proiect cardiopatie ischemica

8/13/2019 proiect cardiopatie ischemica

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INGRI!IREA PACIENTILOR CU CARDIOPATIEISC"EMICA

CUPRINS

ARGUMENT

CAPITOLUL I- NOTIUNI GENERALE DESPRE CARDIOPATIE ISCHEMICA

CAPITOLUL II- PARTICIPAREA ASISTENTEI MEDICALE LA ACTE DE

INVESTIGATII ŞI INTERVENTII AUTONOME ŞI DELEGATEII.1 PARTICIPAREA ASISTENTEI LA ACTE DE INVESTIGATIIII.2. PARTICIPAREA ASISTENTEI LA INTERVENTII AUTONOME ŞIDELEGATE

CAPITOLUL III- DESCRIEREA TEHNICILOR IMPUSE DE AFECTIUNE

CAPITOLUL IV- PLANUL DE INGRIJIRE AL PACIENTULUI CUCARDIOPATIE ISCHEMICA

BIBLIOGRAFIE

CAPITOLUL I- NOTIUNI GENERALE DESPRE CARDIOPATIE ISC"EMICA

D,4**(*,

C#r$!)+#t!e !"'e!'# "e $e0!&e"te '# 0!!&$ #0e't!&e# '#r$!#'# 'e #+#re '# r#re # $e(e'!,!br,!

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Cardiopatia ischemică "# b)#,# '#r$!#' !"'e!'* ' #! e $e&!t* e"te ) "0er!&t # !&!!!

$eter!&#t $e & #+)rt !&"0!'!e&t $e )/!e& &e'e"#r 5'!,! '#r$!#'* 4&$e)"eb! 4& ')&$!3!! $e

"),!'!t#re 0!(!'.S0er!&3# +)#te 0! ,#te&t "# #&!0e"t ',!&!'* +t6&$ ',!&# ' )#rte# "b!t.

C%$3*4*$+,

C)&0)r O.M.S. "e $e"'r! $)# #r! '#te)r!! $e #0e't!&! @

1. '#r$!)+#t!# !"'e!'# &e$rer)#"# "# #"!+t)#t!'# @

- t,br#r! $e r!t "! $e ')&$'ere $e &#tr# !"'e!'#

- )#rte "b!t# ')r)&#r!#&#

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2. '#r$!)+#t!# !"'e!'# $rer)#"#

- #&!&# +e't)r#,# 7AP8

&e'e"#r, $e 0,/ "#&!& e"te #r!t. De #"ee&e#* 0,/, "#&!& ')r)&#r +)#te 0! ,!!t#t +r!&

tr)b! #rter!#,!* "+#" "!* r#re)r!* eb),! ')r)&#r!* +re' "! +r!& "te&)(#re# )"t!#,# $#t)r#t##)rt!te! ,et!'e. A&)#,!!,e ')&e&!t#,e* ' #r 0! )r!!&e# #&)r#,# # #rtere! ')r)&#re

$e"'e&$e&te #&ter!)#re "t#&! $!& #rter# +,)&#r#* +)t $eter!&# !"'e!e "! !&0#r't

!)'#r$!' ,# "#r* $#r #'e#"t# '#(# e"te 0)#rte r#r# ,# #$,t!.

De #"ee&e#* !"'e!# !)'#r$!'# +)#te #+#re# $#'# &e'e"!t#t!,e $e )/!e& #,e !)'#r$,!

"&t #&)r#, 're"'te* #"# ' "e 4&t6+,# 4& !+ertr)0!# %e&tr!',#r# "e%er# !&$"# $e

!+erte&"!&e "# $e "te&)(# #)rt!'#. A'e#"t# $!& r# "e +)#te #&!0e"t# ' #&!&#* '#re &

"e +)#te $!0ere&t!# $e 'e# +r)$"# $e #ter)"',er)(# ')r)&#r!#&#.

