URGENTE MEDICO-CHIRURGICALE : TN CABINETUL DE MEDICINA DENTARA - Ghid practic de diagnostic i tratament prespitalicesc Sub redactio Prof-dr. MARIA VORONEANU Prof. dt. ALEXANDRU BUCUR Prof de. NICULAETORDACHE conf. dr. HORIA BALAN 7 comuraneoiata Suara‘era Mee ee mac frp SFA Mil J ANS999 one depanieetrte parin excsviae Et Mein Poi tec inept Er Mil, ind pts inte Ae ein itr ncaa Once area one in fra liner ses legs permanent ee inert pus fruopak Act lee ee all penta oie reprodsere ine Pl iinet de mijonce (matics, een, mini ans peace ee) Ugene dir chirepeale eb Tract edagonc trataent prepare rel pl dt Mavis Verona pode Neve lace pot Alesana ‘osu cnt eH ln, Bose Era Mate, 2011 itp ISaNviagrs3903.2 Torin, Nl Boer sod Bn, Hori S161. 9.09 esac cae: INA BELOW ‘Sonar ance MARIA ELENA NEANT ‘eonreacre PRAMAVERA PANATT Corer CORNAGHNOU. in loc de introducere Denar ai uni phil cet asap egal egeie icone cept apes cbc de mein den ee de vin coma a nar etre acc ao expen cont, Se ete 25 ean acto itor medi Seth ind een nae pre a co mana cones anil dsp eset vr apie een pape “kept ext mer ston” ou ya pet vert de ssa consider ee ul shorn din dese img ae Spe princi Soman, dere tpn d wee (Ce spac rin prema at ump un gil din stra de specie gchar ese Dumont sai ene ese percocet touInstead of an introduction “The atmo of wring ich a itt coves te inet of te medial and rial emerges which sold appear ate meal Sa ar isthe ifthe mal dese af sone ech witha ich epee of nr 25 yeas ath atvy with thee ti decors Due tothe nes ht npr of is ext sho aso epee te ebook of he reset ve dip, ber spepitan wl este “Repti et mater scorn’ atl ead mei, a i why ws coder nt hs edo apache point of oe Aira yes fences, tt on ml ene eel oping at ogh the preset ean we i gap othe eta Tiere, and ven JOU fees, mere wai for our pion fe Ingroving fate oon, he AuthorsCHIRURGIE ORO-FACIALA ror. Maa VononeansCuprins 2. Balu scl nue in aioe d media dena 3.Ghesionar de err (pot Cole! Madior Denti in Ronin) 4. atin adsl ccovascalein cabinet 5. Ati fh de fea repr cabin indi deta. 6 Ate fh fee ero pie cbt de atic fad fej metaaie cabin de {Ati fhe fei endocrine in ain de die ear. 9: Anes i mise elon ntl 10. Attn ade eptpt nail de iia eta 1 atin de pasa ev incite rd era 12 Alin de scien gncre se abs es ‘ep ineabowal de meds Sr. 13, Resisirs canines in cabinet de sii eta. Ais a de ale onl in ciel de1. URGENTELE MEDICALE IN MEDICINA DENTARA — INTRODUCERE Prot dr Mania VonoNesst, Po de ALEXANORU BUCUR Urgeni metal tn medina dena survine ea sae plo- Tope impr eaepas fn mnie dua suscep tm bnele cazur s& compromith prognostcul vital si functional a pacienuu ‘Reconouseestablouu csi al uel str de urges medi- cali ait corte ce abate adoptte In asemencs sti de ‘Sire medioul dents eprevintadezderatle majre ce tebue res pst pnt se aigura un at medical de cai Urges nal reprecin rin excel o stu cine com lexi care necesito nterveni eapeuic prompts competent In ‘oni in eae aver Is dapocite au dour profil” paolo al pax- rl (abt nines ited) gi mloeeethnio-matrile hres pert ie wate deca Ne confi fn cabinet de media demarh cu ptr mati catego de snag1, bolnaei care preva simplomitologa subnet 2 une fen sistem care Se pot desompens, une bral, dna, ‘orm aan stomatolog; 2, bonav diagnosica cu fen! semis, ear me respects recomandileteapeatic forse de medic! seit, 3. bona diagnos cu fein sistemice ar mu au fost = ‘valu clini bole de oar mat ip, boa ere nea (in od dliberet sau) pen wor feu geerle sas unl tument mdicamenion sna. Din acete motive se impr, pe lngi eats sbictvs 8 ecicaul (pin compara chestonarlr), efectares uel same fone fi amanunje. Deg ln ean de ambolaor eft unt ‘examen general complet este dll acess up diagnostic thie ‘st fo consis tebuie adopt un sistem ena efcien se ‘xamiaare in eopl bier dtl neces scent pia sabe Trea gad ee. in stabiirea devizieierapeutice tn cabinet de medicing den- ‘at, medical va ehut shaban vedere doo element prinsial: ‘+ amploata inervejiterpeutcesomatologie eventual palgie semis ascii gradl shu de comm pensar, care po permite sau mu dessa in ni de siguong 3 ‘Sul terapetc stomstologie Recincagea wc wgente medical plicren hor munopee prompts de cte metal dents In cabinet ese oan nce rave, inierventia mpi prin mis sexi $i irre stir con pn la prelure aces de cie Arbol pots al evalurea ugeats medial uebuie late in eons ole ‘ei fini vitae: stars de congo, respiai gi cca. Trebuie vil in vedere interdependenfa foneilor vite, dfiiena une Slrigind dopa sine in cee viiosdesompensaran clorlte fei ct scyeea scl le in mod aomul, reumentle stomatologice de rine as0- clash ou on rise serieatv (dey exer 0 aumd pubic puri supra pcietilon), deoarce resus energie i fio Gry ow aca 8 tale ale organismolui sunt sufciente pentru a preveni gi combate real nado sun cxagerte determinate de ste nerve Le prea cu tere organice = importante disfuncti ts inser custo, real, methoie sav neurologic, feta chiar fia une interven stomatoogic minore se poate asocia cu un rise {reset pd uncorpue in pescl vn point ‘Urgenge medals pena af prevents gh watt cfcient vrebuie resuoscush 9 dagoosticad api, cect gi cu mult is fevnimdat Lupta ine viola i moar dueszapofine inate su se tumira chr fn secunde in rgenja medical, de decea medicul dentist este obliga! st posed preptrea neces penta a recunayte ain ul gravitate sinptoncor semper de lara” Penuu reconoateree urgegeimediale, mediul_ dentist tree st observe presocesemacle de sues cerebral, dice respirator twlbursle cardo-ireulaai, Simpiomele de lama ale uni gente mescale sunt urn soa "+ molifcares comportanentul, sea deans; ‘tubule contin (tare de conti, obmbilare} 4 smell gra, vrs moar respirator 1 lor, cea extent, varspici ule flifor, seep TA, fn vederea uni orient rapide I xz, Aneel ecomand e- peste ne! ite de cont pet urna metals, it ear apie ‘kamen nial facile ie: '> Staen de content: ea patient asi verbal rec pen ana a stil dues, ‘> Aperatalrenprator: canter migetilor respira, falar esi, sop respira. © Sistema cardio-vascular: =" modifica plsll aera,= moietie ens sterile, ‘colori peril, paral, atl uh, reflex poplar foto. Desfiuares ia confi optime a tatmenl somaaogi in ‘bine presipunesnroizarea anor ltr es inch we comple tereh umdrindse monies saa rcror dere. Aces ‘ctr ja de ect medical, epaiens dedoure hnico materi 'D Echipa meicalds nests 9 intrest asia evi pase, tooe declan vorizanh urges medi, nite’ dagstice, dar cups nfo findameiale de a le rial jar, caza opr! wn cveiment mea eee. ‘Ese impo a membr echipe! mediastent posse aga) coespnsator de canals coece pate, relennae flares media specie fete’ aera tn pate tae ap ‘ati dar sa manevor de ge api a iti clini speci Perfesjonarea colin perl mac n cence prvete ojale wore pecum $1 objacea une! bane manus a dep ‘ni scp imbue acu medical Hemet de bird ce pane im igre actor personal ce chips in ead) cla cunoseea aluilor lerapetice pe ae Tsar membrs al asia ebuieseexrce cert condi ose sare sigur uel nerve de ange tice 'D Factor pcient es el tai vail inconstant factor linge eat we, Hin Singur ce se mode la fear iterenie so ‘matlogit. Aciviaia clea fico ese phidat gi delat In fancied asst, Fecrepacict ete o nt bos seil care inane ca vatneatle sf He adap fete wfejiuni In prs, aigutindose ‘sel opsinizaea epi tomsoogice, Din morn intr in abet paint tebuie pid de cite ‘chipa omtoogich i va contin in lpia roll atv pe ‘area fn proce spent. Raa date pacent ech moe sister se basa pe un clinst de inereere i coperr, ia lg ire acta arin dolar de conentzapaietlin eet <2 Siisres aul tapes de a lafoma echipa ssa suns cenui i a modifier nepevizate ce pot piven. Pact ‘presi elem asupa cll cia factor webu sk se concer tere pe pron inca acess afl in cabinet dedi ena “D Dotaret sl infastrctra cabinctulal de mediind dentari joscd un rol esenil prin fptul ed Timea say peo inervejia ewoc In sii ose su de gen "ate ces at darn corespunstoare cit funciona Ia pane opin a aprtlor din dtr. Aces fp permite mo nasi ‘nonrzea stir cen, dar sabiiea cu ext & momen- {uli opi de ntervene Orie modifier a nivel optim de fanconre a apraielor medical va candela o informe era a echpe stomatogice, ‘pseu’ esp dino ipl as dec teapetce. ‘Monionaes pasion dar slapca alin de wg impan exisena oblgtore i ahead mdicin dena ats de ‘pena (bea, “Trade get ponte bint de medi dent Apa serie Fetes ere ei Thi ask ese 0 ae Sere see | ‘ice in ales ONION OFC oe eo* cat ect dint ne ota 2 abt irs 7 Tab entire) ‘etc {Omg ier aes ab —— « | Shani ext 5 Baas md [Sola ‘ne ropa TP Rrocherat | Compra Tia Gama ia ln foe fae a OSes | angina) | cnn de ann pct “ it tna de a ase ‘cme Secor 50 prpranatond ‘ssp 7 ables pone fed lsu dit ‘oes one Ip ete Svea) is ens ‘anges | eran | Fase] 78 ORT] Sener an eninecat’ |100me, [gsr | putts) eet Niven Kam — [Tan] Spt aga ST Folezing | hati) | frac somo sor [Aatmgeon |g) | severe, | Stamens lc Newpeci FE Siberia | Rin Taare — Wak Teg pr a 3 | Seat oi | te ao | Sp ng net pu ar = 2m a esis _ [apa acca omen sre ‘apna [Wa — | eccor esse od oie [Tsar scetatcise | ime eeepc _[Simyzat {Bi Nesncanaie ie Sagzol (Contin Pret 3 Aad —] e100] Suz — aca ra a Sa Haron Yoga selene anita FE Tha |e espe Sata dia [ating —Y te [Pb en aT ‘ers ta Boma focuser or | {a Sec ie ___| ferret Spina | ° eer e300 in pe TAS 90 mal thts iememet on ‘is nile ms. ‘thm ete ‘ai Po ce {ie esa oe L I gd pet rpmtte“ gente meso cig cit de mci dees Tol omar Tear roroal [Fe [a 2 Siar aoa eee Fea TT [S| Te } a ™ EVALUAREA RISCULUI IN URGENTELE DIN To] Reawae | FeSO | Sac | Oras La cage CABINETUL DE MEDICINA DENTARA ie aaa gem an Prof dr. MARIA VORONEANt, Prof: ALEXANDRU BUCUR, Seni . sefdshar Mowaw Ni Getdobcntids even Car 1 Res esha — [ae Tapa pa dito de OCTAVIAN DN, Ast de CAINTANVEADAS, See scatman Ais soh Ge Mas Bocbuw Bc, Aoi COs TOMAS Ti | Risin” | Compas [Toe ede em)—| Medicina dentrt repent un domeaia ear lana di prea ‘metic resgonsbiltate moral, profesional, nu i uid id ‘oli-leal cee x comput aborares uifcorial ‘+ tanger sas clinic ptoleogi al pacienu {tatipaes factor de rise In instars urenflor meee; 4 limite lmersejilr eapewice care pot 8 despre fn conuii de ambaltr Orit de corecth arf tchnics i manuaitatea medica den- ist, varie deossbia a paologilgearale impure consi mi lsc, ese pecs putes ncepe ttamentel sormtloie Is ‘epline cond de sigur pen pacien. Din azste mative, s inpueo eapert rguroas, fn vederea nour cit mi smdnunie lei generale pe eae le pein acenl precumsapreiee oprtunii tameatl somalia,a gene mad cig eto de mec certs Ananea, xamenal lnc general investiga parse tofu de a dep uel defcee oi lasuflene funcjonle sa orgnice, Iter sau mans Ta om actal, mela de viet a pacino este tn contin reer determin ssl ereeen runs sever aco tenerl sole mnt perro ear ete neces 9 olgarcevluarea Proopeatorc a real a iscull rapeut vans, . sore neraik S panricuLaniran Facto care confi organismal cate mofo emconale 5 bicchimie ce codonech reactivates ein adap) sunt Fepezcti pin toate elements cae av conivert Ia devotes ‘oli paient pn a momenta respect (Ti 1) fcr geet: 2 soul, vs aes de mi {Meu ascine prose acu ‘+ purcularitle coastal, imunobilogc,biochimics, eosin, neat + Iliac homeosri cor social Desitn confide ambulator asipynrea unl investi generale complete este uot de resist, roan sie raion eent ines reise gt un examen med, pe haa un Chetona de ‘value a tn generale’ ‘Phin fal ch paceaal semners acest fnnulit comple, 52 sigurdresponsbiizarea acestua cu pve In asubeadaelor ssa3. CHESTIONAR DE EVALUARE (aprobat de Colegiul Medicilor Dentisti din Romania) Prof ALEANDRU BUCUR Prof de MARA VOROSEAS, [As OCTAVIAN DENA, As id OSEAN LABS, ‘Sede de VICTOR GMI, Ast un,de COSMINTOTAN, fe ar de Tne NIV, Asin de MA-BOGDAN BUC Chestionar de evaluare a stir gene Seat Mei depen ate Prset ain hon AVENE rsp mou ale tan soem DAS, Avante compe 0 Dh Paseo ~ roar de Con Nai Cale Meir Dani Romie DA ace a, Api sie Sino, Tob “ore eon tomatoes eum fea 82 7A dagen again Ave end peso i ape? 9A dapsone” enemies Meat BD T9Ce Dh rice ‘adopt chem ech ag etalk inte mia pet nome poe a ‘on eae hare fai ae) 2 tut econ >| ieee Npetestn na pti ra chee non ea eshte2 ao dai net eet eal wl apn) ao da ne 1A Pein ee: am gl crn emf Ato go ct DN cin ce: epi paris inp ‘ot ti 1 alae cai A sine: a rc fin el crn emai Pein ce: oii i cen plan pe eres vin sce i 7 1.4 dnp DAS ein ore nn huni enti ate ia 2. 