asas estat taata

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?a???s?as? ?e??stat????????t?a?µat?a?

• Ts????? ??? ?ap? ?a??a

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?s?e??? 58 et?? d?a??µ??eta? µet? ap?
a?afe??µe?? t???a?? at???µa st? ??s. ??? st??
1730?at? t?? e?sa???? t?? pa???s?a?e GCS 15 µe
??t??? a??s???a ?a? a?µ?d??aµ??? ast??e?a.
?peß???? se p???? ape?????st??? ??e??? p??
a??de??e ta pa?a??t? CT ??? a?µ?p?e?µ????a?a?
?µf?, ???se?? p?e?µ???? ?????? de???? ??? ?a?
??t? ??ß??, p???ap?? ?at??µata p?e???? ?µf? ?a???
?a? ?p???a ?at??µat?? pe??fe????? tµ?µat?? de????
??e?da?. CT e??ef????-CT ??SS-CT ?????a?
???µ?de? ??ta?µa ??? t????µat?? ?a? ???f??
?f?a?µ???? ?????? de???, p??s???? t????µat??
??µ??e??? de??? µet? µ????? s??????? st? s?st????
??t??.
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• ????ap??? ???se?? ?pat??, ?p?????a ?a?
  ?f?pat???? s???????. ???a?? a?µ?t?µa de????
  ep??ef??d???.
• S??t??pt??? ??ta?µa de???? ?a??????, ??t????
  ?a? ?ß??s??a??? ???d??, d??tas? de????
  ?e???a??????, ??ta?µa a??ste??p????? t?? ?e???,
  e??????µa a??ste??? ?s???? ?a? s??t??pt???
  ??ta?µa de???? ???µ??.
• ?p?s?? ??ast??? t?a?µa t????t?? ?efa???.

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• O as?e??? ?p?? a?af?????e ?ta? a??s???? ?at? t??
  e?sa???? t?? µe GCS 15. ? a?t???a?? p?es?
  ?ata???f??e 65/37 ?a? ?? sf??e?? 108. ?et? t??
  t?p???t?s? ?????a?et??a e??f??sa? 150 cc ?????
  ?a? a?af??eta? st? s????e?a µ?s? ???a?a d?????s?
  45 cc/h.
• ? as?e??? pa???s???e? ta??p???a ?a? ? ???esµ??
  t?? d?at??e?ta? gt95 µe µ?s?a Venturi 60 sta 15
  lt. O p??t?? e??ast???a??? ??e????(18h) ? Hct 39,
  Hgb 12,7 ?a? ??µ?pet???a 380000, ????? d?ata?a???
  p????. St?? 20h Hct 21, Hgb 7 ?a? ??µ?pet???a
  266000.
• ? as?e??? pa???s???e? ??????? ????? ???a ?a?
  ?????.

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????a a?µat??

• pH 7,25
• pCO2 33
• PO2 131
• Hct 20
• HCO3 14
• BE -11

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• ? a?µ???a??a e??a? ? s????te?? a?t?a s?? st?
  p???t?a?µat?a.
• ?a???? a?µ???a??a ?ap??e?a e??? ????? a?µat?? se
  24 ??e? ? µ?s?? ????? a?µat?? se 3 ??e?.
• ? ???t?t?ta ?fe???µe?? se t?a?µa e??a? p??t? ??a
  ?t?µa ?????a? 5-44 et?? ?a? 10 overall.
• St?? ????p? t? 2002 ?800.000 ?a??t???
  ?fe???µe???? se t?a?µa (8,3).

