Trauma Toracico

KWWSZZZHOSUDFWLFDQWHJDOHRQFRP
75$80$7,602725È&,&2
$LWRU(W[HEHUULD*DULQ'LSORPDGRHQ(QIHUPHUtD
KWWSHVJHRFLWLHVFRPVLPSOH[
+D\WLSRVGHOHVLRQHVSRUXQWUDXPDWLVPRWRUiFLFR
x
x
x
x
/HVLyQGHODSDUHGWRUiFLFD
OHVLyQGHORVSXOPRQHV
OHVLyQGHOHVSDFLRSOHXUDO
OHVLyQGHORVJUDQGHVYDVRV
/(6,Ï1'(/$3$5('725È&,&$
/DPDVIUHFXHQWHVVRQODVIUDFWXUDVGHFRVWLOODV/DVFRVWLOODVTXHPDVVHIUDFWXUDQVRQOD
\ODGHELGRDTXHHVWiQPHQRVSURWHJLGDVSRUODPXVFXODWXUDWRUiFLFD
(QODVOHVLRQHVGHODSDUHGWRUiFLFDWDPELpQVHLQFOX\HQHOYROHWFRVWDO\ODVIUDFWXUDVGH
HVWHUQyQ
/RVVLJQRV\ORVVtQWRPDVTXHFDUDFWHUL]DQODVOHVLRQHVGHODSDUHGWRUiFLFDVRQ
x
x
x
'RORU
9HQWLODFLyQ LQHILFD]
5HWHQFLyQGHVHFUHFLRQHV
/RVSDFLHQWHVFRQIUDFWXUDVGHFRVWLOODVUHVWULQJHQODUHVSLUDFLyQSDUDOLPLWDUHOGRORU
TXHOHVFDXVD&RPRUHVXOWDGRVHDFXPXODODVVHFUHFLRQHVUHVSLUDWRULDV\SXHGHQ
GHVDUUROODUVHDFWHOHFWDVLDV6HVXHOHXWLOL]DUDQDOJpVLFRVSDUDDOLYLDUHOGRORU\HQFDVRV
QHFHVDULRVHOEORTXHRGHORVQHUYLRVLQWHUFRVWDOHVFRQXQDQHVWpVLFR
(OYROHWFRVWDOUHVXOWDFXDQGRGRVRPDVFRVWLOODVDG\DFHQWHVVHIUDFWXUDQSRUPDVGHXQ
OXJDURFXDQGRHOHVWHUQyQVHGHVSUHQGHGHODXQLyQFRQGURFRVWDO/DOHVLyQGHVWUX\HOD
LQWHJULGDGHVWUXFWXUDOGHODSDUHGWRUiFLFD\ODKDFHLQHVWDEOH(OVHJPHQWRGHVSUHQGLGR
WHQGUiPRYLPLHQWRVSDUDGyMLFRV
(OUHVXOWDGRHVXQDUHGXFFLyQGHODYHQWLODFLyQTXHVHPDQLILHVWDFRQXQEDMRYROXPHQ
FLUFXODQWHDXPHQWRGHOHVIXHU]RUHVSLUDWRULRHKLSR[LD3XHGHUHTXHULUHVWDQFLDHQOD
8&,\SUHFLVDUYHQWLODFLyQPHFiQLFD
/(6,21(6'(38/0Ï1
/DVFRQWXVLRQHV\ORVKHPDWRPDVSXOPRQDUHVVRQODVOHVLRQHVSXOPRQDUHVPDV
KDELWXDOHV$PERVVRQSUREOHPDVIUHFXHQWHVGHVSXpVGHWUDXPDWLVPRVWRUiFLFRR
OHVLRQHVSRUDSODVWDPLHQWRWRUiFLFR
/DFRQWXVLyQSXOPRQDUVHGHILQHFRPRXQDOHVLyQSRUKHPDWRPDHQHOSURSLRWHMLGR
SXOPRQDU3XHGHSURGXFLUVHDWHOHFWiVLDV\REVWUXFFLRQHVGHODVYtDVDpUHDVLQIHULRUHV
/(6,21(6'(/(63$&,23/(85$/
/RVWUDXPDWLVPRVWRUiFLFRSHQHWUDQWHV\URPRVSXHGHQFDXVDUOHVLRQHVGHOHVSDFLR
