhhõ...
Avaliação e Atendimento Inicial 
OObbjjeettiivvooss 
· AApplliiccaarr ooss pprriinnccííppiiooss ddoo eexxaammee pprriimmáá...
Atendimento IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo 
OObbjjeettiivvooss 
1-Identificar a sequência e as etapa...
Atendimento IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo 
OObbjjeettiivvooss 
5-Entender a necessidade de realizar...
AAtteennddiimmeennttoo 
-- FFaassee PPrréé--HHoossppiittaallaarr -- 
OObbjjeettiivvooss 
· CCoonnttrroollee ddaass vviiaas...
AAtteennddiimmeennttoo 
-- FFaassee IInnttrraa--HHoossppiittaallaarr -- 
PPrreeppaarraaççããoo 
· OO ppllaanneejjaammeenntt...
AAtteennddiimmeennttoo 
-- FFaassee IInnttrraa--HHoossppiittaallaarr -- 
PPrreeccaauuççõõeess--ppaaddrrããoo 
· ÓÓccuulloos...
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
EExxaammee PPrriimmáárriioo 
Vias aéreas com proteção ddaa ccoolluunnaa cceerrvviiccaall 
RReessppiirraaççããoo // vveenntt...
Exame Primário 
TTrraabbaallhhoo 
TTrraabbaallhhoo 
ddee 
EEqquuiippee 
ddee 
EEqquuiippee
A VViiaass AAéérreeaass // PPrrootteeççããoo ddaa CCoolluunnaa CCeerrvviiccaall 
Estabelecer e manter a permeabilidade ddaa...
Exame Primário 
RReessppiirraaççããoo // vveennttiillaaççããoo // ooxxiiggeennaaççããoo 
B 
Avaliar e garantir ventilação ee ...
Exame Primário 
CCiirrccuullaaççããoo // ccoonnttrroollee ddaa hheemmoorrrraaggiiaa 
C 
Parar o sangramento ee rreessttaauu...
D E Incapacidade, Essttaaddoo nneeuurroollóóggiiccoo 
AAvvaalliiaaççããoo NNeeuurroollóóggiiccaa Baassaall 
· EEssccaallaa ...
Exame Primário 
E Exposição // CCoonnttrroollee ddoo aammbbiieennttee 
DDeessppiirr ccoommpplleettaammeennttee oo ppaaccii...
MMeeddiiddaass AAuuxxiilliiaarreess aaoo EExxaammee PPrriimmáárriioo 
Sinais Vitais 
Eletrocardiograma Gasometria arterial...
MMeeddiiddaass AAuuxxiilliiaarreess aaoo EExxaammee PPrriimmáárriioo 
Procedimentos DDiiaaggnnóóssttiiccooss 
· RRXX ttóór...
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
Reanimação 
OObbjjeettiivvooss 
· PPrrootteeggeerr ee ggaarraannttiirr aa ppeerrmmeeaabbiilliiddaaddee ddaass vviiaass aaé...
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
Reavaliação 
Vias aéreas com proteção ddaa ccoolluunnaa cceerrvviiccaall 
RReessppiirraaççããoo // vveennttiillaaççããoo // ...
CCoonnssiiddeerraarr TTrraannssffeerrêênncciiaa 
PPrriinnccííppiiooss 
· NNããoo rreettaarrddaarr aa ttrraannssffeerrêênncc...
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
História 
e exame físico 
completos 
EExxaammee SSeeccuunnddáárriioo 
T TTTuuuubbbboooossss e eee d dddeeeeddddoooossss e ...
EExxaammee SSeeccuunnddáárriioo 
TTrraattaammeennttoo ddaa DDoorr 
· Alívio da dor / ansiedade, conforme apropriado 
· Adm...
QQuuaannddoo rreeaalliizzaarr oo eexxaammee sseeccuunnddáárriioo?? 
Após: 
· Ter completado o exame primário 
· Ter reaval...
Medidas AAuuxxiilliiaarreess aaoo EExxaammee 
SSeeccuunnddáárriioo 
Procedimentos diagnósticos especiais 
(conforme indica...
EExxaammeess SSeeccuunnddáárriiooss 
 Mecanismos do trauma: 
a) mecanismos de lesão. 
 História do paciente. 
 Exame fí...