16 Ageia no male DAs. ri gos i se it ht Snmt asin DA ri ces: im tp sb Aion ot gn fon esl? ‘speci 22 A et capone sein pie! DAS. rc esi nei epee a tpt dope nee tt 2s ‘Nit Sian sein nc 25 Aes tae dena a? 26, Caner hn aedeagal ca se ese: igo ae frie de min et edna antral cml Tt {megs report pnre edema comple cepts 98 ‘evens cactus nampa Det fami de unsvnursanconentle Baw ‘osu cet epee et)2 Le mes cual cate de mec do nage rots 2 Sconul anrletsql dentare (lig. 2) EVALUAREA RISCULUI ANESTEZIC $1 OPERATOR IN ‘CABINETUL DE MEDICINA DENTARA i“ rice tratsmentstomatologe are un earcertauratizan, chiar ery un cient pnd stun! comsirt Sats, cu at mat malt ack Renae al ‘See cen unit pasent cu un teen tn con fixlogce prelore inva (baci, coi, Ferme ravi) sau organise arate “Traumatsmeliaterenfel tub echilibal newrshonmonal glo ‘ul al pie nro etc iasintes ages (anesieico- lena metaraesnes chiargcle), dar sou capoctsten de reac fess intrest rin \atsntntnte ingrien somatlogeh. Timpani scl aneseico-denar na tebuie sf depjeses rszervcle fucose le rzanismull decree din dezecilibea actor ina ate aoa 1 cot deere perlite elma nit ie operator”. | sintsbunt rotine ‘CALM (DAS-C= 1) frcorventie | scorns.) = Stone ‘PUTERNIC ANXIOS (DAS-C~ 4) Rina interventie [rare eine MeArcher (1965) a fost penal autor care a sabi o claire lis a gaeloe dere i care sa dovetaproape de sepa props “Ale, grpele derive dup Archer sunt 4 pod rik: pint ne 8-10 an use general bn 1 far sinks: pint ne 3550 ani cv uncle sue organice tac in general uo sae de seats han poor i: pciea csferin orgie porate, Societsten de Anesesie din SUA esaesch rss opertor pe taza 2 dows elements fundamental: amplosresinerengel shite sicondja deren a pacient (63) event grade de rise wnanim acepae in pratienshirc- sical, dap Seiten de Arete SUA, sunt ig 4) Pee. In faneje de staren geaeala, poloict 3b onpnic, de imporasja sctull chirueal (zone reexogene, tach pe nae 5) nevi, dua previ a anes raonamentl edi sb st Sc orenteve dp umole supe de i: te at a + Camrile fvortile (Good Ris) a ee rscul anes 5 pert poatef considera ca nega. Ace ust pci eu stare general un ar afiunesptsogck local ma are sine eral + Cane nafverae (Por is a care ezine lea st sunt de sever pent produce fete generale prune sau care ‘resin tinge import a una sau amt mltorogane vile. de nem infeed cent (eu 3 Ta, hipertensane ari ‘scan, infin epatresover, abt vabart dif de eh rattle gn cerebral ee = Ine acste dul prope se star oats seria He cau ier roar (termediate Ri, eae terenal obec ct a exe pes ‘Crem <8 ntervenfilestomatlogice wae a comport unis vital safety arate cds inlet scidemte ale, acta te produc cel mai ffeventca'umare a eval complete a sit feteales pens msi ml det iervenil somatolgice pop4. ATITUDINEA FATA DE AFECTIUNILE CARDIO-VASCULARE IN CABINETUL DE MEDICINA DENTARA Po dr ALEXANDRU BUCUR, Po. de Mana Vowoxtst Sede sed THRU NIA, Se deuce de VICTON GTS, Asis ide OCTAWIAN DINEA AS i dr CRISTIAN VLAD Ait uiv de COSMINTOPAN, Asti de Mir ocDan BC Patologia card include mulpe enti clinic, due acest «cle mai event implicate fn ractiastomataloges Fd 1. Hipeteasues aril. 2 Coforaopaile 3. sain cadaes 4 Ariel cardiae 5, Valvloptie HIPERTENSIUNEA ARTERIALA, Ese un sino caracterzat pin ceestr een aerial i tole sacl dasa pest vale normale OMS, consider lo ‘orale pon resus ares masks 40-160 rg (inrprtate ong x Jn rapt ew vista, sex 9 prewtes),ar penis minima 90:95 mata. Timi de eolge iperesiuen ate se lass = hipensiune aera esi, in eare mu se post identi cau ace + hiperensiane arterial secundr car enallbipertensinile renovasslare (nama congenital ale valor rea, romboze et), penn Sunil da bole parencinului renal (glomerlonetis cut cron ite, ieloneite ete) fe card endocrnt feoeomostom,biprldoseroism primar (denam cricosuarenal cu secre exces de aso), sindrom Cushing. petro, In cars ravi in esl prime sarin poate apnea o hipertensine revert reliving event ev feare eurogeot (afeqimn trumatce, tmorle sa inl stor) {cau cardio-vascular coca de sort, Hoe cam Pet nse wie te, Se pot tats in eabinetl de medi deta paieni eu hper lensiune arte cot medicament, nasa ator fe cre nice interares, ‘Condaita a cabinetl de medi dentart + "conaltcatologie eft rainten tatamenul stomsto Jogi, t maximum ons dacs acest itera de inp au srveit mo Ai le st general a pacenu, se epet consulta adobe; ‘Ministre ir nerspere a mein de si nels tn iva interven stmatoogice (em excep medicated ancoagulate, care va fi modiisiadolas de eae maicalcadolg, sob contol rapuograme), Admiaisarea acdulu oceislicic (epirna) se Tnterupe peat 7 ile In cell cre cardologalitersstal @ considera iil, dt ind afta petra eae a fst recom); mares presi rteraleiaiatea cept atameta stomata emgrizsaa tame doe presnen srl etea mare eu 2030 mle Fa de vbr tension habia ale pa ‘nul, solickinduse reevaluares canilogiea. De seme se vor ‘eels tot pcieni oa ens’ aterale mame 160 mnie in ferent de vale tensions obignuite sau cu Teevenis cardiack > 10m: analgzie optim -analgt atinlamaornestoiia ani sta pe iol inane ramen tomatoe: ‘ premediaie eu amolice de tipo deaior de beno- Aiazeine Mizar comprimite 7,8 mg pero 1 0 or nine de imerveni) + anstezie local de cata; sscierea de vasoonsvictr la substan amestezil in concentaie de maxim 13100 00, fk & seis doza e102 mg Adealin. Nv ce folonete Nonahnalina a ‘tush de urgent a ndemna medic , rea hipertensves (aig scien Ungene media; Urs Iipntensve tia hipetensivs repent cteren bras avalos sterile, eu real de producre de lun ale organs fn (cod, Fini, cri, cicuietiin). Simptomatalogie: Tolur le ui de contin: efile pum; disp: tol de vedere: set eeu, “alo TA sistolioe>20 mig dacit TA de fond, lin eae abi, en un ee st oe SR vrai see pce Me Ci eas pe on at Aitdineaterapeatie (ig. 5) (Gia de hparnsane aid) Pes ‘+ sc Ineropettamentl tomato; 4 Se supimenea anaes fe pin suplimertara acseric locale (Gu eoniia st nu se depensl dora mania de sluice ‘eae, es alinsienes rales “+ poccaul ste ajezat in poi semigerind, cu ridicarca coven eels a ‘linia de oxigen {+ mortrizae semne vise (FA, plo 4 dict tensianea arterial mee Ls aor ict, ea niswous Cappel ecmpeinate de 25 mg sling castle Se rapi (-10 minut); administra sidings 9 Niepins op. rePn ene nec cete m eatt de mec de crue conmmanocst: (pate deena sederea based tte ‘Soni ane, eu hse ellen, cee mica, sehen ee teas eal, WOARTESUBITA) Se lize conor recomand ale ft se dihreaaigila ul compen e 28 mg 4 Coptepi so Nieopisrng 1 comprinat subingual sa 1-2 pte de aco- sol bagi dupa mint se recvalueaztensanca ari “aed vaoarea lesion se normalized post tea flares tamer stomaooge da be alperh l'va 8 de seus dura lterot Paci ing teaporatTatan serviu de Ca Sao sau Matin er pent evar: ck wore ens e meme reset, 0 ice Ambul se sda Farosemid Sols (2040 ma) ims indent dace lores TA seade sa se menie a el iia tt obliga espacial nin seviu de Ceri Togs Medina tert per var. CORONAROPATIIE (sei si sejinea Uigeaje medide: Due tek) Reese un grup de efetan areata comun sui mio caus coneevd devel! dine ful sanguin coon $i evil miearice In ean de medicinn dentarpo raat ustourl et ale boli cornatien ‘+ angi pectoral sabi, 1 cardioptiscemicd nedueros 4 Sagopa ew entry pas, 1 Infretmiocardi vec a ul e 6 an de a produces, oar dap eevalure ealogic gl aviz de speciale (nu se seo ‘mandi intersonia mal deveme de 6 luni, devacce rel lel este de Upon, 40% las del instars necoze meade de 15% ne $76 ans dup 6 undated mortal eee Ia 6). Conduit in eabinetul de medi dents in coronorapatile compensate terapentic = consul cardiologic efteust eu maximum oun nin ts ‘amen stomstolge; dak fe zest eral dein a sre di ‘cl ale ti general a pacen, seepets consulta arologi + adinistara fired inerspere a mola de ig inchs ‘in ia inervenelstomatoogice (a excep medi attaptla cre va f modiieialapts de care medical cadiolog, sub cin sagulograme).Adminisrarea. seid actaiiie Aspirin) = Inrerope pena 7 ile [a cella care colognes considers sbi a fin afeiunea pentru cae a fest recomandat), 1 ulgeie oping: slg atnanstornesteridian adni= risa pr of mein, nine cu 30 minute de ncopere tater Siomatoog: ‘remedies cu aewolitice de tpl drivin de benzodia 2epine (Midazolas compris 7.5 met sci onsite de infer. vesie ' anestezie loa de caliate;aneeren de vaoconectaae e sus anes in concen de maxima 1:200 000 se evi de ite o ete posi + ttament omattoge In poze sien, fm cal ine Aiie arince ascites, + aces ap Ia medical neesard tn canal spiel un sind eoroarian set Nitrogen. As elise 03) + taamenal conc eu anicogulnt sa anageptnte poate leering Hs erescut de singer, de aoe npn eu loc de been ‘Sindroame coronariene: ria de angin8 pectoral Simptomatologi: ‘Angina pectoral peso 0 for clinic a cadopai sche nice, caracezat pein erg daernse paxstereo ‘Seal, cae dure citera mine s dsr a sdminstare uno? ‘compas nite (Ninoglicerin). Ateul de dure revostemalt = radaninoasd ope i tsi in car evo oxigen a miocari este ton mae dest ea acoperta de axa sanguin lenentle carters ale dari angnoise suture: + Toealzare ped retstemal; naar darren este precordial, pina, nteseapulr; 1 nie in undef membalsuperio, pi altel dou egee, uot ee egunen cer, mandibular deiare (a ‘isle nt obligate) 7 "sens darerous are cancer cost et ino de sett; neon on deeria darts ex pe o senna de su a Ae isconfor gre de defi ‘ acceni dures are de regula o dura de 3S minute: daca tute pad, ange un matin, ap senza dares se et evd su dpe, op achinstaen de Nitoploetings ‘+ ineaal In care riza de angina pectoral ee sever, duces se pat inode spine ascie uaz: dspes, espe. fu Toor get (eete spore ssc apr al event i fact tmigarie neat in angina pectoral) _Atudinesterapeties In evan de anging pectoral fn cat apne duvet coronarene in mpl tataenila stomatloge, se vor anica umstearcle mis erapete: = eruperes trtmentuli stmatloge 1 afer pace ‘uli in pri semipennd eu pciuce pall ea lanl ron 2 geome are 9 bpenemie sma anno erie perf s vain cxigenttapie (6 Uni) ‘> lmiisvare de NivogTcedaa sublingual, pn la wel doze 40.5 mn ineriale de proximate, Nil cre a Iniocu de oxigen prin aurea vaselor coroaine pie i Scale heal mecnic depus pin seslerea presi (prin vendita aninisara de Nigiri eal ita a pcenics resin aril Ss seat (100 ming sau loll eae exis suspen ci deni de voi eg (reverea peso ene jaar, ascuae relmen noma hips) + psbotcapic aso, neg tas a acs sinpiomatologia duct persisth pete 2030 minute pa instniven misurilor terapeuice de urgent, se suspicions inslares un infaret cari ae Sindroame coronariene acute: infretul miocartc acu (v7: secjunea: ,Uignte medial: Durer torrie") ‘Simpiomatotoic: Drea repent smptoml principal, vind caer simile cs din eriza angina, dar ee de repulb al sevrk co tat ‘mae. Tip, dreea se localize in eines central oraclsat igs 3 casio pt iin woo superior, pnd Ia teins oc al da niioda mura nfrorde obi, Drees ee aden Init de dice, pir, el vis ‘ui, amie serie de moar inincnti Doi drt exe cca ma hii cw, ca mu te ew Tntdenms pez pc 32 ‘np a pci