SOHXUDOHQWUHORVTXHVHHQFXHQWUDQHOKHPRWyUD[1HXPRWyUD[\ORVGHVJDUURV
WUDTXHREURQTXLDOHV(VWDVOHVLRQHVVRQHOUHVXOWDGRGHXQDSHUIRUDFLyQRODFHUDFLyQGH
XQDHVWUXFWXUDLQWUDWRUiFLFDKDELWXDOPHQWHHOSXOPyQRXQYDVRVDQJXtQHR(ODLUHROD
VDQJUHVHDOPDFHQDQHQWUHODVFDSDVSOHXUDOHV\UHGXFHQODSUHVLyQLQWUDSOHXUDO
QRUPDOPHQWHQHJDWLYDODKDFHPDVSRVLWLYDKDVWDTXHSDUWHRWRGRHOSXOPyQVH
FRODSVD/DOHVLyQHVSHFLILFDSXHGHVHU
1HXPRWyUD[DFXPXODFLyQGHDLUH
+HPRWyUD[DFXPXODFLyQGHVDQJUH
+HPRQHXPRWyUD[DFXPXODFLyQGHVDQJUH\DLUH
$1HXPRWyUD[
+D\WUHVWLSRVGHQHXPRWyUD[
&(55$'2
/DPD\RUtDGHORVFDVRVGHXQQHXPRWyUD[FHUUDGRVRQHOUHVXOWDGRGHXQDODFHUDFLyQ
SXOPRQDUFDXVDGDSRUXQDFRVWLOODIUDFWXUDGDRXQREMHWRSHQHWUDQWH(QDOJXQRVFDVRV
HOSXOPyQVHFRODSVD\VHLQVHUWDXQWXERGHGUHQDMH
$7(16,Ï1
6LODSUHVLyQLQWHUQDFUHDGDSRUHOQHXPRWyUD[FHUUDGRVLJXHDXPHQWDQGRFRPSULPLUi
ORVFRQWHQLGRVGHOWyUD[(OUHVXOWDGRHVXQDXPHQWRGHODSUHVLyQLQWUDSOHXUDOTXH
SXHGHGHWHULRUDUHOUHWRUQRYHQRVRDOFRUD]yQFRPSULPLUODYHQDFDYD\GLVWRUVLRQDUORV
YDVRVGHELGRDOGHVSOD]DPLHQWRPHGLDVWLQLFR
(OQHXPRWyUD[DWHQVLyQHVXQHVWDGRTXHSRQHHQSHOLJURODYLGD\GHEHWUDWDUVH
LQPHGLDWDPHQWHPHGLDQWHODLQVHUFLyQGHXQWXERGHGUHQDMH+D\TXHEXVFDUVLJQRVGH
KLSR[HPLDGLVWHQVLyQGHODVYHQDVGHOFXHOORGHVSOD]DPLHQWRWUDTXHDOKDFLDHOODGRQR
DIHFWDGR\VLJQRVGHVKRFN
$%,(572
8QQHXPRWyUD[DELHUWRHVHOUHVXOWDGRGHFXDOTXLHUOHVLyQSHQHWUDQWHTXHH[SRQHHO
HVSDFLRSOHXUDODODSUHVLyQDWPRVIpULFD
%+HPRWyUD[
8QKHPRWyUD[HVXQDDFXPXODFLyQGHVDQJUHHQHOHVSDFLRSOHXUDO(OSDFLHQWHFRQXQ
KHPRWyUD[SHTXHxR SXHGHHVWDUVLQWRPiWLFR\KHPRGLQDPLFDPHQWHHVWDEOH6L
UHDEVRUELHUDODVDQJUHQRVHULDQHFHVDULRQLQJ~QWUDWDPLHQWR
(OKHPRWyUD[PDVLYRVHGHILQHFRPRODSpUGLGDLQWUDWRUiFLFDGHORPDVGHVDQJUH
HVXQDOHVLyQTXHSRQHHQSHOLJURODYLGD
$PHGLGD TXHODVDQJUHVHDFXPXODHQHOHVSDFLRLQWUDSOHXUDOODVHVWUXFWXUDV
PHGLDVWtQLFDVVHGHVSOD]DQ\DOHMDQGHOSXOPyQDIHFWRGHWHULRUiQGRVHODYHQWLODFLyQHO