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tr#&"+)rt# )/!e&,* ' #r 0! 4& #&e!# e/tre $e "e%er# "# 4& +re(e&t#

'#rb)/!e),)b!&e!. N r#re)r!* $)# "# #! ,te '#(e $e !"'e!e +)t ')e/!"t#* ' #r

0! ) 're"tere # &e'e"#r,! $e )/!e&* $eter!&#t# $e !+ertr)0!# %e&tr!',#r# "t#&# "! )

re$'ere # #+)rt,! $e )/!e& "e'&$#r #ter)"',er)(e! ')r)&#r!e&e. A$e"e#* #"ee&e#

')b!&#t!e ')&$'e ,# #&!0e"t#r! ',!&!'e $e !"'e!e.

De"! #rtere,e ')r)&#re e+!'#r$!'e #r! "&t '#+#b!,e $e ')&"tr!'t!e "! re,#/#re* ,# +er")#&e,e

"#&#t)#"e e,e "er%e"' 4& #re #"r# $re+t ')&$'te "! "&t '&)"'te '# %#"e $e ')&$'t#&t#*

P+**'$%,%, 4/+),%, , )$*4,3($+, $%, CI

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Drere# e"te +ter&!' ,)'#,!(#t $e )b!'e! 4& re!&e# +!e+t,! "e "!te 4& re!&e#

retr)"ter&#,* 4& +)r !&e# !?,)'!e* "+er!)#r* $#r* &e)r!* ! 4& 'e# !&0er!)#r.M,t #! r#rț ș

"e$!, $rer!! e"te #t!+!' @ ,# ')t* #rt!',# !# +&,! * &! "# b!,#ter#, 4& re!&e# '),)#&e!ț

t)r#'#,e "+er!)#re "# '!#r 4& re!&e# ,)b#r Drere# #re & '#r#'ter ')&"tr!'t!%* 0!!&$

$e"'r!" '# ) "e&(# !e $e "tr6&ere* '# ) !#r '#re "06"6!e +!e+t,. U&e)r! #'e#"t "t#re e"teț

4&") !t $e te#* $e "e&(# !# )r !! !!&e&te* tr#&"+!r# !!* ,!+" $e #er* er't# !!. A,te)r!ț ț ț ț ț

b),&#%, "!te $rere# '# ) #r"r* )r! '# ) #+"#re $rer)#"* #"e&t)#re &e! ret !ț

'#re 44 +re"e#( +!e+t,.

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'6&$ "&t ,#te 4& ')&"!$er#re t)#te r+e,e $e %6r"t#* '#r$!)+#t!# !"'e!'# e"te 'e# #!

)b!"&!t# '#(# # $e'e",!* & &#! ,# b#rb#t!* '! "! ,# 0ee! .

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$e #&!)r#0!e ')r)&#r!#&# ,# #"ee&e# +er")#&e $e(%#,!e 0re'%e&t b)#,# ')r)&#r!#&#

)b"tr't!%#. Ne'r)+"!!,e +#'!e&t!,)r ' b)#,# ')r)&#r!#&# )b"tr't!%# '#re & # +re(e&t#t 4&

#&te'e$e&te #&!0e"t#r! ',!&!'e $e !"'e!e !)'#r$!'# e%!$e&t!#(# #$e"e# '!'#tr!'e

#'r)"')+!'e "e'&$#re !&0#r't,! !)'#r$!' 4& re!&!,e !r!#te $e #rtere,e ')r)&#re

"0er!&$e. P)tr!%!t "t$!!,)r +)+,#t!)&#,e* #+r)/!#t!% 2:; $!& +#'!e&t!! '#re "+r#%!et!e"'

!&0#r't,! !)'#r$!' #'t +)t "# & #?&# "b "+r#%eere e$!'#,#* #'e"t! +#'!e&t! #%6&$

#'e,#"! +r)&)"t!' &e0#%)r#b!, '# "! 'e! '#re "e +re(!&t# ' "!&$r), ',!&!' ',#"!' . M)#rte#

"b!t# +)#te 0! &e#"te+t#t# "! e"te ) #&!0e"t#re 0re'%e&t# $e $ebt # '#r$!)+#t!e! !"'e!'e.