inves. unde ifr se pe isla ou spe pu bruce poate evlua spre edem ulnar act Ry, infarl mioerie cut Se poste mais prin pereea So cena ta coal, es bl a ‘Obiecvee watamenl paceilor cu suicane deine ioe con ac inca el ce cada trast rapid ito te spite ees asigue spor vil cade get prompts 8 ‘Grape do repre micas seat (U6) ‘+ solcarea Ambuane an 36 {+ cominuare mini doze; + montorizaeafanilor vale (espe, pus, tasune at 4 contol drei (Algocalni, Ketoroas, Team); 4 ac survine spa! eas, se nis’ mapevile de esas itr pnd sosire chip speilcateri de angind pestoralé ‘nieapea tobnentad oma (setae tang patos i (Gaimseesonee] >) 5 aneipeeen [eT et (Reames | sour em) (Sempcine WA] SRE [ soars Ania] INSUFICIENTA CARDIACA Insulin case repent incapeitten mga de a fui ult priferice ua valu angus, nomen ca fertie mal mor ferns cree, cele al facet find HEA ‘oa coronains. “rate stomstoogie simple, de seus dura se pt eects tn ambulnor in carl boar eu nse adic compensa pe tat 2 ‘Conduits in cabinetal de medicns dent 1 "consult eadiologi efetuat isnt tamer) somo logic, cu maximum | Tank ded n acest inceral de timp su srvenit rode ale sti generale pacemuli, se repet egal ear logs ‘+ slmiisuare fir interapere a medic de rain, inusv tn i intervenes tomatologie (eu exepia media nticogulne, ‘eva fi mdieat/adapat de cave mee earolng, sab conta rapulovame). Adminisirea seidult accticlice (Asi) 32 Inverupe pen 7 le Incl In care cadologlinnislo cosierh post dain teen pent cara fst eeomansa) ‘+ reduceen desea de ealeolamine endgene, pin anal= ecze bind i premediet setivs (Mido ero 7 tg), hue folosebe corti wasoconstitnHcarl bono Agia ie de albu de tm grave); ‘ atameatlstomatalogic se va practca cu boasvl ia pic semigezind ‘ proflnis endocaite bacterone, daek exis valulopstit demu pulmonar at esses ne mie: er cca ei") ste urgen meicld major, interven prompts si ort medi ptin salva visa cient, Edema pulmonar seu (EPA) repent wy snd line par ii determina de ereteen canta iki np extravascular lepine Simptonstolgie: spe proxisit pope ex onpnee; tein omaclen tegument ple, tania res canoe expecta sere, reat, tac, jugular urgescente;+ tsauscuha: alr saberepitant ise; 1 iotersane, cola Atiudinesterapeatis in cabintal de medicing dentars ta EPA ig 7 emul puimonar seat yewwree “Wiener aameria tomioege il (a Tap omy | [ia <0 mn 1 eget 19 ata Spit nat | + iuerugrea untamenuli stomstoloie gi ageaten pace tol o uaneia in poke vera gi membrleffeoare in zie el petra reduce pesarcinn, 120min, S20 <6 ‘esomandaea uel ees edalowies, ‘> robusen dete de cteolamine endogens pin anal eric i remediaic solv Midazolam pers 73m9), has floss coc adrenergic Ta pacieni gta (se dean seve, 2s pier punitors de pacemaker cardiac: webu eviate imertreile empuilr electrmagneie(nictmetor elec, apa Ae dtr ud lesrocater iol) fest ecesartanbiopfixa VALVULOPATILE esi valvaeeronicepezin 9 stiogie divers, cel froventreautisald. De reply Pcie eu fej valvular ‘nose digo, dat exist simi in ere pie velteaz doar ‘vie anor sulla eae, eemest cae webbie spun sspcincs ‘ne valance ear nul eons despevaiate Valvloptite se spocia cu acl unse coma ce pot inate tetametl somatloge 1 aprinaimior (exasitoe, blai); + declanare une ctize de ania peter * insalnea uses sinopae in steno sortie ts, edocarita bacteians, dent: "Comal calpe ecu Indes tetanus loi, ca maninu lad se act nce de in a0 sven ‘of ale sti gence & pace se rept coal ca Siti i ven ie it pr mie ran ns in a nee somatic (on ccepia eset ows Inne). Adniniseaes acd cea (asa) se noeepe ent 7 eit denen) eile carloguiaternslo Conse psi da in ia ety ae fot comand > atop cnet tree ‘TRATAMENTUL CRONIC CU ANTICOAGULANTE ORALE (ACO) Tent stags ol ee ina peny prevence ‘ie oblast ac age Cele ms events fesse fn cau mt w- taney andcagl de egh dient i ail one tombora vent profndh (cca sat cu mtolie pulmonar) ‘Administra co nea nro ae ele ‘Stiinta eu set eeu, yas vse, poe al ‘ule, pstAVC, snom rte, side snore anc Trimet Moun aninaguan ll ete repeat Se devi uma ~ anugongt avian K: Warn Accncumal {rontsioy, Stn. atl oepsc Aceon ae 2360 ose min 72 Tine nic be“ ecg iin ements Moaitrizte atamentasi ACO se relinc prin Sterne peti a INR (International Nealized Ratio), un rao Sundar {oteatioal ote valoarea TP (Smpul de prevombin) a paces fi Tr (Limpulde promi) marr. “Tstmentele slomablogice so vor desig obligatory In soni de splalizae In sete de chirurgie oromaxiotacil in ‘ator ai intervefi singerinde de urgent (ou exis posits tem oir ptr iterupeea ACO): interven sngerinde programate dish ete sess sub stn ev heparin stand, ads pe ljectomat (purr de Proters eu valve mecaic) Conduit in eainetal de medi dentaris + cont calolope eect nana tatamenul stono- loge, cu maximum Tu dae in acest intra de timp av sureni ‘modifica ale sth generale a pacieni, se repo const car Aol: administra ra Inrerupee a media de int ini in aut itersenpe somatologie (e8 excepia medias antcoat ane + died seu aiotogresomand inrersperes ttn sdenagulant ors substi cw eperndfracinst (Cleo Frasparne bmolsp 1. se nerpeadministarea ACO; 2. se aminiszea heparin faconatl ince! ce vias arma iterpers ACOs 3. se monitrizent INR zi; clad INR sjunge la valoarea LA se pout eferu infervenia somarlogiedinge- and, 4, hepuina fiona se Snerype cu 12_o1e inna intrvoni se ia a 12 oe dp aceasta: 5. se teintodace in tstament anioagsanl oral clad Tisanle hemorapce sunt dep, cancomita t a- rinisarea de heparin ction 6. se Inrerpeheparina fiona cad tmp Howell eu are se urmarese activa anticoagulant a healer) aunge ln vals) 22.5 of dbus reco ince ‘+ tatamentl aniagregsot plchetar (acid sets! Aspiin ssa Plavix) ~ se va cere avizuletdiloglineuologuli’ interislieae init trap (ghidure sont into coi shims tre) 4 scimpuneohemosta chinrgial mitoasi: + dick este neces ainsoaes de snalgeice se rcomands le cae mu interfrdaregurca places (Pascal, ihbioare COX "se conrandetadminiseare preter jntamosculas (se dehemitoan) ‘dic pacientl declare urea un trates tcongulant oar dup efectaea und iscrveni stomatlogicesingernde co role caltatenhemsiz locale se wine pint nun seria speciszat de Canoogie sou de Medicina nea PROFILAXIA ENDOCARDITEI INFECTIOASE (conform American Heart Association/2007) Endocariabatran repent boll infecjosh grav ere syre ino serie dean candace congenial, pial Im eee In cae se prodoe usu sanguine ov veloc rit care ‘ler ei’ endocale ce predipun la formate unr deporte de Plachete gi ving Acese one reins un se mare de colonia et iwefe sence tn curl bacteremil, eu rie de deere) moro. Fieionale sales emboli site, Profilin endows infecionse cons fn alminiraren de atibiotcnsinten ore interven imaive cae poate determina etre. Tn fun de fetus cade, scl de endoardit infviouss poate fi mor, meds su negli aden pens anbopotlaneind sabia i inl de cet rise. Acete ele dese a fost sie rnizate de Al ‘Recomandtille AHA pers prevesteaendocrdite infeiase revisit nal 2007 enelpsoeart eb paceyi ou au ic un cig fin adniniseaea isi atboic In Scop prflace, ip caval unor {ntervent lo ivell tact digest se penton “oti pad Ia acest moment, Soccutea Europeanh de Car Aiologie peed in pul propriu igiaile de profile penta ‘erenfestomalogce ce tmports un ana gra es In cin ren enocaditsinfeonse, ‘Coniile ptlogce asocae care cree ical apni endo cate infections sunt pez in abel uot (abl (Paka sree pats [Pda ere nce pin Pasir mo Peering 1 Sitmopiadicccme |” Cela 2 ii me ater [ee thee Tot rafkenacanowuesle | pspedemiralt treat (oe mera csc or ‘Sonam. Srp hea ea 1 fig an a xpi ENE cama ips In cabinet de medicins dentar se recomand efetsrea de inten sngerinde dara pacienpi cu ise negli Proce) sonisblogice singende care indict insiires profavieendocantetHnfecfoase sunt cupinse ia tall umsor (bell; =e aces ] + fsoata dr mp Scheme erapeutice de antiioprofilase indicate de citre AMA: fi 1. Regia standard: Amoxiciin 2-3 gol co onsite Ae ineevenie 2. Regimuri alternative: seamaster fe anc cd pasi= otal a. primit tn ulimele 14 2k, este clad psn hipesensiitate a betalactanie: Clini 60 me ole 9 nine de interven: Cefaolnis 2g oral cu 0 ot isnt de intervene (acd aera la pence neste de ip imedin, ‘Aaitroniioa/Claritromsind 50 mga oor nine de iter ack nu = pote rcalza alminisrarea pe sale onl, se recom anise de Ampiclia 2 (saya) cu 30 ete inant de interven Dack pace reins lege Bt-actaming,| se vor liza he Clim: 600 mg iv. ey 30 mine frais de imervni, fe Cefazotin: Ig Lv. cu 30 mine isnt de lterenie (dd lergian ee dep ined). Tn ambel suai, se vor rept dzele din prepara adminis ‘uo or nine de interven lao pa en5. ATITUDINEA FATA DE AFECTIUNILE RESPIRATORII iN CABINETUL DE MEDICINA DENTARA Se etre THO NT Sede dV HTS, ASTMUL BRONSIC (vei si ssfianss .Urgeofe malice» Asim roms") Reprint un indo infamator en a ilo aevee, cate ‘maces prin obstuee tronicl eversbi parall say camps oo hipereactate bronsch, Ts fut de factor determina i prison, se desc ous forme cine: 1. Asma exrinsec:bronkospasns exe sez wor ale enone 2- Asin inrinsec: benbospastul ee aut def one lrg bonite ronice, sina noxemiement ssc eS Conduit ta cabinet de modicing dennis consul de specialise + use inerupe medica de fond; ncaa pacer af sb tment cu corn, se eecomands mien dst preopertor pour via para crzladisonine: * temporgares tntsmentallstomallogic dich asin pre sinh whessng ‘= prezzra inhalant latagendaa medica stmatolg: ‘+ premediaiecu Midazolam 75mg peros; + evuren vasoconsicior, desece acta confi sul care pt declangasrize severe de astm; evra arealin! ese juste Ta i penta preven scidntloe generale ioascuare pia ‘inten ca brosodilstntarle de tp beta adenergiss ‘evra gedieloe plunge (peste 70-75 minute) de wat ment tomatoe ‘even macelielor (eet toxic Ia asocirea cu maibantneley, ‘evil aninflanatoulor sesteridine (acid set clit Asiin te). (riza de astm bronsic (is sous Urgene motile: Cin de sim hone") tis de tm brome realizes o insfcet respiratoreaesth de ip obsatv prin bronsolosenont (spasm + sre viscous n ‘nite mare eer), Enola, a srl roe, conserva dn aii salir - bi sali - meatisufil de sin (ioxidat al arene din caput de apeszzc loa), data prelugit procedure terapeste, aid ‘illic, tone aninlamatoarele netroidene pt delanga cia de ‘stm, Unele antiboie~ Erzomicina sau Cindi ~ pot pep ‘za de astm npn siti tt eo metiatns,Apstia rzelor poate eit sau br ind rece de tse seat efile, agi, tans anv “Tabla link cusnde: 4 dispnee predominant expire ‘wheezing ‘shia isi even de hpotensune aerials Sano pure leo di cara bipeii, terace destin, in mobil (ema eas patgnomoni) ‘Stara de ri simatic esa lini el mai several st lat bron, refrac le uatamentul eu bronkasatoace obi (ia se instaleaza brutal, pind dra peste 24 or, carterizindese Pin + oon sei ia cxpetorals ’ sient: 4 seme de iasucions respintoie mart, cu tein de cbs a clo respite poate cralia spe com perp ‘trae ob Sern eves psngnomens). _Attadinesterapeatis in ren das bron. 8) ‘+ inrerpres samentls tomatoe, {sera pcientl in poi sci, + Slminisrare de 03(23 Uni 4+ Se iminisrera un rothodstarinklatar sav motion propre a accu (say-ulcu substan mimetie), ‘+ montorizarea TA spl pain, dacs dt Smite dispense remit, epost anni Amigos 240230 mg iv. foarte lent (n ea 10 mine, a= ‘wind pull nerope inject ncaa piel etait 1 adinistare de Hidrcortzonbemisecinat 200 mn bos 4 ac dispense prelungee, se dmiitears Clerastinam 24 mg. ae sols Ambul (Ra) a eRe Te) a] 4 aera 3Gang 22] — (aetna ASPIRATIA CORPILOR STRAINI TN CAILE AERIENE Aspirin scien cori stint determin 0 nails ‘espraore act, grav, eu prognostic rzervat Insulin rep rntore ere deermints de hipercspnia isu de hiponia cerebral roduc prin obra llr acriene supeiar cate se poate complica cuss Simpromatologie: ‘+ seazaa de