AAtteennddiimmeennttoo IInniicciiaall
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
Reavaliação 
Vias aéreas com proteção ddaa ccoolluunnaa cceerrvviiccaall 
RReessppiirraaççããoo // vveennttiillaaççããoo // ...
Conceitos da Avaliação Inicial 
EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo 
MMeeddiiddaass 
AAuuxxiilliiaarrees...
TTrraannssffeerrêênncciiaa ppaarraa TTrraattaammeennttoo 
DDeeffiinniittiivvoo 
Que pacientes devem sseerr ttrraannssffeer...
TTrraattaammeennttoo DDeeffiinniittiivvoo 
 TCE. 
 TRAUMA CERVICAL. 
 TRAUMA TORÁCICO. 
 TRAUMA ABDOMINAL. 
 TRAUMA R...
Registro, Considerações Legais 
· Documentação concisa, eemm oorrddeemm ccrroonnoollóóggiiccaa 
· CCoonnsseennttiimmeenntt...
EExxaammee TTeerrcciiáárriioo 
 Lesões despercebidas varia de 9 a 65%. 
 O exame deve ser realizado em ate 24 horas após...
AAtteennddiimmeennttoo IInniicciiaall
BBiibblliiooggrraaffiiaa 
 SABISTON, DAVID C. TRATADO DE CIRURGIA: AS BASES 
BIOLÓGICAS DA PRÁTICA CIRÚRGICA MODERNA. 16....
É impossível ppaarraa uumm hhoommeemm 
aapprreennddeerr aaqquuiilloo qquuee eellee aacchhaa qquuee jjáá 
ssaabbee.. 
((EEp...
19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar
19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar
19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar
19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar
19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar
19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar
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19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar

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Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar

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  • 1-2Objectives
    The instructor should review the objectives with the students as provided on the slide.
    The instructor should emphasize that ATLS has a unique language, including such terms as primary and secondary survey, ABCDEs, definitive care, etc. Those who complete the course speak the same language, and thereby communicate more effectively.
    Each objective appears with a mouse click, the preceding item dims as the next one appears.
  • 1-2Objectives
    The instructor should review the objectives with the students as provided on the slide.
    The instructor should emphasize that ATLS has a unique language, including such terms as primary and secondary survey, ABCDEs, definitive care, etc. Those who complete the course speak the same language, and thereby communicate more effectively.
    Each objective appears with a mouse click, the preceding item dims as the next one appears.
  • 1-2Objectives
    The instructor should review the objectives with the students as provided on the slide.
    The instructor should emphasize that ATLS has a unique language, including such terms as primary and secondary survey, ABCDEs, definitive care, etc. Those who complete the course speak the same language, and thereby communicate more effectively.
    Each objective appears with a mouse click, the preceding item dims as the next one appears.
  • 1-2Objectives
    The instructor should review the objectives with the students as provided on the slide.
    The instructor should emphasize that ATLS has a unique language, including such terms as primary and secondary survey, ABCDEs, definitive care, etc. Those who complete the course speak the same language, and thereby communicate more effectively.
    Each objective appears with a mouse click, the preceding item dims as the next one appears.
  • 1-13Primary Survey
    As the instructor reviews the primary survey with the students, the bracket with the text, “The priorities are the same for all patients” wipes from top to bottom to emphasize this point. With the next click of the mouse the bracketed text disappears and the ABCDEs appear with each click of the mouse. These items do not dim.
    This is the student’s first encounter with the “ABCDEs” and the instructor needs to allow adequate time to discuss why the priorities are ordered in this manner. The instructor may anticipate some disagreement from the students about the order or they may claim that each is equally important and deserves equal attention. The instructor should emphasize that for the purposes of this course, the ABCDE priority is the standard.
    This also is an appropriate time to stress that ATLS is intended to guide the assessment and resuscitation of the injured patient. Judgment is required to determine what procedures are necessary, because not all patients require all procedures.
  • 1-13Primary Survey
    As the instructor reviews the primary survey with the students, the bracket with the text, “The priorities are the same for all patients” wipes from top to bottom to emphasize this point. With the next click of the mouse the bracketed text disappears and the ABCDEs appear with each click of the mouse. These items do not dim.
    This is the student’s first encounter with the “ABCDEs” and the instructor needs to allow adequate time to discuss why the priorities are ordered in this manner. The instructor may anticipate some disagreement from the students about the order or they may claim that each is equally important and deserves equal attention. The instructor should emphasize that for the purposes of this course, the ABCDE priority is the standard.