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?a????sµ?? t?? ?a??t?ta? t?? ??µ???a??a?
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• ? as?e??? pa??µe??e se a?µ?d??aµ??? ast??e?a pa??
  t? ??????s? 5 µ???d?? S? ?a? 2 µ???d?? FFP. ????e
  pa????te?s? a?µ?p?e?µ????a?a ?µf? µe t?p???t?s?
  bullau ?a? s???af? t?? t?a?µat?? t?? ?efa???.
• St?? 00.h µetaf?????e st? ?e??????e?? ?p??
• ???et???? ??e?st? t? e??????µa a? ?s????
• ???e?e????? d??????? t?? p??s???? ?a? ???
  d?aµe??sµat?? t?? ?e ???µ?? ???? epape????µe???
  s??d??µ?? d?aµe??sµat?? ?a? t?p??et????e
  e??te???? ?ste?s???es? Orthofix
• ???p??et????e e??te???? ?ste?s???es? Orthofix
  p????? ?a? s?e?et??? ???? ap? t??? µ???a????
  ???d????? ?e

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• Recommendation 1
• We recommend that the time elapsed between injury
  and operation be minimised for patients in need
  urgent surgical bleeding control (grade 1A).
• ? e?a??st?p???s? t?? ?????? µeta?? ????s?? ?a?
  ?e?????????? a?t?µet?p?s?? ße?t???e? t?? ep?ß??s?.

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• ??a????sµ?? t?? ßa??t?ta? t?? a?µ???a??a?.
• ??p?f??? ?pe?ae??sµ??. ?p?f??? efa?µ????.
  s?µa?t???? PEEP se ßa??? ?p?-???a?µ?????
  t?a?µat?e?.
• ???µ???a???? shock ?a? ?a?t?p???µ??? p???
  a?µ???a??a?.?pa?t??? ?µes? a?t?µet?p?s? t??
  a?µ???a????? est?a?, e?t?? a? ? a????? a??????
  ?ta? ep?t????.

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• ???µ???a???? shock ?a? ad?????st? a?µ???a????
  est?a
• ?µes?? ??a???st???? ??e???? (1B)
• ?FAST ( focused abdominal sonography in trauma)
  (1B)
• ??a???s?a s?µa?t???? p?s?t?ta? ????? st? FAST ?a?
• a?µ?d??aµ??? ast??e?a. ?pe????sa ?e?????????
  ep?µßas?(1C)
• ? ??µ?d??aµ??? sta?e??? as?e?e?? µe ?p???a
  ????s?? ?efa???, ???a??? , ?????a? ?a? µ??a??sµ?
  ????s?? ?????? e????e?a? . ??a???st???? ??e????
  µe CT scan.

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??µat????t??

• ?? s??e??? pa?a???????s? t?? ??µat????t? de?
  s???st?ta? ?? µeµ???µ???? e??ast???a??? de??t??
  pa?a???????s?? t?? a?µ???a??a?(1B).

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Ga?a?t??? p??sµat??

• ?? µ?t??s? t?? ?a?a?t???? t?? p??sµat?? ap?te?e?
  e?a?s??t? de??t? p??sd????sµ?? ?a? pa?a???????s??
  t?? µe?????? t?? a?µ???a??a? ?a? t?? shock(1b).

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Ga?a?t??? p??sµat??
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???e?µa ß?s??

• ?? µ?t??s? t?? e??e?µat?? ß?s?? ?at? t??
  e?sa????, ap?te?e? e?a?s??t? de??t? p??sd????sµ??
  ?a? pa?a???????s?? t?? µe?????? t?? a?µ???a??a?
  ?a? t?? shock(1C).

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???e?µa ß?s??
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• ??s?e?e?? µe ??ta?µa p????? se d??stas? ?a?
  a?µ???a???? s?? p??pe? ?a ?p?ß?????ta? se ?µes?
  sta?e??p???s?.
• ???? eµµ??e? ? a?µ?d??aµ??? ast??e?a apa?te?ta?
  ?e?????????? ??e???? t?? a?µ???a??a? µe eµß???sµ?
  ? ep?p?µat?sµ?.

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• ?p?s??? e??????µa a? ?s???? ????? ??ta?µa.
• ??ta?µa de? ??t???? Tile ??? µe ?e?t????
  e??????µa.
• ??ta?µa de???? ?µ?p?????(s??t??pt??? ??ta?µa
  ?a?????? ?st??, ?ß???? ?a? ?s??a??? ???d?? ?a?
  ?e???).
• ?e????? ???d???? a?µ???a??a?.