moare ininent: 4 dspmce instore, (abso st neice gto reapiatonsate motor Indepitara copula sein doe la remiterea manifesto ‘ce Pens corp strtin dace In agravatea si peerless oplu canoer chiar moar Corp san localiza taringlan Teblou cline pote deste» snplomatlage dite fn rape udimersane oepl spit, Corp sin volaminoy suri vel sot pot determin 0 sti complet old a clr serine din la nasi pin Asse su sincops Sinpiomatologie 4 facies annos cant; 4 site piemotorie evident, ‘ 4 dispe accent aie otal a zgomotlrrepicatoi Corp sin’ mie 9 moet = determina de edb apne ist, ting coma chit de tse; "+ dutt volte prvecate de marie sscjie ale comput Corp stint ocala trata In majoras eazwilor, cori sini de le ces nivet sunt mobil an Sinptomatloge: blow dramatic earaceriat pia agitate psibo- motor, dispce accent nitrite cant In cau de gravitate moti, ces fk acu daca aos ‘naiy 30 mina, dup cae simpomstoogia se amelioeard dais Sind compl stn fn una dine boi, exitndpericll de mobs Haare a aces a fre a miei acct, Aun ind coral sta ete oat in tae, se perepe un egomot sama inspira expiata (tlt dpa vin) fn Cinescore = cuz grave, devel se pou instla iedit sau la seu timp ein iis incops, Cori sini localiza brome ocaliare al ecveath esti bong priv deep saul Ditwreapa wae. Dack sagoare copula strain se planes, par complica obstructive ssepice Atitdinea terapeutidin eaineal de mein dena Deeidrtal jor al condi de urge inspira de orp ‘tin nee esata const in esac ma api apo eer istantance aT; oi teams ina td dares: 1 anestzielelocoeegioale x soi cu vasocnsrctnr Debut AVC et rose pin coma, seme neuroogice cerns 4 focar temiplesie, devia conjugal» ocr gi caput de partes ‘put lea = dolaval peste lesan”) praia tip nia afi. Cefalen, verjelevoma son prodromal ua sere ‘isu cerebral, Accidental ischemic tensor rpevinh isla brs noe erisoue x carat reps de pete a une anf sere dee te densa tamper canine ie rope, ‘dura are na epee 28 oe pcre eres ra asset nen terapetich de urgent (9 “eke cae eat] (neenpees ater somaoRe | 1+ inrersperea tntamnia stomaolgic gi ageatea pasion: ‘ulin tno: ‘+ asguatea cri clr arene sper; 1 Spevarescapl pact in pone de iguran ts 1 alin de oxigen 1 monitrizaea sensor vil; 4 Slices Ambulat pens want tonal ini. secede speci, hie ack sas decongient se rela eRTUUL Repro dia mig sa senza de otis Islinie a eviures matic co ext eal consul de special 1 trtamentle so cfectucre la minim 7 ore dela gens de bemodaih (pnt Ia dii= ‘ars efecaluanioggun al epi) ‘+ umbipeoine (rise erscut de infect «putt serio ‘eons, rin bacteria eztv ‘nu se ullzarh gut arterosenos det in stunt de ‘+ respecurea masusilor universe de protest riots tlilor eejouse paietldazat fice pure din prope dere osra HV, VC, HIV. © Pacienisupus! ransplantla renal: ‘+ comul de specialise + anibioproilcis nfeflor ocale (medieaaimenospe soars caicotemiek ‘se contaidicd Eriamicina gi Monaco accent toxin mmosipesearlor dei corporine.10. ATITUDINEA FATA DE HEPATOPATII IN CABINETUL DE MEDICINA DENTARA Prof. de ALEXANDRU BUCUR, Prof dr Mat VORONEANG Sede na Tne NIT, Sad ede VicTOR GH Asst oni br OCTAVIGS DINE, Ase ne Cxtsi4n VEADSN, Assur MIBAEBOGDAN CR, Ast, de CSM FOF HEPATITA CRONICK. CIROZA HEPATICA Indifereat de colopiahepati eronicelioei haptic (via, alcool, birt) sunt prevent © serie 6 mails puoogice spe ‘se 4 redueea rate metabo, eu reducers clearance pls tial iferteor substan crane (de exerpl,aneseicle oa) {ise de bipoglceni, “+ ufbura de hemwstzseusigerre sander prong in ‘ipl interven in prime oe dup acest sau epi a eeva opin ia eeagul for) prin ‘fecrea hemos! primaire prin pete vasclar de sla callte, ev spastciatereduh afar aun ruliincionalia wrestle, ls (wpe wots seer sori hepatic atror coaulir Y. Vil IX. X, Il} preva ga anicombie 1 Plksminogenl,inbibtoreRiolzt = Teiete sintezl inhibitor sili: Siteraveametabotsmull taming K, cofitr fn sine {era componenisor compet protombins (ac ‘Sv hipovtaminor K pin dismerbism colon) Ramin duce care constivie ceea ce numele Sreting properatr al hemos: > uma de ambos Gin de singer 1 remeys cheng: {timp de engl sau inp Howell; timp Quick Gnvesiparencoaulri exis 1 timp de eid Gnvetares coal ita 1 timp de robin Gavestipheara iiolormaes inhibitor iran al congo, + Avinogeneri 1 iacheagulif37'€ Goveighos Meinl), Unserening preopeator minimal cop namie d romboct Tip de singer, inp de coogulare; timp Quick; 1 tip de xing (APT) fate valor acetora poate certieasigurants Intervent shiruglale din pencal de vedere a nedentelriee enter hemeragice. ‘ace pot ft i omit ambulatodar eu aval mei cal speci aso-enerolopintes. ‘Condit in cabinetl de mein dentar sen efecto tame stomaolgic singer, se ‘a opt eu medicl specialise amie peta evalua bemo= ‘uel, vestige mnie eapind tinpul de proteins (INR) 3$0___uure nection cate deme et ‘mumirl de wombocie. Nu se vor eft interven singeinde dec INR>24 ‘1 pain cu mai mult de $0000 tombe pot lc ‘us interven singeande de mics anploste; ‘+ chiar Ia pacienicu este de Remosz8 normale se va feet hemos rigueast, + se vor evi imervenfile de lang drat, pent eit att ris geri encesive ct gel despre ahipoglic is + imerenile pe mame cadre s€ vor face Tn sede separ, pera a redoce scl apa! tsi! cu substane anes tence oe, sec, 28 INS cr in amet is io Hie); +" seconde sedative (sede precipita ene onal ms va adminis Asi vitae AINS nesting; pnw esiguatea analeziei se pot fost Paraccamolul sau. AINS coxa; ‘anibiopoiaie a ineilor lose ta bolnavi sub corto ‘eae, ‘+ se va evita declanareasevrj (consul de aloo! le cient ewbepatte etanoie ava iter sl ml de Sse) tient alli sub corcoterapie vor ua midst de ntbioroiatsfxilrlocale *espectavea misulor universe de rte mpotiv olor Infeiose ei cu hepa cronie vile - VB, HVC). 11. ATITUDINEA FATA DE PACIENTA GRAVIDA IN CABINETUL DE MEDICINA DENTARA Prod ALEXANDRE UCU Po MARIA Vonone Sef ci TER NIT, ede as de WieTOR Gt Ast unde OCTAVIAN NEA AS nid CUSTAN VLAD ASL ui de MNEAocDAN BLUR, Ase, COMIN TOA Graviite erent o tae fiilope pacar ce determin rmotifcasisemice cu eaacter vanity, ce nfvniears status ‘avi rl al struct entre Evol proses de concep pesns 0 percads mbrionars so prin tl, Perioada embrionara (pimle 10 sgtimin) este 0 peviond uerabil in care se desig organogenca, iat ef pros de facto raoped este maxim. Periada flea (Sptimivile 100) se caracterzet2s pin cetera si dezioltwea difertelor aprate 9h siseme ch scorn ‘roresiva a senshi fa de factors teratogen. In peroneal ‘pt 28 situa’ poate pars rea de nagtere prema, Tn eza ce privet ogansmol mem, sina peda mai mule tape+m trimer (ule 1-3) apar mote adaptive con plese ce se manifests in pencipal pin eis mila g) ves = Sines dup mesee principale, rimestal a lea (lane 46) ese carci pinto sae de etlbrwa gravid; in times al Iles (ile 7) sare gravid e moles lent prow, soliciaes orgnismuli mater devine maxi arn ‘ecb Grape isc sind de compress ven cave iro. ‘Teatamentul stomatologie al gen ice legate de: 1. momenta opti de programa; 2 fetle eal duet din tinpul amentelor stoma tologice asics prod de concept; Vref ogative ale medeamentlor i suhstntelr ans died probleme spe- * 4 raiodiagnotia! tn sing: 5S. Sindroms compres al Yeni cave infroare 1, Moment opin de programareapacenteInsircinate In primal mesa saci (predominana vagala exit isu espe (aston ic, rest aula ete agave eu te tng de vor de azeaatamentlstmataogie ev pratca eo p= ‘Sena In pie geri. Seva eit pogramarea in cus cine, Couece cist ac legate de fenomensle de disgravide (cat tinal. “Taamentle somatologce de rin pot 6 efcrante incon de sgurah tn ersl el al dies timesty sarin, gai ‘nae linn stare de eons ‘Serecomands cin rial im utimu wines de saci si seaulvate doar orpenele deno-parootale 2 fectele ster i drei in tinpalrtemental soma Iologic apr produsulu de conceppe ‘Suesul dures din tpl talametelor stomatologice dc Ia escircucautor cant apresaile de enecolamineendogee,s=stea inucojin ait cirelfafto-pacentrs, et 9 civisten musculus teria. Lao conceniniepasmaties reas adrealna simuleazt In principal receptor, anlioring cco placer, eu eft ool sopra musclsuri rine. Can crescue de adrenalin stimula feos rosin ewes placts cnc ms ‘Acie daze efetle caeolaminlorendogene sf exogene (oaroconstcoral soca slur anestezice) poate dce le diminsea ‘maa a circle eto-placentae cu bigoxe i hcariereflad a ‘Btu, dr gla declangeaprecce atv 3, fectele negative ale unor substan alee tn erie stomaotogica Produce farmaccutcewilzate in inp sarin webu i tnunesetumtoase cali great molecular mae; + osolbiite stat; 1 egaedeprotine plsmatce rida; 1 sduaerseze lent sou dele baie placenta Modicamentleiiniseate In tpl srl pot 6 ieadace ‘tana dn xe cn clase dei tal (4 FDA): ‘claus sd mane conto at probit ipsa oir "sca pet evin sau clea clas stale eft pe animale mo adept ‘xia uno scr semaifctve, ar tale mane fat indo + Glug 2: sd eficmate pe animale a evident 0 tonite reds der sale umane a8 demons pan scurlor dup slzarea lr, + casa C= eit ufclete dala animals om cae 52 probezeexistena nor eecte avers; cia aed stile pe animale a {nda existona uno as de fete, para lor lesion umn m3 fest dove4 cla D:siseurile adminis lo a esl sarin fot Above. Vor f ilizate cand Benefcioleste seria ta mare ‘sot ea loi lo * casa rule embvio-etale we fost doves in mod ce 3 epapes vce Beefcu liz or. In cee ce piv subtenfleanesteeflst in mod revert In stomoiogi (conform FDA), cle ot casita ‘ela B Lidocaine 4 asa C: Acai Mepiacaina Subst anestezie posed ipeslubiitste erect ptind tree ase pid baie placenta, iar tocerea anterior din heuaia mara tc atl fave cust a aid cet pec tlepat de prtcnce plasmatie ete mai mare. De scsea se pert substance aneseice ey. ral elegaedepeeice pasate eit a mare Majin stir einio-saiicew ont ci 1 Arisina slag fm pocet de 90 de protcile plasmaie, , ‘beta-blocantele (Atenolol, Metoprolol) > eects Sra int lr de Oconee ars coer a aFenomenle oxic a aneticle ose apa Ia 23 minted inject intravascular espoctvfn 0-30 minute nc supadozi ‘eagle stemice ale aneseicelr Incl npc a il od SNC # sister eaio-rasul. SNC find ma susp In afunee sistema anestezclor locale, simptonele inj le toxic nde Ce anescie se manifest la acest vel, Simplome neurlogce: Priel sinptome unt subete: ‘epursi al ini i boston, 1 Sel senate de ple’, olor de vedere Somme dectve de toxic: ‘+ eomprtment veri incocree; + conracirimscaae, . earn congien, + comalspenrete; > com + apes Simptome erdo-vasulare: Seldeen cocactiliii somo load ani festa pees ~hipoteasune aerials; 2 tdi + stop ear. ‘Vasodilan: hpeemie tegument, Evitareasupradoril slur anesterc se lize pri 1 respecte dvelr mame; 4 doze marine NU au valour absolut doarce bsortia somite foe vasa fie de thie ‘ls pacing ov insfcens enall su pais tmp de ‘njunai exe pein. Evitarea etl intravascular erelizev pin 4 spies oblignori mint ine inne ss njstar fens dict sunt neossre mai mule inject, cesta vor spain imps ‘+ mestnereagermancos ub observa pcintli penta tea spin rosooeevetalele ei once, “Tratament efector one epee: ‘Traumenl ras dept fini de pie oper primer wae detonate se vor is usoarle sid open inte instars nese 1 Sloped idee cose paar gi dsprtia fearon ‘Dock rca apd mise eit ants. Dac slo mesh fost inject rte po inavascl, poste sven det com, pra pemeor sented xe sa orto nace shui or este ma xn aad {pal emi i aint Discpart aalo in carl pve spare pesca ca ipesane eral abe. Alaa ewe cont ip instar Je Ete 1530 np onan deme bina tru puls de pest $8 inn oe esa tile Slo pesmi aca tn care suri slop eae se eep manele de reste coer Reactiletoxice ale adrenaline! Supradozares adrenaline din solu anesezica sau inject ecient nravascular doce i apr de eft eoxice. Daca main fist de adrenalin petra o edn de tame! siomatologe