    This also is an appropriate time to stress that ATLS is intended to guide the assessment and resuscitation of the injured patient. Judgment is required to determine what procedures are necessary, because not all patients require all procedures.
  • 1-13Primary Survey
    As the instructor reviews the primary survey with the students, the bracket with the text, “The priorities are the same for all patients” wipes from top to bottom to emphasize this point. With the next click of the mouse the bracketed text disappears and the ABCDEs appear with each click of the mouse. These items do not dim.
    This is the student’s first encounter with the “ABCDEs” and the instructor needs to allow adequate time to discuss why the priorities are ordered in this manner. The instructor may anticipate some disagreement from the students about the order or they may claim that each is equally important and deserves equal attention. The instructor should emphasize that for the purposes of this course, the ABCDE priority is the standard.
    This also is an appropriate time to stress that ATLS is intended to guide the assessment and resuscitation of the injured patient. Judgment is required to determine what procedures are necessary, because not all patients require all procedures.
  • 1-23Adjuncts to Primary Survey
    The instructor may query the students as to what diagnostic tools could be used to further assess the patient during the primary survey.
    Graphics are used instead of text to depict the chest and pelvic x-rays. These films disappear to reveal the last 2 items, DPL or FAST (Focused Assessment Sonography in Trauma).
    The instructor should relate that in previous editions of the course, all patients were required to have a lateral c-spine x-ray in the primary survey. This film is now obtained selectively and at the appropriate time, based on the doctor’s judgment.
    (X-rays courtesy of Dr. Ray McGlone, A&E Consultant, Royal Lancaster Infirmary; UK.)
  • 1-23Adjuncts to Primary Survey
    The instructor may query the students as to what diagnostic tools could be used to further assess the patient during the primary survey.
    Graphics are used instead of text to depict the chest and pelvic x-rays. These films disappear to reveal the last 2 items, DPL or FAST (Focused Assessment Sonography in Trauma).
    The instructor should relate that in previous editions of the course, all patients were required to have a lateral c-spine x-ray in the primary survey. This film is now obtained selectively and at the appropriate time, based on the doctor’s judgment.
    (X-rays courtesy of Dr. Ray McGlone, A&E Consultant, Royal Lancaster Infirmary; UK.)
  • 1-25What is the secondary survey?
    The instructor should reveal the definition of the secondary survey after the students elicit their responses.
    The anterior figure zooms in first and then the posterior figure with another mouse click. The head-to-toe arrow with the text wipe from top to bottom on the third mouse click.
  • 1-47Pain Management
    The instructor should emphasize the need for early and judicious relief of pain associated with careful patient monitoring.
    Each text item appears with a mouse click and the preceding item dims as the next one appears.
    The instructor should provide a transition phrase into the final phase of the initial assessment process—transfer to definitive care. For example, the instructor may state, “I have conducted a primary survey by assessing and managing the patient’s ABCDEs, and the adjuncts to the primary survey are addressed. I have reevaluated my patient’s status and conducted a secondary survey (head-to-toe), and conducted the specialized studies within the capability of my institution. Now, should I transfer this patient?”
  • 1-26When do I start it?
    The instructor reveals the responses after the students respond to the question. The instructor may use these 3 items as a summary of the discussion on when to initiate the secondary survey.
    Each text item appears with a mouse click and the preceding item dims as the next one appears.
    Slides 1-25 and 1-26 help the students make the transition from the primary survey and resuscitative efforts to a more orderly phase of complete examination of the patient and continued assessment and management.
  • 1-45Adjuncts to Secondary Survey
    The responses appear sequentially with each click of the mouse. The instructor reveals the first line of text as the adjuncts to the secondary survey. The instructor then reveals the responses to “Pitfalls” after the students respond to the question, “What are the pitfalls?” The instructor may also use these items as a summary of the discussion on pitfalls associated with adjuncts to the secondary survey. Each text item appears with a mouse click and the preceding item dims as the next one appears.
  • 1-48Which patients do I transfer?
    The instructor reveals the responses after the students respond to the question, “Which patients do I transfer?”
    The instructor uses slides 48-50 to stimulate the students’ thinking about early identification of patients who need transfer, the mechanics and rules of transfer, and the importance of doing it efficiently.