UHWRUQRYHQRVR\HOJDVWRFDUGLDFR'HELGRDODH[WUHPDSHUGLGDGHVDQJUHHOSDFLHQWH
SUHVHQWDUD VLJQRVGHVKRFNKHPRUUiJLFR
/(6,21(6'(/26*5$1'(69$626
/RVJUDQGHVYDVRVGHOWyUD[ODDRUWDODVVXEFODYLDVHOWURQFRLQQRPLQDGRODVDUWHULDV
FDUWLOODV\YHUWHEUDOHV\ODVYHQDVTXHODDFRPSDxDQSXHGHQUHVXOWDUOHVLRQDGDVD
FRQVHFXHQFLDGHXQWUDXPDWLVPRWRUiFLFRSHQHWUDQWHRURPR
/DDRUWDHVODTXHPDVIUHFXHQWHPHQWHHVOHVLRQDGD(OWLSRGHOHVLyQSXHGHVHUXQ
GHVJDUURGHODLQWLPDXQDURWXUDSDUFLDORXQDURWXUDFRPSOHWDGHOYDVR
9$/25$&,Ï1
92/(7&267$/
'$72668%-(7,926'LVQHDGRORUHQOD]RQDGHODOHVLyQGXUDQWHODVUHVSLUDFLRQHV
,163(&&,Ï17DTXLSQHDPRYLPLHQWRSDUDGyMLFRGHODSDUHGWRUiFLFDDEUDVDFLRQHV
ODFHUDFLRQHVHTXLPRVLV
3$/3$&,Ï1'RORULPLHQWRVREUHODVFRVWLOODVOHVLRQDGDVSRVLEOHVFUHSLWiQFLDV
$86&8/7$&,Ï1'LVPLQXFLyQGHORVVRQLGRVUHVSLUDWRULRV
&21786,Ï138/021$5
'$72668%-(7,926'RORUHQODSDUHGWRUiFLFDGLVQHD
,163(&&,Ï1$JLWDFLyQSRUKLSR[LDWRVLQHILFD]KHPRSWLVLVSRVLEOHVDEUDVDFLRQHV\
FRQWXVLRQHVDXPHQWRGHODVVHFUHFLRQHVSXOPRQDUHV
3$/3$&,21(63RVLEOHGRORULPLHQWRGHODSDUHGWRUiFLFDOHVLRQDGD
$86&8/7$&,Ï1&UHSLWiQFLDV\VLELOiQFLDV
1(8027Ï5$;
'$72668%-(7,926'RORU WRUiFLFRSOHXUtWLFRSXQ]DQWHGLVQHD
,163(&&,Ï17DTXLSQHDH[SDQVLyQWRUiFLFDGHVLJXDO
3$/3$&,Ï13RVLEOHHQILVHPDVXEFXWiQHR
3(5&86,Ï1KLSHUUHVRQDQFLDVLHVFHUUDGR
$86&8/7$&,Ï1'LVPLQXFLyQGHORVVRQLGRVUHVSLUDWRULRVHQHOODGRDIHFWR
+(027Ï5$;
'$72668%-(7,9267LUDQWH]RGRORUWRUiFLFR
,163(&&,Ï17DTXLSQHDH[SDQVLyQWRUiFLFDGHVLJXDO
3$/3$&,Ï13RVLEOHHQILVHPDVXEFXWiQHR
3(5&86,Ï10DWLGH]
$86&8/7$&,Ï1GLVPLQXFLyQRDXVHQFLDGHVRQLGRVUHVSLUDWRULRVHQHOODGRDIHFWR
/(6,21(6'(/26*5$1'(69$626
'$72668%-(7,926'RORUWRUiFLFRTXHLUUDGLDDODHVSDOGDGLVIDJLDGLVQHD
,163(&&,Ï1,QTXLHWXGURQTXHUDHVWULGRUHVSDOLGH]
3$/3$&,Ï1'HVSOD]DPLHQWRGHODWUDTXHDGLIHUHQFLDHQODDPSOLWXGGHOSXOVRHQWUH
ODVH[WUHPLGDGHVVXSHULRUHVHLQIHULRUHVSXOVRVIHPRUDOHVGLVPLQXLGRVRDXVHQWHV
$86&8/7$&,Ï1+LSRWHQVLyQPXUPXOORSUHFRGLDOJUDYH