este de 11.003 mere, ‘Simptomaoloia in cau inject scien innavaseulre a ne doze rede de vasoconstrictor const in pariahi 2 sme + eta: lie ances Ace fenomene sin tanztr, cod ln citeva minute dup Inerupre amis coc dene ncaa inject une doze mart de vsoconsicior pot area ‘omplica gave: ipeensiune ae, loa de tm ai ek deanpin pectoral, top cado-respir. |y momeal aparish acesor complicit se aplict mssuie ‘ecfes(meatonnte ncpitolele precedent), montorzcera semncle alesse soles Ambalanja 3. REACTH ALERGICE ACUTE ’ Reso alerpceecute pin sevrttea lor pot produc is ‘cient respratoie aut cu prognostic sever, {a medina dentart area majorite scidntelraerie sunt Frovocte de substanjeleanesteice locales de casera i «aceten(Metisguaben). Aneseicele locale ke ip entre sche araaminatenoie sunt ma fecvent incriminate in prodeeren ae ett alee. Anestercete locale de tp sina st implies ma ain product reeilor serge Recanoserea si didgostical manifesser grave ale reseior sete alericetbuie 5s fact imedat sigs, peu ce tama ‘pect ti apicat cu mare urgent [Monifestér eutanate acute Urticaria etait rare ee bse insta, fat din ple pis ritemninedematoase, ign, mile, pilose co ptnersa mcrae ol is suet ge oo ass Aitudinea de urgen tn cabinet de mein dentard: ‘= aiminisrarea a 200 mg Hiiocoaon berisina nt ‘venos in bolus, spmveghorea poem timp de 60 mite: ses nomena se splch apr gale reac grave (eden Iingin,goeanaflsctc, se vr acorda masurle de pm tor Specie spacial va ranspra urgent + daca fenomenele sad ea intent sa dep, cent vf Innate m servic de Aletgologie pent identfearen erent Edemal angionewotic scat (Quinche) (veri gt ssc Urgenje edie: Sol aaflactc") Repeeinl un edem asst, ncnlamator,nepiigins, bine de ‘nara, nteresind stature mat profunde ae egunetl: hemi, Inco osu elulo-adjpos subcusnan Cel mal eevee spare con omit cu eryia cunt ucarans generis, Clinic apare cu dem afb, moas, cu localzare preecs In este axe (plang, tue, bai maconsh juga Tinga i lst godeu, Teiemal Qunckeapae bras, Fra sme premiere an arate tuator, et 0 dai de eliva ore sau al, dpi a fl de Ts, fr soho etna ei ce mn ters La ae "FE SR pt ¢ Siete smin : Serie 5 SSCS a he sos beet 2 a et sete ‘Edemul acu laringlan (edemul lotic) Manisa eric tip medi, rar, rave discs aeen: ‘at de ip instr apr bras, dopa conta in slerenere medic ett de mec dents Auituainea de urgent in eabinetal de medicind dentar ‘ inrengeen ttamentis somatlope i a alse substan alergzane, * sliciaren Ambalans ano; 1 pln pce epost ex 4 minisrarea de oxigen (-10 Uni); 1 Caerzarea une! vos sper i nsracade Hei seca edrocortizon n doz de tae 250 mg et, connie ln a 300-1 000 mg ‘+ sdministares de anhistamince:Clorfniemina 1020 mp franscla sa ent navenog, + in az de insfcen repre sever se poate ijeta Adelina 3-05 mg 1:1 O00, dain 10 ml ser fiilozeseutnat ‘30 inalingual. Daca se poate isalao Tine enna, se amis TOL ser iol se injects 1 mliminat nm ety * ccoirtomie de necesita cz de utes 1 dud intervie stop eardorespirator se neepmanevele de resuscitae pnt a sosea Abulanel ano. ‘Soculanofitactc (veri scien ,Urgene medizale") Reqrsintd cca mai severk foil de reac lergcd de tip Imei, ce spare ea ware declan nl spun nun utc, ‘iplat x eliberrea unor can ride de mediator (histmid, ‘osaglandine), eea ce dleming vapoiaaje sities bral ct Setdeeabrscl a tensunil aval, dezoltndsseastelo inset ‘suse cu grav (Cele mai events cauze ale reser anailaetice in abil de etc deta sn ™Suhsapele anestzie loa sau consrvaniicomnui de scouea(Methyiprben) ~ mdkamente Penis, Asin, AINS): {bmi somatolgice diverse, * luexul maa din eae sunt sonfesinate miniile chi viele re rat 2 Simple spar la clteva minute dupdexpuneres Ia legen (ijstar su contat cu sons ont u tenia er aid ‘ati ete mai fav Primal singtom este senza de riu gene pe care © acu yecienn Sere sbicte: + "pront Ia nivel basor, pal, ocho, maior 5 ricoator, + sf, iti; > dmc + papi + gre Sonne obec: angioetem, ‘fem ing; ‘wheezing tabi; ipotesune claps; vom dae. ‘Aituines de urge in eabinetul de wedicnd dentars (i 1a; + inrerpera tamil somatlogc gi indplnare ae seul suspcat(eoatteapcintull din nese, iminares aur ‘+ aprare pied decubit dona ca Fr ice rember infrowe(conrintica’ ded spar bai espa) sas In ponte de iguana" * "xigenterpi na crest 10 Uni: + instiea uni fn encase pierce i adminsraea de sole de ser izologi sau Rings nj (compensarevlemic), Tn car de bipotensune Seve Se alminisrnas soluje Ade ‘alin 0,19%0,3 mg soca su lingual dacs bipotesines per Sis, dup 35 minute seeped administra (mas. mi, pi aS bilzwea TAS0 gee meso Ashcan! de mint ers + stinisrarea de 200 mg Hemisccnat de hidrcotizon jan (eau lent, ‘+n sopalcariosespiatoe- resent cadiorespmtre $i soliccarea Ambala 13. RESUSCITAREA CARDIO-RESPIRATORIE IN CABINETUL DE MEDICINA DENTARA (sens seinen Urge curse Prof dr AUINANDRU BLCLR Prot Malta VORONEAN, Sede lor de. Tien NT, Sef de tt de VICTOR GIT, Asis: nde OCTAWANDINER, AB nde CHSTAN ADRS, Asis ini de MA-BOGDAN BLUR, Asin de ComMN TOPAN Stopul cardiowespiztor ete ca mal eas gent medical, succes tutamentull depinind de recusoytea raph i corel | sii, pe de'0 pare, ar, pe do ala, de corcituines 9 eine ‘nisuilr de essctare opiate ‘Cauzle pull eario-epiaor sant mpl: 1 hipoxeie 2 bipovolemie; 3 lurid coin eo zig 4 dezehiie nie (Ks Me, C2) 5. fecte adverse ale uno subsuate medicamenoas; 6 amponadl pesca: 7. peumotore ov pan, 5. embolic mona 9. bipoemie, 10, infart mien aa02 igen eat de mess Sts Derelile fncile vile wbuie Senet ip maxim 30:90 secune dela pieetea sti de consiena. In eabnetal de medicink Aenara obcctvee medial ebuie 3b fe esabien, meniere ‘montorizaesclor 2 fnsivle resprjia eeu, Lop ent Spier se muna In minute tm sopel respirator sn secu In stopl cada. Siopu respirator infil, open cond (eco wi pls bun I arr cart. permite cinta interval valde 0 ie te resusetrenrespatore sab yn de sues, ‘Stop cardia nia exe ml i rv, esuscitrea mai dels si prognostic mal Inca Itrall optim de resist apes ‘In 30secande pint I I mia 30 secon. Stop cardiac in dscursde ‘teva secu (20-30) ese uma vari de sop pia. Reconoaserea stopull cardio-resprator: veri pus Jn areraeartida mu este Cea mai oxacth cod do sonnet cli. Ttoda, nu exist dover ef migere, pri st reel de {use ar semne cae indice preg sui. Se resorted nce ea manewor de vesusstare dat ecient spun asim ‘espe orm ‘Seopal prim ginal a resuscitir cardiorespiorit ete oxignaea suena a subsane cotzale devarce, in cxz cota, se pode ein’ dstive reversal acest, in aproximaty 5 mi- ue din moment pele porta de oxigen a iel cosa ‘Metodele de reunite caesar sunt crs univesle Resusiare este comps dint ste de eps, grate ate TE Asiqurarea suportaai ital bara “A (arway) = asiguraca ai lor serene soperioare B (icathing) = mapa ails ‘(relation = as cara exter 1, Asigurarea suportaa ita avans D Grugs)= meta (cecisiy) = deity eleeics (huis) ~ petri endovenoase itor fanilor Vise susiare ceria | ig a sa 03 Asiguraressuportuel 1 Gatensive eae) resmcie reasi. ‘ssguraestsamectl prelungt Sop fn cabinetal de mediing dentard se poste sigur in imita de compte, supra vital bz, Acct faa resus mu neces 9 ‘hare tehnicovmatrl costae cl pun a prince seeunde-nioute ‘sata ls Bazzaz pe aboedl acca det, spl cu mato pte care sant Is inden oer mie ‘Stopul cardiac tebuiestspectat In orice pace cai gi piewe src de engin. La aparfia sari de inansens (ipsa de spurs a ‘ml penta va aezat In deci dorsal, pe ur plan dr ean Somatioge, pode) i ev fcepe protocol! deaigaare» suport ‘ial Real ABC"), pl ce mal ih se soe Amboli (gua phone fas pone ft {nana pacer sal la cop mal mar deans la cel cu rine de arte, soietrea Ambulane eebue reali Inne de se teat de ress ( pone fist”) Inceperen imedia a resusciti, urmaih api de solictren Ambuane (pone Est”) est adeats ia cop sob # ani a tone ‘xl decom sin, rou su supadoeare medicamentoas A (airway) = Eltberarea ell aerene superioare Cale aertane bul literate cit mal rapid, dearee obsia respite precip desea top caro espator (unoor acest ms ‘neve est tle pen reuse sponte), in practic samailope, real csr acidentale 9 eilor ‘esgirttsupencae este important ind favrizat deo sere de con ‘secitice maneprelo stomtaogice ‘peal. paciutlu in scaunl somatoogie (apelin center ‘isco pictl acide in evitatn orl i conscoui In lle respira uno cheap de singe, ragmente decorate dene, ‘ura digi, ace de canal, cmpess ‘> spin scien 8 uni ae de seringh deta in inp espe onesieDect pci ete acct (nconiea),tnssel msclor ee sedan acest siti limba pila pot obsrucona frngel. Repemmesbilzarea clr scien superoae Se obine prin deflectarea ectemiji efic gi ascensionares mandibul, paint fin pow tinatindecuit daca, pe on plan taco csp ints to parte Pri aceste mance se exevith atl > © min iid regiunea ceva possi a bohvuk Ge pe planul faa, timp ce cu ina celal va spa regianesfomala yo va eps poserion + meninind exwemiiaia ceed in acast poi, ou ‘mina cae apas rat, se va dia manila inde ul sf mediuolesleidhe mii, apfen sub reiunes ‘meson, enna iss indeahish cia ol petra via ebdeea limb, pe ling sana ante= art & mandibulé ete ecesaré fixes limbiy co © esd sau, dad est posi, inafucerea une pipe 1 Feige tp Gace = capi sun afl in eavitates ora st oofrnge vor Indep manual re jr aspntoul acd respitia spntant mse retail 4 tase Meas tumatone. Fst bligatore venice siti or, scien sop Int cardae sau bravia. severdimpunind. qatamenal conus ‘oes. Veicarea cali! se face grin plpares uli ‘oii in dep atl ian, 1B reathing) = Resabilra respirait Feniru & evalua repiraile pace, medical webuie spropie urechea de caviutea rls wide fesele maze, in timp ce sfesucaza manevele de mefiee a 5 mine mews de rec incon I cont etl ee elu on rumen pie petra apna cra on emeicanentonsC); ae ‘dupa restabilirea eparenta a stirii bolnavului care a suferit args acl crbine smal, pain va i= fora pl Ia prac sca oun service.14, ATITUDINEA FATA DE BOLNAVUL ONCOLOGIC IN CABINETUL DE MEDICINA DENTARA Po ALEBGNDRU BUCUR, rode MARA VORONEAN, Sef de err de TmeRIU NFA, Se de ed, VICHOR GAN, sit or OCTAVIAN DINE, Asie de CRISTAN VLAN, Sis id Mia BOGDAR BLCUR. ASSL. us de COSMIN OFAN aie cu tumor malign less in terol oro-maxio facil prevniaoplla de maid items, cae se adaugh afc sil lcoseionale speifie albu generale sunt ucla, pe de 0 ure cual neoplaia ia, pe de ai ute, tart mitimodsl (chirucl psa rai-cimisterspc). ‘MODIFICARI SISTEMICE Tule maligne produc ait moiftHsale la veal roi Ae oigne a tumor pemare 52 metasazcoy, et modi sstamice in lezen faci orpanelr dts feta de preven tani sa de ttamertl multimodal spies nage rt 1+ cliboara de etre ecu tumoral a unr substne blog ” a efetle locoregional i sisemice date rao i chimio- epics ' efxcle boli supa pill pacientli Indien de localize tumors mage, pcieni pot prez: 1, Depresia Be frosveth gs dtorezt att efter pice se bli de bark, oft i efvelor scoudare ale trpish (naliate, alopece, sete), 2, Malnutritio se reruns comin mal mult ator fe reducrea apo mart pi I ores, arse dle a richie gh factor psi; ~ lai si Vsaturie sunt in principal conscinaterapich Fadlase close He se ot datora gi turorilor ere Meter tb dies: ecure inter ula gest rn preven tama sau tor rezcilr chirurgie; = malbiorji, x urmare recor fst tne ‘Sufi a radionape regu abdominal, + creverea caabollamdul ators modifier biocinice genet de prezana tumorloe maligne, de 9 eomplicfileinetoase =p mpliica set enon: + anomaly meabae exe apa a nivel metabolism sci tiple pete a sensl eet trove Clini mamaria se pate manifesta pei + redvceren reat aceasa putin de a forms wos (3% 4in greta iil) Forma grav 10% din peta nal ‘ snemie ~receres nivel hemopobine! se pate dara ical dei, ci fie, wtaminh Ba aninoasie eet“+ lb de congue sinteza tro de coagulre poate at de pa vitamin! Kastor esi ‘+ imunodepresie In uma asetsit mtabolinmal poi # ‘iii ese feta at imitate cfu, et cca umovall, ‘= vindewe deft spligilor» in special datos afi simeaei de tein: ‘seni iil pid esi defiiormuifonle com plete (rote, lipid, guile, amine minerals). 