    Each text item appears with a mouse click and the preceding item dims as the next one appears.
  • 1-51Records, Legal Considerations
    The instructor should emphasize the key points on this slide and give examples of each.
    Each text item appears with a mouse click and the preceding item dims as the next one appears.
  • 3-20Questions
    The instructor allows for adequate time for additional questions from the students and further discussion before proceeding to the summary slide. A mouse click causes the question mark to spiral onto the screen.
  • 19.09 - Atendimento inicial ao politraumatizado - Dr. Pedro Cuellar

    1. 1. AATTEENNDDIIMMEENNTTOO IINNIICCIIAALL AAOO PPOOLLIITTRRAAUUMMAATTIIZZAADDOO Dr. PEDRO CUELLAR MESTRE EM CIRURGIA UFT-2014
    2. 2. AAtteennddiimmeennttoo IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo O TRAUMA É UMA DOENÇA DE GRAVIDADE VARIÁVEL COM ELEVADA INCIDÊNCIA DE MORTE.
    3. 3. AAtteennddiimmeennttoo IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo A BUSCA DA QUALIDADE NA ASSISTÊNCIA AO POLITRAUMATIZADO INICIA-SE NO ATENDIMENTO PRE-HOSPITALAR(APH).
    4. 4. Atendimento Inicial ao Politraumatizado PPOOLLIITTRRAAUUMMAATTIIZZAADDOO O traumatizado deve ser considerado como um paciente prioritário, pela potencialidade de sua gravidade, pois pode ter suas funções vitais deterioradas em curto período de tempo, uma vez que o trauma grave frequentemente produz lesões em vários órgãos dependendo do mecanismo do trauma e da região anatômica do organismo que foi atingida.
    5. 5. Atendimento IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo MMoorrttaalliiddaaddee  PRIMEIRA GUERRA MUNDIAL(TRANSPORTE 12-16 HORAS)-5,8%.  GUERRA DA CORÉIA(TRANSPORTE DE 4-6 HORAS)-2,4%.  GUERRA DE VIETNÃ(TRANSPORTE 1-4 HORAS)-1,7%.
    6. 6. Atendimento Inicial ao Politraumatizado Distribuição Trimodal da Mortalidade 400 350 300 250 200 150 100 50 0 MMoorrtteess IImmeeddiiaattaass MMoorrtteess PPrreeccoocceess 0 1 2 3 4 MMoorrtteess TTaarrddiiaass 2 3 4 5 HHoorraass SSeemmaannaass TTeemmppoo ddeeccoorrrriiddoo aappóóss oo ttrraauummaa NNúúmmeerroo ddee MMoorrtteess
    7. 7. Distribuição TTrriimmooddaall ddaa MMoorrttaalliiddaaddee MMoorrtteess iimmeeddiiaattaass:: TTCCEE ttrraauummaa rraaqquuiimmeedduullaarr ccoorraaççããoo // aaoorrttaa // ggrraannddeess vvaassooss MMoorrtteess PPrreeccoocceess:: hheemmaattoommaa ssuubbdduurraall // eeppiidduurraall hheemmooppnneeuummoottóórraaxx lleessõõeess bbaaççoo // ffííggaaddoo FFxx ppééllvviiccaass lleessõõeess mmúúllttiippllaass MMoorrtteess ttaarrddiiaass:: sseeppssee // IIMMOOSS
    8. 8. OO IInníícciioo ““AA ppaarrttiirr ddoo mmoommeennttoo eemm qquuee oo aatteennddiimmeennttoo pprreessttaaddoo nnoo llooccaall,, ccoomm rreeccuurrssooss lliimmiittaaddooss,, ffooii mmeellhhoorr ddoo qquuee oo aatteennddiimmeennttoo qquuee mmeeuuss ffiillhhooss ee eeuu rreecceebbeemmooss nnoo hhoossppiittaall ¾ eexxiissttee aallgguummaa eerrrraaddaa ccoomm oo ssiisstteemmaa,, ee oo ssiisstteemmaa tteemm qquuee mmuuddaarr ..”” ~~ JJaammeess SSttyynneerr,, MMDD,, FFAACCSS ~~ 11997777
    9. 9. TTrraauummaa Principal causa de morte nnaass pprriimmeeiirraass 4 ddééccaaddaass ddee vviiddaa EEUUAA:: 6600 mmiillhhõõeess ddee ttrraauummaattiissmmooss//aannoo 3300 mmiillhhõõeess –– ttrraattaammeennttoo mmééddiiccoo 9 mmiillhhõõeess –– iinnccaappaacciiddaaddee 330000..000000 –– iinnvvaalliiddeezz ppeerrmmaanneennttee 115500..000000 –– mmoorrtteess CCuussttoo:: 40000 bbiillhhõõeess ddee ddóóllaarreess//aannoo