De #"ee&e#* +#'!e&t!! "e +)t +re(e&t# ' '#r$!)e#,!e "! !&"0!'!e&t# '#r$!#'#* "e'&$#re

$eter!)r#r!! !"'e!'e # !)'#r$,! %e&tr!',#r "t6&* '#re & $eter!&# "!+t)e 4&#!&te $e

> !&0,##t!#!&0e't!# 'r)&!'#

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C/)'%*$ **ț

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#&!&# +e't)r#, e"te ) b)#, '#re +)#te $r# $e ,# 9= "e'&$e ,# 9= $e #&!. )',Ș

'#r$!)e& re+re(!&t & $e0!'!t '!r',#t)r 'e&tr#, #, +)+e! '#r$!#'e $#t)r#t #+r)#+e 4&

e/',"!%!t#te &e'r)(e! !)'#r$!'e #'te. C)+,!'# !!,e "e'&$#re "&t ')+,!'# !! tr)b)ț ț

eb),!'e #,e !&0#r't,! !)'#r$!'. Eb),!# +,)&#r* #''!$e&t, %#"',#r 'erebr#,*

tr)b)(# %e&)#"* #r!t!! ' )#rte "b!t* r+tr# '#r$!#'* '),#+".

T+$($),(&% $+*/'$(*,* *3;,)*,

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-tr#t#e&t 'r#t!% e$!'#,

-tr#t#e&t, '!rr!'#,

-re#b!,!t#re# '#r$!)%#"',#r

-N!0e$!+!&# 7 A$#,#t 8 t#b,ete $e 1=* 4& $)( $e 9 t#b,ete (! )r! t#b,ete ret#r$ $e 2=-9=

-Ver#+#!, 7I")+t!&8 t#b,ete =*= 4& $)( $e 9 t#b,ete +e (!

-D!,t!#(e <=-= (!

-A!)$#r)&# 7 C#r$#r)&e8 ' #' !&e ')r)&#r)$!,#t#t)#re ! #&t!#r!t!'ț ș

T+$($),(&% *5*,/-*,(,(*

-re+#" ,# +#t*)b!,!(#re +r)re"!%#

-$!et# !$r)(##r#t)%eet#r!#&# "! re! !+)'#,)r!'

T+$($),(&% ;*+&+5*$%

- Re#,!(e#re# b +#""-, #)rt)')r)&#r!#& ' %e& "#0e&.

- A&!)+,#"t!# tr#&",b!&#,*')r)&#r* +er't#&t.

Re"+e't#re# r!r)#" # +r)r#,! $e re#b!,!t#re 0!(!' ! +"!!'-4& '#re tr#t#e&t,ș

'r#t!%* #,!e&t# !# r# !)&#, ! #&tre&#e&t, 0!(!' )'+ & ,)' !+)rt#&t-$'e 0!re"' ,#ț ț ș

re'+er#re# "tr!! $e "&t#te ! ,# re!&ter#re# 4& ")'!et#te # b),&#%,!* tr#&"0)r6&$-,ș

$!&tr-& #&$!'#+#t !&tr-& ) t!, +e&tr "!&e ! +e&tr '),e't!%!t#te.ș

TRATAMENTUL DE INTRETINERE

A. T+$($),(&% , *(+,(*,+, * $5;*$ ',(/+$%$

Tr#tee&t, #&!&e! +e't)r#,e %!(e#(#@

1. St#b!,!re# '#(e,)r "! # 0#'t)r!,)r '#re +re'!+!t# #+#r!t!# "# 0#%)r!(e#(# #''e",

$e #&)r. De)#re'e #?)r!t#te# '#(e,)r "&t* r#re # #ter)"',er)(e! ')r)&#r!e&e*

tr#t#e&t, %# %!(# re!, "! tr#t#e&t, #ter)"',er)(e!.

A,te '#(e@ "te&)(# #)rt!'#* '#r$!)!)+#t!!* HTA.

I& #'e"t '#(* tr#t#e&t, #&!&e! +e't)r#,e "e +re"+&e tr#t#e&t,! #'e"t)r b),!.

D+# '#( "e tr#te#(#@ #&e!#* !+)/e!#* !+ert!r)!$#* !&"0!'!e&t# '#r$!#'#. Treb!e

')b#tt 0#t,* )be(!t#te#* "e$e&t#r!",* !+er'),e"ter),e!#* b!#bet, (##r#t*

"tre",*!+ert!r)!$!",K ' #,te '%!&te* t)t! 0#'t)r!! $e r!"'.