3. Manifestéri hematologice le pot apkea pe toue cole eh Fn celulare:estocitrd Cee ir eter, usps) robs le rareshemosti) In scese cara, anemia se poate dtora at pirerior ees prin henoragitceute sau manifese cline, eit pi regener rede ators, pe de o part, defi defer, acid fle, vitamins By po ten, ar, pe de lt pare, aba hmaopoiezei deci r-chimis terape In cal replailor hematologic, anemia ete datos bls de buok Lewcopenla i tombocitopenia int praduse prin afer hemutopiczei de care acing fac ca In cal seri rte De asemeen, ele fetal sinter foie cogulir 3 ihi oli eu depasrea esi montage! nt-an snes all $6 appa edie! a sngerare sau wre, 4, Manifestari neurologicesi/sau endocrine Acesca pot foarte variate, determinate si de tamara primis (i ante de localiza sere cde substan baoge etive, 9 de sindwaeleparanoplzie. 5. Aparita unor neoplazi secundare Aces fenomen post verizat de ratioshmiteraie. nop or sia IMANIFESTARI LOCALE Din pune de voder al medicls dents, acest complica gi sechee ale atamentul makimoda in ans roma fall pun maui algorm erapoue caine. 1 Complicatissechele ale tratamentulu chirargical “Terapia muimdals a tymorlor maligne orm de- vermin deveon tbc fanconle gi fzionomice severe. Decaece ron TA rect pia descacan shnptice. ‘+ Repu si adminisraes de Nivogicerin subline, care sivolez4 angina conch sts, at adestod_ dour un eect ‘emporrginomplet angina sab Examen sine: Poa ela 2gomote I 1V plogic (de galop, event un impute apical skins, sogerind disfncia daslcs entries ‘ngs siminarea compliant sau un suf trator de regains tal in cares medio dunt un epaod de achome (prin dine ‘epilr ers ma us), Ace sunt as nee, pon prea st In angorl stabi et inne ear cat Be + modifica travtr al sepmentuhi ST (subdesiveae sau spageivelare) iss iveraizes une! Tapar de obi dat nt Indes, ‘+ motif dnmmie ale segment ST (ubenvelae say spratcivelare epalt ca sau de pesie I'm sepmentuli ST) st ‘egnvarca unde, care sunt rte imprint atne end simple se amstionezh, spent marke ans prog pray, 82 eve Spreinfrt ioc wets dees. IB. Elenentl cae deosebese agin insabila deforma subi sant: fiurile-rptarileintlite a nivel lille aterom st ‘wombozele eventual hemoragileproduse It nivel pet fsurate (instal) Det, angina instal se combind stenoza corona Hx ‘factor inant siceurel coronare(rombus placer st sts ‘matos: fragment dito placd insabilé” g vasomotictate),ccea 2 plied de ce eplsoadele ischice se rode In epaus, fro ere esab necesito de Op ums Inkl in angoral sabi. Conduit de adopt ‘apelare imediatt 112 posi solicutee unei Ambutante ota cu posits de resusltar cardloasular wt tarsi tacanphvastna ua Taternare media, dar, pnt a soskea Ambala data ca poss de reset cardio vascolars: ‘ “seoprest orice procedurisomatologied; 2 rapa abit 1 montaes nt nil de abord wens ini coli (postile) versa86 gene med pe tant de mes dets ‘+ camaea due anit Morfin iv. (1 ol, ie eu ser Holgi) sau te analgezice: Pang (Forty, Min» sab sono TAP = sede: ‘oxigenoeape hierar, eu debit de 6 inn tatamest orenarodlaeide dimiauae a solicit cca ‘Nitoglicting ‘ublingua 23 compre, PEV ati ln TA (TAS mu webuies sca sub 10 mia) st Ie AV (mu fe mai mare de 00a + fetblocans fn special selective, wind seen fevenel cara Ia 6m ‘niagongt clei dar nu Nifediin sublinga sent recomaniste cle cu stiane prelngth (Nifediping GTS, Verpamil SR), + ctsment aicoagulnt: + eparne = adminstaes poste incpe fn cabinet era Su meat dps interac; se poste anc de Tnncepat eu Acial aces (160525 mg), Se ‘ministeaz L500 UT heparin en rete le: ‘ar mae in bolus, apo perineal de 1 0 1200 Urs Does sae pin APT end Howell (Ge urmiree objneen tne vale late 1 2 de alata de conto, NBL Este de dont a avea In dotare etbineus fe bepaine frist (eu gette mpecurd mies), cae se adnseacl Se neces contol repeat al flat aninapunnte), fe acvalor ‘iar al plasminogsnul, care poate de asemics sins cabinet incon de doping sguani Hparnele eu prevatemeloclr8 mics FrxipainfEnoxaprins se adminseaz se. de 2 of pe i, soit, ea in cual heparin co ‘route molecu mae cu Aid aise Clopiogel Pan). Up medial n chien de sn det ea INFARCTUL MIOCARDIC ACUT (IMA) Definite: Infretulmibeardie acut este © noro2h zomal8 9 mugchivu ‘lla, data scheme! ate, evr eng de cele alte ‘prin celia complet a nel artee coonae = uty in cz de ‘ole favorable mara une ccavce ase nce par bolvi eu IMA in forme cx und Q(inficta trsumural) gi fed und QGafartol subendocardi) Mal recent preatre clinch. odewat ete noises de slndroame coromariene (eat care nla angina inti, infact ir ts Q; * infarct ea uns ‘Acs tient ula baz un subset fioptlogiccomen, 53 sume, fur ropa plicit de ale, ear dete formar ul trombus complet obsretv eu devote utero» IMA) sam (engin ins, ceca ce expikneesiaa unl interveati competete 5 energie Inch din cabinet stomaalogie, in voderea Hine rl) ofl necro ‘nl any a deta IMA a fost abut elemento pein sport enor marker de necroe8 micariet ral specif! si sen troponinel earce sf iznforele CKMB. Troponin care fn al serve de peste dous od norma, in context clinic. de ischemic iccardicd‘acut uere coronaria), ceri diagnose de IMA, llr de modiiie ECG speiie (er mio. ‘Tablo aia: Direres clases + Inenitate vrais, de cele mai muke oni sever, wear insuporai + Corateral durecit este constitiv, de stivre, apse, ‘singers, et If in torace, ste + Durata duet ee de peste 30 minute, adesescteve ore (pin che 101224 or prelugies ei se explicd prin prelunivesince sa apuiin uel complica (peenares acess depiete dese ert, 2 Localize drs * radiees sant sila celordesesise in cael zi de angr ibid efor Unoos, dre Icepe in epi fare Poseroinferiowe), pose fi maps de gah ogi asset (aa a 50% ire puienft cu IM wana duet tried Seer), lane pobll ao scvaren refs vagal bw de inl sscepiorior din ves stng pei rls Bessa) in, stl de ecven, pei grata ca nage’ ‘NIB! Uni pace speci bi elon abet 2barat (02), preznth daret orale, cf simptome de tsufnt Yevirculardstingh (IVS) acu nce marc ssheine sa slncoph, Aces simptome se pot fst de tani poze, wea, it . La unit pain pot apres: senate de sic, ame tulpiai, transpire ee, senate de moore iminen ays, Sunt de asemeneapostile manifest neuoogc: sco ia debut IMA, ors de fos (ember aca). Diagnostic ferential dues in IMA se ace co dic in + Chcle de angor sai de efor sn de angor insu sro ara eb 200 mint) eentezd nga ea ac xe dp Ib asa! ECG avalos troponin ale CKMB, 1 Darerea pleura este oil ssi, co Empuns ‘i cen mat ies apa pouty, mal pi cn ae etn infamatr peal) geste agra ci de Recar eple, Spr densbie de area da IMA, ar etic, ec mae eee, + Ella pulmonar produce de obs due inp ate ‘altri ete de oie! devas ples (ves carcese escie mls) 4 pone nso de mop ee sere VS, neil meets emda zy + Pevicardta acu» dreea este predominant pecodil f ‘ii la nveul uma gt pe mavgines taper aceasta ste considera una dine waste care o deosbese de doers da IMA) si velo pti; este agravatt de tise gi de mig epi ‘sori ae modes BCG dfs. #Disefa act de aorta est de bis laa etter! Jn cen trae, eteextem e sever exe desersd de potent senate de fiir, rupee; persis desea mi multe or Hi aleses ities i spate 9 ta membre interior. Adsea ete asc ols a ‘sau mai mle arte ale memo 1 Aectani digestive de tip coecisite acute, panreatet acwe,alerl perorat«darete ae de bie aclzrea abril ‘acteristics nso de manifest digestive de masa cae ‘erie lun examen obietv abdominal + Acti ae arieuallorcono-condrae i condboste rat ke exempt, sindom Tits: daca est localiza de ice punt forma, sfgettoae; se poste asia cu amelie rosea la nivel acer acl xg cu evetualaprezeih de nodal Te ive egw ment earch este considera generatea scent dae ampresiunea zone Examen clinic general: La pocen cu insucens veniculat tgs i stmulae simpaie8apar: transi ei, psloarea tegumenelor, repre opt sisuperficial, ropes, se, neo eu pura (acces elem Pulmonar acu = EPAY, + “Frecvenj cardiac poate vara de Ja bradialie marca ‘ahi eglatineregla a mod ebm pul este rai replat (hice saws 10-110 ba pe miedo der sme onsvuli La 95% din bola, a primele 4 ore dele Seba simpt cor par exasioe vericlre; ‘+ Tensiunes aerial: in primele ore se postin oeretere a TA in jur de 1600 ut, co comeing a hipencatvi space eclonjate de duce sai. Paiei cu soe cardlogen aa pein fine 0 TA ssl sub 90 ming eblgatoris seca eu semne deuo gene 2 cat ee mec dens * seven jt meen nupearene, epee fame ea pe ts a tse am sso et ly ela scrote eed ; ‘zeta pce in tm snl. Se mele ie fe es SoLaeen re e emaes =e ie aap deans ‘sever a ventriculului sting; a i ae eee scan ee ear tens amb denature pose Py 1 man ptt pow Hrs 620% di ‘Pacienpii cu IMA transmural. ee eG: Moditetile ECG evolueaz8 in ore si 2 menu sunt foare imporane: infical tensmural pate debut ou modiiegs when ‘anze,undsQ pote ape uncon ca ma aioe, ds Q pote pea anor pecs, da el mal adests spe e | | Ischemia mosiea ands T (eplarizares). In cae de ischemic subepicarich, nda T devine invest, nega in ear dicho subendcaic und T devin na, siete, sci Leaiunen prespane 0 injure esulard mai sever, dir ned reverse modifics segmental ST (depolariarea tril ae rei earl o sipradenivclare in ctz de lesiunesthepicaich. sau 0. Aesvelae, end eruns exe sbendocadies, Necrora afeciezh depolariara, cu dispariia unde Rs tans nite undl de ptenal enocaitar - una paolo larg cu 0 frat de eel pin 0,04 sccude (unpre pe taseul ECG, in earl vitae de dele de 25m) svn o ince de ce! pain un ert in apis uodt care urea Evol tipie a ECO in IMA transmural (eu nd Q prezeni): fz inils Jemmita de uni autos spac) 28 aac ‘esa prin spar ice’ iecuni subendoanic, siting de a debut IMA pe o period de pn la ie 4 or: apace una de ecroz. Ast, pe ECU ep ising: inal unde T pov, ample, set; + subdenveluea segmental ST Gecune subendocarlct) cere se siz rapid undelorT pote simetice + spo apd, apr evunensabepicaric;supradeaivelaea segmenului ST (cones fn sis) eu inclderea unt T postive; titesor are proresia ce marea unit monarch, de- ums unda Pace, n are suradnivele devi ex ttm i convex i sus Inglobears ua wor chat da taza de infrt cat constitute nine de tn 2-4 ore a 3 siping cupinde tate ele ted lerund ECG earcteisce (ects sine ache), oeaiarea topograis IMA este apreiats dap derivate in ‘are aparmoifcurle ECG casters, Ast pute void IMA: anero-epalcu moifetri pezeste in VI = V4, Inet cu modifi presente VS.V6, DI, aNpose. cv mdi rezone n IL, DIL, a; al venta deep cu most prez fn VIR =VSR Conduite de adoptat souirranns avataasteavasoe a, Stat cu posible resuscitare cardio vascl ‘+ tratamental dureri (ese ese, deoaece contbuie la Almira extense necons prin reduceren cet de ctesolamin, fe carsctrencd amit gi dureea se icepe cu Alpeaimin 1 ld is, apociat eventual cu Dizepar | Fol ine de infclem, dupa 5-10 mite se continua cu Morint (1 fol iv, e 12 cu sor Feige) sau Mialgin (2550 mg: 1 folsyPenacoi Fora 1 ol |), NBL Opiaceele wobec inca dehipensun stron, 4 “tatament coronarodilatatoeide dimiauare. a soletiit vente Nitoglctink: sublingual 2-3 comprimate (cabinet iteror PE, NBL! tei a TA (TAS iu trial sub 100 msl AV (sr emi mare de 10min) ~ exieooterapahiperburd pe sonds maa st mas (6 V min), pat reduce mas de neeoch, ee a anlsties + betarhocant, in special selective, amsndschdere fe ven carie I 60min + snag cleii (dar nu Nien eu absorb iment, iar eimiiststensblinguald in sani ae evoloars co sol hipeiensiv ete strict conrsindiea sun rena ‘le cu ajne peng (Niapind GTS, Verpant S, “Amiodiinds, +, TECA