    10. 10. Avaliação e Atendimento Inicial OObbjjeettiivvooss · AApplliiccaarr ooss pprriinnccííppiiooss ddoo eexxaammee pprriimmáárriioo ee sseeccuunnddáárriioo · IIddeennttiiffiiccaarr aass pprriioorriiddaaddeess ddee ttrraattaammeennttoo · FFaazzeerr aa rreeaanniimmaaççããoo ee mmoonniittoorraaççããoo aaddeeqquuaaddaass · RReeccoonnhheecceerr oo vvaalloorr ddaa hhiissttóórriiaa ddoo ppaacciieennttee ee ddaa bbiioommeeccâânniiccaa ddoo ttrraauummaa · IIddeennttiiffiiccaarr ee aanntteecciippaarr--ssee ààss cciillaaddaass
    11. 11. Atendimento IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo OObbjjeettiivvooss 1-Identificar a sequência e as etapas dos exames primário, secundário e terciário do paciente. 2-Definir via aérea definitiva e conhecer suas indicações. 3-Identificar e tratar as lesões torácicas que trazem risco iminente á vida. 4-Estabelecer as manobras para deter o sangramento e os critérios de reposição volêmica.
    12. 12. Atendimento IInniicciiaall aaoo PPoolliittrraauummaattiizzaaddoo OObbjjeettiivvooss 5-Entender a necessidade de realizar uma transferência responsável. 6-Valorizar e interpretar adequadamente o mecanismo do trauma. 7-Saber os exames complementários e quando devem ser indicados. 8-Entender as indicações de exploração cervical, torácica e abdominal. 9-Compreender a importância do exame terciário.
    13. 13. AAtteennddiimmeennttoo -- FFaassee PPrréé--HHoossppiittaallaarr -- OObbjjeettiivvooss · CCoonnttrroollee ddaass vviiaass aaéérreeaass · CCoonnttrroollee ddooss ssaannggrraammeennttooss eexxtteerrnnooss ee ddoo cchhooqquuee · IImmoobbiilliizzaaççããoo ddoo ppaacciieennttee · TTrraannssppoorrttee aaoo hhoossppiittaall aapprroopprriiaaddoo mmaaiiss pprróóxxiimmoo · NNoottiiffiiccaaççããoo pprréévviiaa ddoo HHoossppiittaall · CCoolleettaa ddee ddaaddooss
    14. 14. AAtteennddiimmeennttoo -- FFaassee IInnttrraa--HHoossppiittaallaarr -- PPrreeppaarraaççããoo · OO ppllaanneejjaammeennttoo pprréévviioo éé eesssseenncciiaall · EEqquuiippaammeennttoo,, ppeessssooaall,, sseerrvviiççooss · PPrreeccaauuççõõeess--ppaaddrrããoo · AAccoorrddooss ddee ttrraannssffeerrêênncciiaa aacceerrttaaddooss pprreevviiaammeennttee · RReevviissããoo ppeerriióóddiiccaa
    15. 15. AAtteennddiimmeennttoo -- FFaassee IInnttrraa--HHoossppiittaallaarr -- PPrreeccaauuççõõeess--ppaaddrrããoo · ÓÓccuullooss // pprrootteettoorr ddee ffaaccee · MMáássccaarraa · LLuuvvaass · AAvveennttaall · GGoorrrroo · PPrrooppééss
    16. 16. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess RRRReeeeaaaannnniiiimmmmaaaaççççããããoooo RRRReeeeaaaavvvvaaaalllliiiiaaaaççççããããoooo MMeeddiiddaass AAuuxxiilliiaarreess EExxaammee SSeeccuunnddáárriioo EExxaammee tteerrcciiáárriioo TTrraattaammeennttoo DDeeffiinniittiivvoo DDeettaallhhaaddoo Reavaliação RRReeeaaavvvaaallliiiaaaçççãããooo
    17. 17. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess
    18. 18. EExxaammee PPrriimmáárriioo Vias aéreas com proteção ddaa ccoolluunnaa cceerrvviiccaall RReessppiirraaççããoo // vveennttiillaaççããoo // ooxxiiggeennaaççããoo CCiirrccuullaaççããoo:: ppaarraarr oo ssaannggrraammeennttoo!! IInnccaappaacciiddaaddee ((eessttaaddoo nneeuurroollóóggiiccoo)) A B C D E EExxppoossiiççããoo // CCoonnttrroollee ddoo aammbbiieennttee AAss pprriioorriiddaaddeess ssããoo aass mmeessmmaass AAss pprriioorriiddaaddeess ssããoo aass mmeessmmaass ppaarraa ttooddooss ooss ppaacciieenntteess.. ppaarraa ttooddooss ooss ppaacciieenntteess..
