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Trauma toracico según ATLS

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Publicada em

TRAUMA TORÁCICO (ATLS)
DIANA AMERICA CHAVEZ CABRERA
GRUPO 4010
HOSPITAL REGIONAL ALTA ESPECIALIDAD VERACRUZ

Publicada em: Saúde e medicina
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Trauma toracico según ATLS

  1. 1. TRAUMA TORÁCICO<br />Diana América Chávez Cabrera<br />
  2. 2. Anatomía<br />
  3. 3. Estructuras<br />intratorácicas<br /> y del Mediastino <br />
  4. 4. Incidencia<br />
  5. 5. Fisiopatología<br />Hipoxia<br />Acidosis metabólica<br /><ul><li>Hipovolemia
  6. 6. Alteraciones ventilación perfusión
  7. 7. Cambios en relaciones de presión intratorácica</li></ul>Hipercapnia<br />Secundario a hipoxia tisular<br />Ventilación inadecuada causada por cambios en relaciones de presión intratorácica<br />
  8. 8. REVISIÓN PRIMARIA<br />Control de vía aérea<br />Colocación tubo torácico<br />
  9. 9. Revisión primaria:<br />Los problemas se corrigen conforme se van identificando<br />
  10. 10. VÍA AÉREA<br />Inspección<br /><ul><li>Movimientos respiratorios</li></li></ul><li>RESPIRACIÓN<br />
  11. 11. Neumotórax a tensión<br />
  12. 12. Disminución vibraciones vocales<br />Hipersonoridad a la percusión<br />Ausencia de murmullo vesicular<br />Dolor pleurítico, disnea, taquicardia, hipotensión, tráquea desplazada, Ingurgitación yugular, cianosis<br />
  13. 13.
  14. 14. Neumotórax abierto<br />
  15. 15. Tórax inestable<br />DX: inspección, crepitación, Rx, gasometría<br />
  16. 16.
  17. 17. <ul><li>Hemotórax masivo
  18. 18. Tamponade cardíaco</li></ul>CIRCULACIÓN<br />
  19. 19. Hemotórax masivo<br />
  20. 20.
  21. 21. Tamponade cardíaco<br />15-20 mLameritan pericardiocentesis<br />
  22. 22.
  23. 23. Toracotomía para reanimación<br />
  24. 24. REVISIÓN SECUNDARIA<br />Alto índice de sospecha<br />
  25. 25. Neumotórax simple<br />
  26. 26. Hemotórax<br />
  27. 27. Contusión pulmonar<br />Lesión torácica letal más frecuente<br />Puede estar enmascarada<br />Monitoreo y reevaluación<br />Comorbilidades: EPOC, asma…<br /><ul><li>Criterios intubación/ventilación
  28. 28. PaO2 <65 m
  29. 29. SO2 <90%</li></li></ul><li>
  30. 30. Lesiones árbol traqueobronquial<br />
  31. 31. Lesiones cardíacas cerradas<br />
  32. 32. Ruptura traumática de la aorta<br />Causa muerte súbita<br />Laceraciones parciales  sobreviven<br />Comportamiento hematoma contenido<br />Sintomatología inespecífica<br />Sospecha: antecedente de traumatismo por desaceleración<br />Dx por imagen:<br />Rxtorax  complejo<br />Arteriografía que lo confirma<br />TAC<br />USG transesofágico<br />
  33. 33. <ul><li>Ensanchamiento mediastino
  34. 34. Obliteración botón aórtico
  35. 35. Desviación tráquea derecha
  36. 36. Oscurecimiento ventana aortopulmonar
  37. 37. Depresión bronquio principal izquierdo
  38. 38. Desviación esófago
  39. 39. Ensanchamiento franja paratraqueal
  40. 40. Ensanchamiento interfasesparavertebrales
  41. 41. Presencia sombra apical pleural (gorra apical)
  42. 42. Hemotórax izquierdo
  43. 43. Fx 1° homóplato o 1° o 2° costilla</li></li></ul><li>Lesiones traumáticas de diafragma<br />
  44. 44. Lesiones que atraviesan mediastino<br />
  45. 45. Otras manifestaciones de lesiones torácicas<br />Tx dolor!<br />
  46. 46.
  47. 47. Peligros latentes<br />No menospreciar neumotórax simple<br />Evacuación incompleta hemotórax coágulo  empiema<br />Lesiones diafragmáticas compromiso pulmonar<br />Tx inmediato en sospecha de ruptura aórtica<br />Ensanchamiento mediastino<br />No subestimar fx costales, considerar edad y cinemática del trauma.<br />Trauma cerrado  no olvidar gravedad contusión pulmonar<br />
  48. 48. FINBibliografía: ATLS 2007 (7º Ed.)<br />

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