inert cu remodoares venir posit ind ‘ecomadte fn tate SCA (Enalapril, Ramp, Trandlap, Zoe repr 4 Aca acta (Asprnd se umete doar produ fish Bayer 250-325 mg oral - obliguori dacd sun Conan (alert, cer oct): xe mene el demas des 1 +, itopind 0.5.1 mg i se adminiech moma th cz de ‘vatican ub 0/nin iss de hipiensiue antl ‘+ tratamentaltrombolt se face ns ~ dures precordial ene carci, cv duraté. de peste 2030 un, + tscal ECO ou supraenivelre segmenulii ST peste 2mm seu BRS now spt +m exis containdiai iat 9 actiare a cont ingicoilor absolute ale womboin stoke recent ne ‘ei chinrgislepuncie fombar bop hep, ‘woe dent (in uli Iu) stcnperionda pox. cum: taumatsm rea; dinstie dea ancien oie; HT; ressctarecardo-pulmonertpecuagi Age tembolie ce ptf ulin in condi de stan in ‘abineal stomaoogie sin ACT ATORULTGLARAL ASuNOGENAAHGAN AFA: sng tromboltic ce se pote smi In 3 min tw enh blztvtatea mostorizii oagul » Streptokinacs, Urokinaza: este de presupos cf na vor face parte din dotareaebligatrie a unui Caine! soma. NAB! Cu cit timp woeu ote debutal IMA si adminisearca ‘ces era et mai seu, eu at ia tombu ete ma obo ‘dninstat a 30-50 inde a debut rei ads Bene pene ‘ivnd ererea reper, redacees moral pecoee, eee mens IMA si reenze ui peo paioa de pn a 30 hn Se Sonsiderd 3 benefiile adminis gene tomatic mes ase 6 or dela debut sinptomatloieidimcars mal, ‘Trotamenul anicoapulan co heparink na lecacktrombul, dar svn extersia acestn, Se eftctoaza cid nse poate fase tombolon ‘a cin timpul del dbutl IMA pi la recente sxe mat are Dore Recunoajeres si ttamenul complcailor IMA. depjese compen matical stomtaog 5 ma vor fi sbrdate,2. _ ARITMIILE CARDIACE ‘ASSL de GABRIEL ANGELASCY, ef des DELIA DONC, ‘De Cezar MIA POPES, Cond MORIA BRL Defines Arie cadice sunt dette uur se eli cade ‘uate fede motif ale exci inca, fe ale conde nears impulsli electric, Dei rereain in genera, bit de freocopae peat’ medica ime earloge ee sun fecvent Inte in ‘cabin stomtologic. Find pote pseulaase. pn sfestelehmodinmice (oa les pin seers di cna), ait Ile webuie sb fe prompt reeanosete, ade find neces ine ‘efi terapeucd a medic stomuaog, instil pave slcinda- so ambuln dota corespunzter cu posit de resncare card Tespitoie (112), sau, im cele lipste ce grit, pica ind indrumat ce specialist penta evlure comple i sblice ane oie urapetc de ond, Din punct de vedere eiolgie, arte pot H datrt: yoor feat ears, noe afin lear agate ce produc manifest taalace (hperspotoid, singiom hiperknet, peihapal, proces infecjoaseatlanater ete), unor influenefarmclosce’ (verse us ugee median abit de made ets mez agit) sau actu stomatlogc fn sine (psn fits po ogi, Sree, acianessubaneloe mediamenoas amisisrate fm ve (brea pocedu stomatal et) Peru a scien peokabiises spare arimilar cadiace tn carl fren stomaolgic gia dn postlates medi de |nerveni mpd a nevol, o serie de Masur nse presente + otres cabinets cx staoscop, tensionet, tush ca smoliamente; ‘ samneza tenth (mal als J piel vist) leat de olga cade event watamente i cas ‘+ sadrea unr Ta pion emo apiesea anestezeh toca oi de ets exten “> eviaresttamentlor exces pclungte (eventual se eft ‘wewz In odie ucesive, 1 nteugre intervene! stn ind spar seme de suring viene sa eid pic acuzs palpi ameei, dure trace ‘Vom teen revist aril ele mat Hecvet ln In pre ‘st, axindi-e pe dapnostiul cline i tamentl de prim inte ‘TAHIARITMIILE Sunt definite ca arti in cada cra foevefs canis epg 90 imma n fate de tal ere, hail sunt laste in grpe: ew it replat respecte rtm neregul |A-Tahiaritmicu titra regulat TTabicardia sinusoid Defines Crests cree stm snsal peste 100 hii, pins 1a 150 bain co memineres oii ils in nodal sal a caracteriticor nol le ude. “Mecanism creserea automatism normCame: 1 aiolgice: fo fii, emo, er, ses ce, 1 farmacoogice: Eterna, cofeina, eatin, aleooa, nit, pura cu harmon tin str patologice: IMA, angina pectoral, valulpati, cao: ‘nisi, emboli pulmonate, hipstensnne,s0e, ise cardiac pox, period, feocromocto, Simpome yi semne: + “uner esteasmptomati a speci! valor supine ine 99 si 100 biiminu, ts persoane ceili pic gin Son de cexahiviate modems 4 eevent fs, mal ales la valor ale Seen suiae ce eptyese 100 bins, paciental preait: papi, nln le cure, tans jent trace sempele blr caves ‘= "examen general pote eferdate norms, ira, pot ‘onstaste: aloa, hipersuorafi, amet ‘+ misrarea pls arr indict accelaren cesta, ca ‘mepinetea Hama normal a ntensii nd! pulsla + auscauacordull indict 0 ald venture 90-150 ‘mina cu zgmote cardiac pute, de neste dat nove 4 mfineares TA poate of valor oma sa eae os ai In pls Savin imu ale aceein ECG: unde P normale; intra PR oral evens 100-150-160 1 sum egua Goterale RR egal) ‘Manevele vagal: 4 Suoptes fee spd rose; bul ap de ls hess; ance Male, anes Vals; egete adie bint de meen erat “ “compres unilsteata sinasuhiglomusu caro 2 NIBE mane Daini-Ascher ~ foarte simpli: compress bir loi ocular exe stunt connie; 1 escrmin oducres grants even, ca reve fee so nia a cetre or. Tratame 2 ipten pain print aatine cab nfomaren ccs sup Ii de pile ep, 1 nde woud (estan 1 comin, soon com nat, Alacla sori 025 mg). ™ “Aplicarea acestor misuri va conduce Ia sciderea progresiva a frevenl eae pH alot somal, Wwanenal somali pula een ons ‘Trent cron: tamil sa Tdepiaea_ tor ceva og van len cf, tus). mediamenn Tahicarisupraventriculare (TSV) Gener lyre nate vetle 1 Shrn te cnianecppacongentale 2 Steen alos fn foe 2 Sh ek inom Wal Peimon.Wite CUPW cx reduce ima Py fee spect comlea ‘pu net ni nuh a) su Lovo Gaon Levie {Ea caren nel Pi er fk competi 7S) eso ee dei OS) nv tne ops best whi soto factor favorizang: {Afni candosarclre: cadopatia ischemic, valbuo rote, oll eariace congenial ipenensiuea aerial, insfcens {sede perro iat ai,ws Lgeye meses ind demain des >. Factor forza burt clectolitce, agen antainh, Digoxing, agen etamimet (eal Aste brn) periods, afin cerebral, uml aburl de cals de lel Sunt ahead pooxisice dtm tc pe el normale fa intial nodulut AV (nanoda, fom care spre foarte ra) sa jul aod AV Guranods, forma ex mal fovea) Ese en ma ‘even thai sopraventculr (60% din TPSV cn ene) Pest 95% dnt acest acai sunt forme deahicande pi ent care ‘tilizzd nodal AV pentru condoceeaaneograd (cle api) clea srormalé (lent) penta conden regia: aya st cups de ce unele Paper aproape simian ci compexal RS (ee ‘mashes sau apr castors ale pe terminal le QRS. ‘Malt mart este forma pin reinare AV leneapid care Produce nde Pnepative ce apr lint ual complex QRS, ct Incrval PR sce, ‘Simprome ssemne: Depind de dura gi fevenatabcasic, de abenaconibue stil In umplere ventclr gma les de rezena sm ue! Bal Candace srt. Carats este ipa e debaters gi inceie bse, data Ain varias Sontrare persaneeasimptonatic. In general, pacinl deste = psi 1 Sezai de great sau de opresaneanterotrsis + dispnce moder 1 Slabiciane res + acopustri senza de revit” aber ene meal abit ec deta . eve exter + pesados cra sau chiar rr sn vrs ina ee sonia rte ap ee Sega tate etree stein maaan oven cc ain amen obiet: ‘+ alescod a fli in fa apace anv, cu tegumente pliers, tanspiat; 1 nkuracea pula tle o valor de 160-220 bth {esculenta venti de 160-20 Pa "5 sgomotele cardiac sun regu gd ines cpa, {rarer poate aire tml de galop. in cazl in cae TPSV apace in coment wai bol earns, socias sree caracternice ale acti, eventual sempe de inst ‘en cadae,hipoensiue. Pt joa palpi, nervoiine, anite; grave: angled, iasuficien cade, edem pulmonar act, ‘poten arterial, sinops soe Diagnostic BCG: 1 taba exe de obiceiparonse, cu debut ruse de cele tna multe or dolangath deo extrait ce are un PR er; are de asomenca unfit bse; > complexe QRS cu marfloie drat normale (spect spe ‘veniulr)c 0 fever ne 150280 btiminut (eaioal, poste eps 250 bain, ops, ee comple anoma muna da se oct conc short sa lo de asus1 udeleP ce ma dese 0 vind incase in complenu ‘QRS, stu apr en dstorsiuni negate ale pi eminale a complex ‘ORS (pscudeS sau pseud-R) ‘dat este sprint la dtu, se pote const tlburaen de un est ina deo extrasolar xu interval PR along Rispunsal la stimularea vagal aca poste si determine opiea abil sau reducerea ugoart fecvenfl vets, ox reverie even inal la prea manevel — sient it ta tic ict de om ee Werth zai de or ath» esi pe foarte La nl pe ‘pot fi utile: oditna, linigirea, sedarea. : ne a Se fn manele vga; esa sat cu a a feast execute mia pe del card Duct mate vgae sn fe ny ou nut cont inde ef exes nes emer farce ce {Gebese eet npn comer ec nc ea tse ein, nce ate medicament Oren sesr per ‘potest emiowes. deminer legs: ani exe de 6 gx ps uh a neo de 12mg 2 mec ah converse ps0 > antago coll: a pai ce mua spn eae 2in sou dct dp opie nal TESV senso cu cna neni finite (de pp spot admnite Nepal 2:55 mg i 2 min coer och deat a fea 1830 mine, dak ee neve, pat ao deat tot 20 me ~ iti “025 hs opal de 38 mt op Ace macnents nat J it bai x complexe QRS lai, ee pt factor: wane or oo Be epeveniclar conocer seat, oc drama dar agrosiat ‘Seca ene res de ee ve er oct pl Eso dora nil eve de 05 me! gc tn ms rma 3 opr Oya comp eect IW ete la 0 p/p coping Beton webu ofizte freemen yee nse cardi, tll plone cron, arr aca cole: Etonorpon cise Conder lec» eae Se competes medica stomalg. + osname Fam Penne point cy atteune yoscrna vercLAe cvs betasocatele antagonist al Second: ‘even cme nnn Digoin» acfunca se eat lent coe c Gina fel ma ee deh rar: dace st Se aie teal 0.81.0 mpi Osan 19 ie, cme de 028m I ema pan ov cu ont a mst 1g 28d ee Manele vagal, dct 28 fos ieee ptf epee Supt sini Diet Tahicardi prin elntrareatro-ventricuards (tableardi reciproce) Desinies Sin abc paroxisice regulator reins cet ead o eae acevo: sndrmad WPW exis ele woes ee ‘nv itl une lec veniculi cling nodal AV. Rez sn [mera PR sat un complex QRS cout aie del). era aca ou compere igus, cu une Prevopade, invest neo meats QRS. Teast sept ace 62 meicamene cae fxnes com acess AV 1 Aeon te prima mcament deals (vena st),‘Verapamil «act adenorna nu ete eis, cote pre. sui menfonate si ss, Mult mart, in corsa thier, condecres poate fan omic veicu sunt activa pein intel ele secs ny reiaren se fce pin pol AY, Real aicatc cu complene Qe lag, are seamind cu taicartn ventricular, deca ee pes an Aiea. “Tratamestu, penta Sigua, se fice pet tbianie cu complexe QRS lag Pot folste Procsinamig ji Amioduons, das paietl eat stabi ia pune de vedere ennai. = Cardiveria «in caz de nstabiliate hemos, Nu ee ds competes medi stmaiolo = Modicamente de ett: Digoxin, bets Hocanel, acanee caller de cae. 4a sindromal LOL (Lawn-Ganong-Leving) ~ sien scene ‘eaph aul de fiscal His, ccokind modal AV. in stm sen intra PR este set, d complex QRS este normal en mfese rat. Paienil eu sir LGL au assent de stm cer ce Sadr WPM Simptome ssemne: dup ssi de 10 ani In debut celui eal dea deceiy de voit saci tipi dsbutears ease gi sant ssoite ey efota ‘acs pot dra doa eiteva sexunde st tai multe oe arcane mult de 12 of. Attunle pot H fate bine tlemie por ‘simptomatie Transformares tahun eipoc in ii aa et ng orto, ici pout math de un spans veniclar ped (pee 250 mint) amevinitoare de vais +a it mile (45 pn la 60 ani) dies problema de ce ‘spre o tulburare de im (eae impli o cle seca care eae on 19 ugesenesolem tne Gemedtns ees ES penal ie oone vit Se pte a sens erupt de eth opr ‘Beja eto ar conducereveniul-atal. ‘rata mica pos pine: Un crgt el ls) i i a cfc ees ‘AY pe a op reir ae ati aca erin medicaments Vecapnil sau Aseozind - ot fteiasufcentconduceres Sm casa ta: Chinn, Prints, Disopiai. (Casale: Flsanda, ropatenona, are Inetinese onducre in enka accesaie~ punt lb al eet fe reintae. Acete medicament sin foloste oral say fsteavenos in trtmentl cu - Amioron etc in sa, ee flosit mums n ‘ae deg I celelae