    19. 19. Exame Primário TTrraabbaallhhoo TTrraabbaallhhoo ddee EEqquuiippee ddee EEqquuiippee
    20. 20. A VViiaass AAéérreeaass // PPrrootteeççããoo ddaa CCoolluunnaa CCeerrvviiccaall Estabelecer e manter a permeabilidade ddaass vviiaass aaéérreeaass Cuidado Exame Primário SSuussppeeiittaarr ddee lleessããoo ddaa ccoolluunnaa cceerrvviiccaall · PPrrootteeggeerr aa ccoolluunnaa cceerrvviiccaall · RRaaddiiooggrraaffaarr aa ccoolluunnaa cceerrvviiccaall qquuaannddoo ooppoorrttuunnoo CCiillaaddaass · TTrraauummaa mmuullttiissssiissttêêmmiiccoo · TTrraauummaa ccoonnttuussoo aacciimmaa ddaass ccllaavvííccuullaass · RReebbaaiixxaammeennttoo ddoo nníívveell ddee ccoonnsscciiêênncciiaa
    21. 21. Exame Primário RReessppiirraaççããoo // vveennttiillaaççããoo // ooxxiiggeennaaççããoo B Avaliar e garantir ventilação ee ooxxiiggeennaaççããoo aaddeeqquuaaddaass CCiillaaddaass VViiaass aaéérreeaass XX VVeennttiillaaççããoo PPnneeuummoottóórraaxx PPnneeuummoottóórraaxx Cuidado ssiimmpplleess hhiippeerrtteennssiivvoo
    22. 22. Exame Primário CCiirrccuullaaççããoo // ccoonnttrroollee ddaa hheemmoorrrraaggiiaa C Parar o sangramento ee rreessttaauurraarr aa vvoolleemmiiaa CCiillaaddaa LLooccaalliizzaaççããoo ddoo SSaannggrraammeennttoo MMeeddiiddaass DDiiaaggnnóóssttiiccaass AAuuxxiilliiaarreess ddoo EExxaammee PPrriimmáárriioo
    23. 23. D E Incapacidade, Essttaaddoo nneeuurroollóóggiiccoo AAvvaalliiaaççããoo NNeeuurroollóóggiiccaa Baassaall · EEssccaallaa ddee CCoommaa ddee GGllaassggooww · RReeaaççããoo ppuuppiillaarr CCiillaaddaa · PPiioorraa nneeuurroollóóggiiccaa Cuidado Exame Primário
    24. 24. Exame Primário E Exposição // CCoonnttrroollee ddoo aammbbiieennttee DDeessppiirr ccoommpplleettaammeennttee oo ppaacciieennttee HHiippootteerrmmiiaa!! Cuidado CCiillaaddaass
    25. 25. MMeeddiiddaass AAuuxxiilliiaarreess aaoo EExxaammee PPrriimmáárriioo Sinais Vitais Eletrocardiograma Gasometria arterial MMMMeeeeddddiiididddaaaassss aaaauuuuxxxxiiililliliiiaaaarrrreeeessss Oximetria de pulso e detector de CO2 Débito urinário Sonda nasogástrica / vesical (se não houver contra-indicação)
    26. 26. MMeeddiiddaass AAuuxxiilliiaarreess aaoo EExxaammee PPrriimmáárriioo Procedimentos DDiiaaggnnóóssttiiccooss · RRXX ttóórraaxx · RRXX bbaacciiaa · UUllttrraa--ssoomm ((FFAASSTT)) · LLaavvaaggeemm PPeerriittoonneeaall DDiiaaggnnóóssttiiccaa ((LLPPDD))
    27. 27. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess RRRReeeeaaaannnniiiimmmmaaaaççççããããoooo
    28. 28. Reanimação OObbjjeettiivvooss · PPrrootteeggeerr ee ggaarraannttiirr aa ppeerrmmeeaabbiilliiddaaddee ddaass vviiaass aaéérreeaass · VVeennttiillaarr ee ooxxiiggeennaarr · PPaarraarr oo ssaannggrraammeennttoo!! · TTrraattaarr aaggrreessssiivvaammeennttee oo cchhooqquuee · PPrrootteeggeerr ddaa hhiippootteerrmmiiaa