$&7,9,'$'(6'((1)(50(5Ë$
92/(7&267$/
&RQWURODUDOSDFLHQWHSDUDGHWHFWDUVLJQRV\VtQWRPDVGHGLVWUHVUHSLUDWRULRFRPR
GLVQHDWDTXLSQHD\OHVLRQHVGHODVYtVFHUDVVXE\DFHQWHVSRUHMHPSOR
QHXPRWyUD[
&RQWURODUODVFRQVWDQWHVYLWDOHV
&RQWURODUOD*$620(75Ë$DUWHULDOFRQWURODUWDPELpQOD6DW2PHGLDQWH
SXOVLRPHWUtD
$GPLQLVWUDUR[LJHQRKXPLGLILFDGRPHGLDQWHPDVFDULOODIDFLDO$OJXQRV
SDFLHQWHVSXHGHQSUHFLVDULQWXEDFLyQHQGRWUDTXHDOSDUDUHDOL]DUYHQWLODFLyQ
PHFiQLFD
0DQWHQHUXQDRSWLPDKLJLHQHSXOPRQDULQFOX\HQGRDVSLUDFLRQHVFDPELRV
SRVWXUDOHVILVLRWHUDSLDWRUiFLFD\HVSLURPHWUtDGHLQFHQWLYR
$GPLQLVWUDUDQDOJpVLFRVVHJ~QSUHVFULSFLyQPHGLFD$\XGDUDOEORTXHRGHORV
QHUYLRVLQWHUFRVWDOHVVLHVSUHFLVR
&RORFDUDOSDFLHQWHHQXQDSRVLFLyQFyPRGDHQODTXHWHQJDXQPHMRUFRQWURO
GHOGRORUWRUiFLFR
&21786,Ï138/021$5
/DVPLVPDVDFWLYLGDGHVTXHSDUDHOYROHWFRVWDO
1(8027Ï5$;
/DVPLVPDVTXHSDUDHOYROHWFRVWDO
3RQHUDOSDFLHQWHHQSRVLFLyQ)RZOHUDPHQRVTXHHVWHFRQWUDLQGLFDGR
3UHSDUDU\D\XGDUHQODFRORFDFLyQGHOGUHQDMHWRUiFLFR
&RQWURODUSRUVLKD\IXJDFRQWLQXDGHDLUH
+(027Ï5$;
&RQWUROGHODVFRQVWDQWHVYLWDOHVIUHFXHQWHPHQWH
&RQWUROGHODVDWXUDFLyQGHR[LJHQR
$GPLQLVWUDFLyQGHR[LJHQR\SUHSDUDUPDWHULDOSDUDLQWXEDFLyQHQGRWUDTXHDO\
FDUURGHSDUDGDV
,QVHUWDUGRVFDWpWHUHVLYGHFDOLEUHJUXHVRSDUDDGPLQLVWUDUOtTXLGRV\VDQJUHR
KHPRGHULYDGRV
(IHFWXDUDQDOtWLFDVGHVDQJUHSULQFLSDOPHQWHKHPDWRFULWRKHPRJORELQDSUXHEDV
FUX]DGDV\*$620(75Ë$DUWHULDO
&RQWURODUDOSDFLHQWHHQEXVFDGHVLJQRVGHGLVWUpVUHVSLUDWRULR\VKRFN
KHPRUUiJLFR
3UHSDUDU\D\XGDUHQODLQVHUFLyQGHOWXERGHGUHQDMHWRUiFLFR
&RQWURODUFRQIUHFXHQFLDHOOLTXLGRGUHQDGRSRUHOWXERGHGUHQDMHWRUiFLFR
&RQWURODUORVQLYHOHVGHKHPRJORELQD\KHPDWRFULWR
3UHSDUDUDOSDFLHQWHSDUDSRVLEOHLQWHUYHQFLyQTXLU~UJLFD
/(6,21(6'(/26*5$1'(69$626
/DVPLVPDVDFWLYLGDGHVTXHSDUDHOKHPRWyUD[
(VLPSRUWDQWH&RQWURODUDOSDFLHQWHHQEXVFDGHVLJQRVGHGLVPLQXFLyQGHOD
SHUFXVLyQKtVWLFD\VKRFNKLSRYROpPLFRLQPLQHQWH