TRATAMENTUL CRI>EI ANGIOASE

- re+#" #, b),&#%,!* 'ee# 'e !&"e#&# !&trer+ere# )r!'#r! e0)rtK

- #$!&!"tr#re# $e &!tr),!'er!&# "b,!&#, 1 ')+. $e =*===:* "# 2 - 9 +!'#tr!

$e "),t!e. A$!&!"tr#re# #'e"t)r# "e +)#te re'e+t# $e #! ,te )r! +e (!* "e +)#te ,# "!

+r)0!,#'t!e* $e)#re'e & 're#(# )b!"&!&t#* #'t!&e# e"te $e "'rt# $r#t# "! b!&e t),er#t#.

- $#'# $rere# & 'e$e#(# !& 2= - 9= !&. "e ""+e'te#(# & #&)r !&tr!'#t "# &

"$. ')r)&#r!#& "e%er.

Se #$!&!"tre#(# NITRIUL DE AMIL 70!),# !&#,#t#8* #'t!)&e#(# r#+!$ 1= - 1: "e'.

Pre%e&!re# "e 0#'e +r!&@

- e%!t#re# '!r'"t#&te,)r $e',#&"#t)#re 7e0)rt* e)t!!* e"e ')+!)#"e* tt&8

- #$!&!"tr#re# $e e$!'#e&te ' #'t!&e ')r)&#r)$!,#t#t)#re@

- INTENSATINK

- PRESATINK

- AGOOL 7PRENILAMINA8

- &!tr)')+"! ' #'t!&e +re,&!t#@

- PENTALONGK

"ter&#,# "# +e #&tebr#t.

- DERIVATI NITRICI CU ACTIUNE PRELUNGITA 7ret#r$8@ "e #$!&!"tre#(#

(!,&!'* 2 - 9 (! PENTALONG* NITROPECTOR ')+r!#te $e 2=* 1 - 9 (!.

E0e't, #+#re $+# ) )r# "! ?#t#te "! $re#(# - : )re* re$' ')&", $e

&!tr),!'er!&#.

E0e'te "e'&$#re@ %#")$!,#t#t!# 't#&#t#* 'e0#,ee "# #ete,!.

- $!&tre 'e,e ',#"!'e@ - MIOFILILINUL

- PAPAVERINA

- DIPIRIADOL

- BLOCANTI BETA-ADRENERGICI@ - PROPANOL

- INDERAL

- TRASICOR

Se !&'e+e ' / 1=(! 7')+. $e 1= "# = 8 "! "e #?&e +#&# ,# <= (!.

CI@ t,br#r! $e r!t "! ')&$'ere br#$!'#r$!'e* #"t br)&"!'* IC

- ANTAGONISTII CALCIULUI@ !&!b#&$ +#tr&$ere# '#,'!,! !& 'e,,# !)'#r$!'#* e!

re$' ')&", $e )/!e&* "'#(#&$ &e'e"!t#t!,e "#,e !& O2.

MORFINA "# HIDROMORF.

- COCTEILUL LITIC 7ROMERGAN : PLEGOMAIN :=

MIALGIN 2: 8 !& +er0(!e "# !..

- ALGOCALMIN

- OXIGENUL +e ")&$# &#(#,# "# #"'#* e"te &e'e"#r &! t)#t# +er!)#$# $rer)#"#

"! !& 0)re,e !&")t!te $e ")' "# EPA.

Re+#", ,# +#t "! $!et#@

- e"te )b,!#t)r!e !& t)#te 0)re,eK

- !& +r!e,e )re "! (!,e re+#", %# 0! #b"),t !&")t!t $e #$!&!"tr#re# $e "e$#t!%e

7BARBITURICA* DIAEPAM8 "! #,!e&t#t!e !$r)(##r#t# 7"'r! $e 0r'te* ')+)tr!*'e#!

",#b* ,#+te $!,#t !& #+#8K

- re+#", %# $r# !& e$!e 9 - "#+t##&! "! %# 0! ')+,et 70!(!' "! +"!!'8* !#r

+)(!t!# %# 0! "e!"e(#&$#K

- !"'#r!,e #'t!%e #,e ebre,)r* "&t +er!"e $+# 2 - )re* !#r "e$ere# +e

#r!&e# +#t,!* #,!e&t#t!e ,# +#t "! t)#,et# $+# - 1 (!,eK

- )b!,!(#re# %# 0! )b,!#t)r! +re'e$#t# $e #"#?e #,e ebre,)r !&0er!)#reK

- OXIGEN +e ")&$# &#(#,#.