    29. 29. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess RRRReeeeaaaannnniiiimmmmaaaaççççããããoooo RRRReeeeaaaavvvvaaaalllliiiiaaaaççççããããoooo
    30. 30. Reavaliação Vias aéreas com proteção ddaa ccoolluunnaa cceerrvviiccaall RReessppiirraaççããoo // vveennttiillaaççããoo // ooxxiiggeennaaççããoo CCiirrccuullaaççããoo:: ppaarraarr oo ssaannggrraammeennttoo!! IInnccaappaacciiddaaddee ((eessttaaddoo nneeuurroollóóggiiccoo)) A B C D E EExxppoossiiççããoo // CCoonnttrroollee ddoo aammbbiieennttee
    31. 31. CCoonnssiiddeerraarr TTrraannssffeerrêênncciiaa PPrriinnccííppiiooss · NNããoo rreettaarrddaarr aa ttrraannssffeerrêênncciiaa ppaarraa aa rreeaalliizzaaççããoo ddee eexxaammeess ccoommpplleemmeennttaarreess,, eexxcceettoo ooss iimmpprreesscciinnddíívveeiiss:: RRXX ttóórraaxx RRXX bbaacciiaa UUSSGG // LLPPDD · UUttiilliizzaarr oo tteemmppoo aattéé aa ttrraannssffeerrêênncciiaa ppaarraa ccoonnttiinnuuaarr aa rreeaanniimmaaççããoo..
    32. 32. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess RRRReeeeaaaannnniiiimmmmaaaaççççããããoooo RRRReeeeaaaavvvvaaaalllliiiiaaaaççççããããoooo MMeeddiiddaass AAuuxxiilliiaarreess EExxaammee SSeeccuunnddáárriioo DDeettaallhhaaddoo
    33. 33. História e exame físico completos EExxaammee SSeeccuunnddáárriioo T TTTuuuubbbboooossss e eee d dddeeeeddddoooossss e eeemmmm t tttooooddddoooossss o ooossss o ooorrrriiififffííícíccciiioiooossss
    34. 34. EExxaammee SSeeccuunnddáárriioo TTrraattaammeennttoo ddaa DDoorr · Alívio da dor / ansiedade, conforme apropriado · Administração intravenosa · Monitoração cuidadosa é fundamental
    35. 35. QQuuaannddoo rreeaalliizzaarr oo eexxaammee sseeccuunnddáárriioo?? Após: · Ter completado o exame primário · Ter reavaliado os ABCDEs · Ter normalizado as funções vitais
    36. 36. Medidas AAuuxxiilliiaarreess aaoo EExxaammee SSeeccuunnddáárriioo Procedimentos diagnósticos especiais (conforme indicado) · RRaaddiiooggrraaffiiaass ddee ccoolluunnaa ee eexxttrreemmiiddaaddeess · TToommooggrraaffiiaa ccoommppuuttaaddoorriizzaaddaa · UUrrooggrraaffiiaa eexxccrreettoorraa · AArrtteerriiooggrraaffiiaa · EEnnddoossccooppiiaa P PPPaaaacccciiieieeennnntttteeeessss e eeessssttttaaaabbbbiiililliliizizzzaaaaddddoooossss N NNNããããoooo a aaattttrrrraaaassssaaaarrrr a aaa t tttrrrraaaannnnssssffffeeeerrrrêêêênnnncccciiiaiaaa
    37. 37. EExxaammeess SSeeccuunnddáárriiooss  Mecanismos do trauma: a) mecanismos de lesão.  História do paciente.  Exame físico.  Exames complementares ao exame secundário.