medieanenc Tahicardia otrialé veritabilé (prin automatism, ectopicd) Defies on atl pel wa mats anon a celllor aisle sau ein sil. Este cea maa Tehctte ew complexe QRS ing Caure Coens fev: iti sli: umori,percatit; inte moficamentoas (de ex Digosn) sau chmice (le ex. leo, inhaler de sue toxic), rec: Undee P reed complexe QRS, ca marfolope frit de ole i ipl tml sins en pot sha ie vibeTrataent Control scree vencaare sw opr tahcadat se pot reine © Bete bocae, 1 Anlagorit a calle de Ca * Amioduron- dct fein verriculrd este aera Daca arimin ese seuniat intaxicae stalice exe esenala sormaizarea elector sanguin ‘NIB! Manezele vapale 9 slenovina sunt ineficiet i, fm pus prin ocalAY pe ae creer, pt mise ests hic aise 6, Tahiaritmi cu itm neregulat Extrasistoleleatrale (EA) Defines ‘ati (Conta) premature, oven inleite ak Ik pesoane ‘Snstoase, el hie! ev alsin eario-wasesare sa cv ate esi, Caz actor fvorizantis Suit emoionsle, fama, efen, futur alcool, cadionatic ischemic bl valvular, cardiomipat, bol congenital cardace, hi pertividsm, medieamente(gtlce, Elena, Twoxna, agent ate stn) Aspect line vai. De'la sbsena smpiomelo, ls papi enlate sa fecvent, dures proce dspace, obosel, sare eninge La prin suscep, po inkia thea paroxnessupa seni. kee: unde P care spur prematr, umate de complexe QRS ot rmorfloge 3dr normale (excep: concen aera, rer ‘un ble derma), 4 upicle Pau morolgi fer de und Pa mut sisal (exces EA provenie cir din nodal sis, interval PAR normal, de este 0.12 secumde; 1 psc postexiasstlies mu est compres 4 extras ariale (EA) pot apes: ite, I save, sist sntzate (bgeminism tigeminism ee). Evalue Pot ina ale aha supraventricular (acdc paoxision soravetriulr, Oster: lai mil), ‘Tratament: ‘Exassolle aval asinpomatie, cu sinptome minor, sa i atsenja unoe toll cadiace structurale Sau cornariene mu necest ‘Seimpune wn tata males ack EA indus “aici soeaventcuat, “ore repetitive de ite trial a ter trial * prec ils ox sndern WOW. ou aie: ‘optic fama efle, loot, efor expert 1 side woud (Exeverl | compe, Distonesin | om: pina, Alpazolum I compimat 0.25 mgt), ‘+ medicament cate Seca, anagonist i caaleor de Ca, gic gin earn sleet: Chins, Prossinamid, Propesnons, Flcainia’ = dezle gi rtmal de admire vor frente in Extrasistotele oncionale (Es) Definite Contacte veaviulrd pesoce (pemstud), prin automation normal, cre oigine pom fatal inferior sau once Jonetionale (aoa nod ao-venalr, nod isan, face i),Cause: nim normals, bot cardiac, ta mod deoseit acide soo rine act, cord pulmonar conic, txicate digi, hipokaenie, ge anak Aspect nce: 4 aoniates pacienior sat ximptomai 4 moor pot apres: alptati pulai cervical, ved, ube de veers, sinope eG: 4 complexe QRS premature, ngs: + undeleP ale extassolet pot peced complenal QRS, ptf ins nome QS ls Bl) a po rece {ip corpesal QRS; 4 undeleP su negative a I, DI VF; ‘+ ED ptf izle, pistes bisa uigeninisn, so ot cpl, ‘Teatament ‘Lapaceni asinptomati na exe nevoie de trata a simptomatc otf tle kets boca, sntgonii calle 8 Ca-yezial os proprate, doze rtm de adminis, In cant slot: agen aire in caste LA 1C sav I (ea, Tabla jonfonals neurite). Tahicardia atrialé hootcé i multifocal Define: ‘Riimut atk rapide gl mereguat, dtorate activi i foaar estonia. Previn aseminii cu Mblaia srl, cu care este alsce onfundat, darn is nate pin muliple unde de eintareine- tans (ain aia atl), prin noma Fcale ale arcane ‘ai Upon medina deme dent ss et 1 nde P rape cio feevent de este 10min, somal 8 el pin 3 malo deen socal conducere = 9 care precedt compere QRS; ‘= inervleP- complet reepulae, ‘espns vena nregult(Ustate RR ners), are: 1 msjrtaza bolle cardiae; 2 Ma: + poe; 1 exer de: eaeclanine, Teofling, Digan, * hipeatcnic ‘Tratament: 4 "ontamentlbli suze 4 acelas pen li aia, {conta eevee ventult u: ‘sntagonig ai caaelor de Cs: Vespa, Diam, * betabloesne(onindat in BPOC); ‘Amiodarona Fibritogia atrial (FA) Det Tulburare de rm erate pine activate aval deze maa, eu absenis une contact ava fective, datorat wor multiple font de unde de reinrue. Apare un ttm all pid, ecg, sus Particular: selva elects srilor ee resnoseth pe ECG sub forma nor unde ms 9 neepuas, ev smpitiine mor fologievaiabil,cunoseu ca une, ace recto ete de 350. (60 bis, ‘Nodal aiowenticur, ombardat de aces numerase ‘impalsu aisle, devine paral reac Ia impulsurlle wemiae,1s iene mes cnn de mec ne inpotinioate, = in cau proceselrinfratv (smiloidod, soir, se rode), Semne sinptome: Ver ipotimi, sncope, dspace, crze de ang, ssi conf erzeAdams-Stokes-Mergagn cu perderea coment ne lees insfcenseardtce chiar moar sub Examen lini: + itm vesicular sr, regulate 30S, neo! ma ,pemodieat defo sete media abi de meen ent 4 sport nt nteritent 1 Zgomot dtu pin onic iter salar aor sivenculon 7 tenes areal sista ete ees i reins wait ale valor Toate: «+ Bc sri vrriar complet - tara igi, rspnte lnincerperes tate “Aoi ex agli 053 mp2 Bleu aivenelr cle care ampli IMA infor te age ln toi de bic! se ean gota. roo caren IMA nr semicon nit ie extn cu progr tae gov, Debi earde ee Se ek Imeminet de un pecsmaterventclar de npr, dar fnven a {Bick pat a fe forte mh rica sy nonstanth devernd Chigmorit twamer dense niece mows Je peowa toi pemanet Sindromul de nod sinusalbolnav CGrupesst 9 mare variete de anomie fated nodal nwa tide: + bradicordiasinuslépritentts Blea sinoaral manifesta ca Wenckebach sine-aral + Blocul sinatra complet: + oprireasinsala(mpulsl snuse mu revgeste 8 atvece ai. Sindroma brdicardietalcardie ee vast 8 sno devo sinus olay, in eae terol bain tle alereneh prriodeprelunste d sso, ‘Simptome, seme yi dagneticr tse pur ms pode spomesdock foevrg ead ese seus in mod persistent gi eadevat earn fabian sunt reve ‘= asstlle prelingie prods sncpi 4 ace uPiari snt perepate sb forma delta Un pols lent fm speci dacs ene scroqult, pote suger ingnostcal Peatrcertudie dagnosics exe acer inegisvare Holter CG (reise pe 240). Tratame «+ paconisimptomai neces pacing permanent; ‘+ satamentl anirimie pose fi indcat"inpreveniea ‘sharia paroitie 1a pce cu forme eadinhibitor 5 vauodpressare, bet simulate pot Fl fl de ie x pacing, 7 8, Bradiaritmi cu rtm neregulat Blocul atro-ventricular de gradul Il (BA-V gr. I) CCaructeristcts uncle P nu sunt umate mercy de complexe ‘ns Secunose ti variants 1. Bloculariosentienlar de gradu dtp Mobit I (peas diseeia seul de oor, date ‘emongie, taumatsne inracranene recent ‘+ Trombolsk: Strepiokinaza 250 000 UL in bolus, api 100 000 UL in PEV, dip de 24-18 hy; Urokinaa: PA. Se admins trae po am ter insert pater romboras, vr acter ind inflat o womb, Decureceworboliza poate necesita pase 48h pea dzsbsucia complet e vasu, nu pout 1 apca in ischemile Sever, in cae ese noccerh 0 inlerenie rep, penis vara membre ‘ Chirpcal: wombeenboletonie eu sonda Foganyy-rass 'S Combuteres dure: snisiie, neo pias 1 Vavoiatatare:Pssoxilin in PEV. ‘ ‘Trataentl condor patloiee asocite (scheme meant tbr ert et) ‘+ Membre afecat se aaa im poze wyor dees (ou ia prairie) ‘Temperatura ambit 26:30°C. awedTROMBOZA VENOASA PROFUNDA (TVP) ‘Asi nde Coma COsPACH, Contd. oR LAN Defines ‘Trombozs venos profinds(rombotebia venoss profil) ‘eprint prezena un om oni Su mula ta itecnrl veoy Profinde le exremiuilor su pelisul soca cu, open Inflanstor concomitent al pect vasa, TVP afectartfocrent venele membrelor inerioae ale plvsui i mi rsa vons a mmr sipero, Factor’ devise: eimai importa ated ise corel eu paia TVP sunt + tere chiruicale:procedee onopatice, sbi (gent uiae, racic; = vista pst ani, + hesitate + uma, bona pulmonar conics; + imobilzarea rela context no cond patie: + tecdenal vascular cerebral + comvalescena postopera CIMA: + ize estrogen; + tmumatsme ale coloane verterale, pelvis, menbrlor ecu de one lang rin, oplasme: de ances, planda, ova, sical sin, toms: + str de iperongusblate + deci ale protein C sau S reena antzombine! I, rezens accor ation, oagulescravacclart sma + bol mieopoiferatve, + amecedentie deTVP, “+ cconomy class some” care sosied imobilcwea (i same incomodef sme, deavion) ea ativadeshiate, + alt condi: sindom nefote, wombangeita obliterata, book Bebyet, omocisteinuria, obeziea, male factor ce confers reisten la prtena Cacia (in TYP iat, om + Stara venoas inctnien fowl singuin favorzers ‘mupnaia clemenclor gure, cumulates de faci de coeur. “+ Lesnen pertelat venos - solu de connate pin care singsle vine in contact cu seal subendtlil ie produce ada Plachtelr, uma de rein de elierare i 6e formate trembull Pachete, + Mipercongalabiltateasingelu -hperactviate poche 5 iperoagulabiate plastics, NB. Pentru tombotebita profanda_postoperatorie: se ‘aut porta ye masa de opera, yasodlatatiaanesecic,hiper- ‘oagulabltatea, clearance seit al fctrir activator a enagulal ‘atorit stare“Tablos tine ‘In vedere stbilii un igmose de etude ot mai api, «ste sel st anaizam context cline ss au omit precens mus $4 mal mulior Teton de rise, mal ales penne care ssimponie 1, Simpromatlogia romboce!vnoaseprofunde a membreor Inferior ‘+ Darren nivel extrem ineriare: oii soit ev atin dureri ire merbrali lett despa orzo, fendi asc cu scenes dui: poi devs tea, Sint (ema Lou, compresiamscustun pxnbek + semnul Homans: dorsiesa exemiti Hbee a ments infor (bei pias) rovonea dere pe fea poste via a gambel (smn nearer, nrc are a tendsite sau tn duel dn febra muscular aslo Ine antere lateral gan) -manevra Lisker:darere generaté de percuia apie tibial antvioare (sible se transit pin os In eon feat ese consideratd cea ma senibillai mane ‘ve lind pentru dignostel put de TVP; Semaul Pat dure Te compresia malo muscle ae Aurea produc prin compresa muscular gambel ete prezcta at fo TVP, et im mini fra macula ‘endnit potineet, Edema exert infroare: se caactrzeazl prin grade diet desert (dsr msi pon div produce accentuates edema; Tacepe disap fia dort icon) peimseoa, pose extind posi + eo epezind singura maniete af * spas wl codon venos (eesti a alp) pote oi ndagnostc diene vombofibita siperticalt. get neal n cits de eden drt 3 alr: Modi ale tegument: + noted, luionse gi suite in ca de elem imprint, o ‘eperta locals esc, canoe cu seadeea tempera locale in xz de pangens ‘venoas(plepmata cere lens); palde, eu scideren tempeaturt local, prin. spasm rer asoca (plegmati aad) Manifest generale: * Tera in speci i cod unl sas septie) 1 thier (uncon, pul tartor” Male), sae der adfint (pin emboli mic repetitive ~ his dspee nea de spare a miroerboilor pulmonar) “Manifest de vecnaae aston * hide eno reine Ent cllnie ale TVP: ‘hes coerulea dole ru bia alba + form rv trate! tomboze muse i fina a turer veodor peofunde sl supericiale, uneari peo ‘tombe! ilo-femuralpreexseni ‘paren special a nivel membrlinfroae; debut nse, prognostic uncorirezeva. Phiegata aba doers = clini: dere inna i mene fet, elem volunitas feel mem iano, aca exenisi - compliei grvt oul hipowoemie, + cvoie eu gviate maxim: pangrend, emboli pulmonar, eee: Sau evolue mal py sever, eu prezeja complicit de tip conc sindromalposteomboe VP a membrilr supericare (vena allarh $1 subclav- fouma peimitv- trmboza de efor: prin efor violet de due a rau (opie, te, dere de ges desapa expull) sau ner inclfe mec hey cai de mcs ens lini: igidate a beau, edem a mini, due ale sembrs respet ‘Som secundard aur: tora sa tum, 4. Tromboza venel cave lnferivere » spare pin esensis wos ‘eomboze veprse iio femurale saa veer ovariene, ele sa pin ‘raumatsme direct, compres tumerale: + line * dem al anbelor meme infrioare gi pli infrinae ‘euch ane + are; + eveulie venoassubcuana I nivel pert ahdon- info regi orbare, ‘+ infunetie de ocalzarea trombutis ‘obra loth de vise « veneor ovine tepte: tyre dasa acesiora ia vencorvagnale molar,

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