De #"ee&e#* "e #+,!'# tr#t#e&t, IC '@

- LANATOSID 'K

- CHINIDINAK

- PREDNISON.

Tr#t#e&t, $e 0)&$* #$re"#t #ter)"',er)(e! e"te )b,!#t)r!.

I& e&er#, tr#t#e&t, %# 0! $!etet!'@

- < e"e (! ' ) r#t!e '#,)r!'# #$#+t#t# ret#t!! "#,e@

- !& '#( $e )be(!t#te@ - 1=== - 12== '#,)r!!(! K

- !+)'),e"ter),e!#&tK

- !+),!+e!#&tK

- $e")$#t.

D+# '#(* "e %)r #$!&!"tr#@

- #&#,e(!'e@ - )r0!&#* !#,!&* 0)rt#,.

- "e$#t!%e "! tr#&'!,!(#&te@ - $!#(e+#* e+r)b##t* 0e&)b#rb!t#,K

- & "e$#t!% ")rK

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%!&$e'#t* !&trer+e e$!'#e&t#t!# "! & #! re"+e't# &!'! !&$!'#t!!,e $e re!K

- & re&&t# ,# 0#t* #,')), "! re! $e "#reK

- & re%!&e ,# t!+ ,# e$!' !& )e&t, re#+#r!t!e! "!+t)e,)r "! & e&t!)&e#(#

'!&"t!t '# & # re"+e't#t e$!'#t!# "# re!, !!e&)-$!etet!'K

M)$, "! 0e,, $e # e/+,!'# b),&#%,! $e 'e "0er# "! 0#+t, '# treb!e re"+e't#t

tr#t#e&t, "! re!, !!e&)-$!etet!' #re !+)rt#&t#.

E"te &e'e"#r & t)& b,#&$ "! 0er* $#r &!'! e/#er#r! "# e/+re"!!@ Q'#'! $#'# &

0#'! ' !t! "+&* #! #! +t!& "! )r!Q* "# #,te %)rbe '#re !, 0#' +e b),&#% "# +,e'e

!&r)(!t*"tre"#t.

D+# %!(!t#* b),&#%, treb!e "# +,e'e ' !&te,eere# b!&e0#'er!! tr#t#e&t,! "!

&e'e"!t#te# ')&tr),,! $e %er!0!'#re # e$!'#t!e! $+# '#te%# (!,e* +er!)$!'!t#te# +re(e&t#r!! ,#

')&tr),, TA* '#&$ e$!'#t!# %# 0! ')&?#t# !& 0&'t!e $e e%),t!e.

Tr#t#e&t, #0e't!&!,)r '#r$!)%#"',#re !& #b,#t)r !"! #re "+e'!0!', e! "! "e

$e)"ebe"te $e 'e, $!& "+!t#,@

- treb!e "# "e t!&# ')&t@ - $e ')&$!t!!,e +e '#re ,e #re #'#"# 0!e'#re b),&#%K

- '))+er#re# b),&#%,! ' e$!', e"e 0)#rte $!0er!t#* %#r!!&$ !& 0&'t!e $e +er")&#,!t#te* $e

e$'#t!e* &!%e, $e ',tr#* "t#re# +"!))t)r!'#* $e )b!'e!, $e # 0# "#

')&" $e #,')),K

- & treb!e &e,!?#t e$!, ")'!)-e')&)!' !& '#re tr#!e"te b),&#%,* +e&"!)&#r*

"#,#r! !'* 0#!,!e &er)#"#* "t#r! ')&0,!'t#,e* "t#r! $e "tre" '#@ )#rte# &! #+r)+!#t -")t*

")t!e* +#r!&te* ')+!,* 0r#te* +r!ete&.