    38. 38. AAtteennddiimmeennttoo IInniicciiaall
    39. 39. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess RRRReeeeaaaannnniiiimmmmaaaaççççããããoooo RRRReeeeaaaavvvvaaaalllliiiiaaaaççççããããoooo MMeeddiiddaass AAuuxxiilliiaarreess EExxaammee SSeeccuunnddáárriioo DDeettaallhhaaddoo Reavaliação RRReeeaaavvvaaallliiiaaaçççãããooo
    40. 40. Reavaliação Vias aéreas com proteção ddaa ccoolluunnaa cceerrvviiccaall RReessppiirraaççããoo // vveennttiillaaççããoo // ooxxiiggeennaaççããoo CCiirrccuullaaççããoo:: ppaarraarr oo ssaannggrraammeennttoo!! IInnccaappaacciiddaaddee ((eessttaaddoo nneeuurroollóóggiiccoo)) A B C D E EExxppoossiiççããoo // CCoonnttrroollee ddoo aammbbiieennttee
    41. 41. Conceitos da Avaliação Inicial EEEExxxxaaaammmmeeee PPPPrrrriiiimmmmáááárrrriiiioooo MMeeddiiddaass AAuuxxiilliiaarreess RRRReeeeaaaannnniiiimmmmaaaaççççããããoooo RRRReeeeaaaavvvvaaaalllliiiiaaaaççççããããoooo MMeeddiiddaass AAuuxxiilliiaarreess EExxaammee SSeeccuunnddáárriioo TTrraattaammeennttoo DDeeffiinniittiivvoo DDeettaallhhaaddoo Reavaliação RRReeeaaavvvaaallliiiaaaçççãããooo
    42. 42. TTrraannssffeerrêênncciiaa ppaarraa TTrraattaammeennttoo DDeeffiinniittiivvoo Que pacientes devem sseerr ttrraannssffeerriiddooss?? AAqquueelleess ccuujjaass nneecceessssiiddaaddeess uullttrraappaassssaamm ooss rreeccuurrssooss ddiissppoonníívveeiiss nnaa iinnssttiittuuiiççããoo QQuuaannddoo oo ppaacciieennttee ddeevvee sseerr ttrraannssffeerriiddoo?? LLooggoo qquuee ppoossssíívveell,, aappóóss ccoommpplleettaarr aass mmeeddiiddaass ddee eessttaabbiilliizzaaççããoo CCoonnttrroollee ddaass vviiaass aaéérreeaass ee ddaa vveennttiillaaççããoo CCoonnttrroollee ddaa hheemmoorrrraaggiiaa ((cciirruurrggiiaa))
    43. 43. TTrraattaammeennttoo DDeeffiinniittiivvoo  TCE.  TRAUMA CERVICAL.  TRAUMA TORÁCICO.  TRAUMA ABDOMINAL.  TRAUMA RAQUIMEDULAR.  CONTROLE DE DANO( ACIDOSE METABÓLICA, HIPOTERMIA E COAGULOPATIA).
    44. 44. Registro, Considerações Legais · Documentação concisa, eemm oorrddeemm ccrroonnoollóóggiiccaa · CCoonnsseennttiimmeennttoo ppaarraa ttrraattaammeennttoo · EEvviiddêênncciiaa ffoorreennssee ©ACS
    45. 45. EExxaammee TTeerrcciiáárriioo  Lesões despercebidas varia de 9 a 65%.  O exame deve ser realizado em ate 24 horas após a admissão.
    46. 46. AAtteennddiimmeennttoo IInniicciiaall
    47. 47. BBiibblliiooggrraaffiiaa  SABISTON, DAVID C. TRATADO DE CIRURGIA: AS BASES BIOLÓGICAS DA PRÁTICA CIRÚRGICA MODERNA. 16. ED. RIO DE JANEIRO: GUANABARA KOOGAN, 2002.  GOFFI, TÉCNICA CIRÚRGICA , 6 EDICAO . ATHENEU.  GAMA-RODRIGUES, CLINICA CIRÚRGICA. ED. MANOLE. 2008.  FELICIANO, TRAUMA, 4 EDIÇÃO. McGRAW-HILL. 2007.
    48. 48. É impossível ppaarraa uumm hhoommeemm aapprreennddeerr aaqquuiilloo qquuee eellee aacchhaa qquuee jjáá ssaabbee.. ((EEppíítteettoo))

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