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• ?at? t? d????e?a t?? ep?µßas?? µeta???st??e µe
  ???e? 5 µ???de? S? ?a? 2 µ???de? FFP. ?µ?s?? µet?
  t? p??a? a?t?? µetaf??eta? st? ??T.
• ?at? t?? e?sa???? t?? e??a? a?µ?d??aµ??? asta???
  µe ?? 104/70, 140 sf??e??, ?a?? pe??fe????
  ?????f???a, ??????????? µe a?µat??? ???a.
  ?a???s???e? µetaß????? ??e?s?, a???s? e??e?µat??
  ß?s?? ?a? ?a?a?t???? ?????. ???a? ?p??e?µ???? ?a?
  ap? t?? e??ast???a?? e?e??? Hct 26, Plt 88600,
  aptt 74.4, creat 1.6, cpk 11452.

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• ?SBP 80-100 mm Hg- ?? de? ?p???e? ??? ? ?SS-
  ????? ?a e?e???e? ? a?µ???a??a(2c).
• ???????s? ???sta???e?d?? ?at? t?? a????? a??????.
• ???????s? ?????e?d?? sta p??ß?ep?µe?a ???a ???e
  d?a??µat??.
• NB X?????s? ?p??t???? d?a??µ?t??.
• ? E??a??? a?t?µet?p?s? t?? ?p??e?µ?a?.

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• ?St???? ?a d?at???s??µe Hb 7-9 gr/dl.
• NB ?e? st???? 10 gr/dl.
• ????????µe FFP se as?e?e?? µe µa???? a?µ???a??a
  ?a? d?ata?a??? p????. ( apttgt1.5)
• ??????s? 10-15 ml/kg ? pe??ss?te??.
• ?St???? gt 50.000/mm3
• St???? gt 100.000/mm3 se ßa??? a?µ???a??a ???
• S?????? apa?t???ta? 4-8 µ???de? ? ??a? as???

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• ?at? t? d????e?a t?? ep?µßas?? µeta???st??e µe
  ???e? 5 µ???de? S? ?a? 2 µ???de? FFP. ?µ?s?? µet?
  t? p??a? a?t?? µetaf??eta? st? ??T.(10 4)
• ?at? t?? e?sa???? t?? e??a? a?µ?d??aµ??? asta???
  µe ?? 104/70, 140 sf??e??, ?a?? pe??fe????
  ?????f???a, ??????????? µe a?µat??? ???a.
  ?a???s???e? µetaß????? ??e?s?, a???s? e??e?µat??
  ß?s?? ?a? ?a?a?t???? ?????. ???a? ?p??e?µ???? ?a?
  ap? t?? e??ast???a?? e?e??? Hct 26, Plt 88600,
  aptt 74.4, creat 1.6, cpk 11452.
• ??aße s??????a ?ata t? p??t? 24??? ??s??e?a? st?
  ??T 11 µ?? S?, 18 µ?? FFP, 8 as???? a?µ.
• ????e µe?a?? d?a????s? ????? ???? a???s?? CPK
  s??????a 11 lt ???sta????d??.

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• ??????e?ta? ???d????? ? ????-???µa se ßa??a
  a?µ???a??a ?a? t?µ? ???d?????? p??sµat?? lt 1g/L
• S???st?µe?? d?s? 3-4 g ???d?????? ? 50 mg/kg
  ???????µat?? . ?pa?a??????s? a?????a µe ta
  e??ast???a?? e???µata.

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rFVIIIa

• ??p?µ??? s?ßa??? a?µ???a??a? ap? ??e?st? t?a?µa,
  pa?? t?? epa??? d?a???st??? ??e??? ?a? t?? p????
  ?e?ape?t??? a?t?µet?p?s?
• 1? ??s? 200 µg/kg
• 2? ??s? (1 ??a a???te?a) 100 µg/kg
• 3? ??s? (3??e? µet? t?? 1?) 100 µg/kg
• ? as?e??? e?aße ?ata t? p??t? 24??? 2 fl Novo 7
  (4,8 mg).

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