L#&$ !& ')&"!$er#t!e 0#'t)r!! $e #! "" &e +te #0,#* '# #"!"te&t# e$!'#,#* !&

0#t# &! b),&#% ' HTA* '#re "# 0!e ) 0)r# ")#r#* e$!e "# r#%#* !&")t!t# 0re'%e&t $e

&# $!&tre ')+,!'#t!!* '#@ !+ertr)0!e %e&tr!',#r# "t#&#* b)#,# ')r#&#r!#&# !"'e!'#*

t,br#r! '# e)$!&#!'# 'erebr#,#.

B),&#%, ' 0)r# r#%# $e #0e't!&e '#r$!)%#"',#r# "# !&")t!t# $e &# $!&

')+,!'#t!!,e e&er#te* #re !&$!'#t!e $e !&ter&#re re&t# !&tr-& #"e(##&t "+!t#,!'e"' '

+r)0!, '#r$!)%#"',#r &$e "e %)r ,# #"r! #$e'%#te.

I& )e&t, '#&$ "-# ,#t )t#r#re# '# b),&#%, "e tr#te#(# !& #b,#t)r* "e !+&

#&!te +r!&'!+!! $e ')&$!t# $e '),#b)r#re e$!'-+#'!e&t* '#re +)t 0! re(#te #"t0e,@

- "t#b!,!re# $!& +#rte# e$!',! # &e! "'ee $e tr#t#e&t '#t #! "!+,#* ')&"t#&$ $!&@

- & !+)te&"!%K

- +er")#&e,e ' r!"' 're"'t $e # 0#'e HTA* %)r 0! "0#t!te "# #,e## +r)0e"!&! ' "tre"

+r)0e"!)&#, #re. V)r e%!t# $e #"ee&e#* +r)0e"!&!,e '#re +re$!"+& ,# "e$e&t#r!" "!

)be(!t#te.

E$'#t!# +e&tr "#&#t#te "e #$re"e#(#@

- +)+,#t!e! #'t!%e !& e&er#, "! t!&er!,)r !& "+e'!#,K

- 'e,)r ' !&'#r'#re ere$!t#r#K

- #$),e"'e&t!,)r "! t!&er!,)r* '#re $e"! &)r)te&"!%! # !& )$ ')&"t#&t %#,)r! #,e TA !& ,!!t#

"+er!)#r# # &)r#,,!K

- "e$e&t#r!,)rK

- "+r#+)&$er#,!,)rK

- #r!,)r ')&"#t)r! $e "#re $e b'#t#r!e 7+e"te 1= (!,e8.

Te&$!&t# #'t#,# e"te "# "e $e+!"te(e 0#'t)r!! $e r!"' !&tr-) 0#(# '#t #! +re')'e* t!&er!! "!

'!#r ')+!! 0!!&$ !& 'e&tr, #te&t!e!. E"te !+)rt#&t "# "e "r+r!&$# tre'ere# $e ,# "t#re# $e

"#&#t#te ,# "t#re# $e b)#,# "! "# "e !$e&t!0!'e "b!e't!! +re$!"+"! ,# b)#,#.

M!?,)#'e,e "&t "!+,e "! ,# !&$e#&# ttr)r@

- %er!0!'#re# ret#t!! - "#+t##&#,K

CAPITOLUL II – PARTICIPAREA ASISTENTEI MEDICALE LA ACTE DE

INVESTIGATII AUTONOME SI DELEGATE

II.1 > PARTICIPAREA ASISTENTEI LA ACTE DE INVESTIGATII

I&%e"t!#t!! &e!&%#(!%e

1. E,e'tr)'#r$!)r##

Pr!# te"t#re # !&!!! "e 0#'e +r!& e,e'tr)'#r$!)r## 7EG8. D#'# EG #r#t# )$!0!'#r! #,e

!&!!!* $!#&)"t!', e #! +re'!" "! & "&t &e'e"#re #,te te"te.

D#'# !&"# e,e'tr)'#r$!)r## e"te &)r#,#* $#r "!+t)e,e "&t +re(e&te "e 'er #,te

!&%e"t!#t!! +e&tr $!#&)"t!', $e '#r$!)+#t!e !"'e!'#. P#'!e&t, e"te +" "# e#r# +e &

')%)r r,#&t "# "# +e$#,e(e +e ) b!'!',et# e$!'#,#* EG-, 0!!&$ $e e0)rt.

E,e'tr)'#r$!)r## re+re(!&t# et)$# 'e# #! +ret!)#"# $e !&%e"t!#re # b),&#%,! #&!&)".

Pe e,e'tr)'#r$!)r## "e +)t !$e&t!0!'# #&!te &$e "! "ee&te@ &$# P* ')+,e/, RS*

&$# T* "ee&te,e P "! ST .

0!(!),)!' !& 0&'t!e $e %#r"t# 7#! "'#(t# ,# t!&er!8 "! 0re'%e&t# '#r$!#'# 7"'#$e !& t#!'#r$!e8

7V#& $er Gr##00 H#& A&#t)8.

C)+,e/, RS re+re(!&t# $e+),#r!(#re# %e&tr!',#r#* '#re !&'e+e ' +)rt!&e# "t#&#

# "e+t,! !&ter%e&tr!',#r "! #+)! "e +r)+## !& %e&tr!',! $e ,# %#r0r! "+re b#(e "! $e ,#

e&$)'#r$ "+re e+!'#r$. Dr#t# "e #")#r# ,# &!%e,, ,!&!e! !()e,e'tr!'e* 0!!&$ &)r#,# "b =.12

"e'. F)r# ')+,e/,! RS e"te !& )$ &)r#, ' %#r0r! #"'t!te* 0!!&$ 0)r#t $!& #!

,te &$e* +)(!t!%e "# &e#t!%e #r'#te +r!& ,!tere,e *R*S 7A&#t) #&$ P"!),) >

te U&!t 0)r #&$ F&'t!)&8.

See&t#, ST re+re(!&t# +r!# 0#(# # re+),#r!(#r!! %e&tr!',#re 7re+),#r!(#re#

,e&t#8. Dr#t# "ee&t,! ST e"te ,!+"!t# $e !+)rt#&t# +r#'t!'#* !#r +)(!t!# "# e"te !& )$

&)r#, !()e,e'tr!'#. P#t),)!# "ee&t,! ST '+r!&$e $e%!#t!!,e #'e"t!# 7"b- "#"+r#$e&!%e,#r!8* e,e 0!!&$ !& e&er#, e/+re"!# &)r t,br#r! "e%ere #,e '!r',#t!e! ')r)&#r!e&e.

Re+re(!&t# 0#(# 0!&#,# # re+),#r!(#r!! %e&tr!',#re 7re+),#r!(#re# r#+!$#8. Dr#t# e"te $e

=.12-=.9= "e' 70#r# !+)rt#&t# +r#'t!'#8. F)r# e"te r)t&?!t# "! #"!etr!'#* #%#&$ +#rte#

$e"'e&$e&t# #! r#+!$#. I& )$ &)r#, &$# T e"te +)(!t!%# !& t)#te

N#r, $er!%#t!!,)r "! r#$, "b$e&!%e,#r!! "ee&t,! ST ')re"+&$e e/t!&$er!! "!

r#$,! $e "e%er!t#te # !"'e!e! "! ')re,e#(# ' & +r)&)"t!' &e0#"t ,# $!"t#&t#. 7198

Pe&tr # 0! re,e%#&te #'e"te )$!0!'#r! '#r$!)+#t!e! !"'e!'e "e re')#&$# +r)be $e

e0)rt !& "')+ $!#&)"t!'. Se 0),)"e"te 0!e & te"t $e e0)rt ,!!t#t $e "!+t)e* 0!e & te"t $e

e0)rt "b#/!#,* '#re +)#te #$'e r#t)#re,e )$!0!'#r! e,e'tr)'#r$!)r#0!'e@ "+r# "#

"b$e&!%e,#re# "ee&t,! STK )$!0!'#r! #,e &$e! TK #+#r!t!# t,br#r!,)r $e r!t "#

')&$'ere '#r$!#'# 7G. O'e#&#* 2==<8.

Trei tipuri de denivelare a segmentului ST: A) Ascendent, B) Orizontal, C) Descendent.

E/t!&$ere# )&!t)r!(#r!! #b,#t)r!! # e,e'tr)'#r$!)r#e! # $" ,# ,#r!re#

')&"!$er#b!,# # +)"!b!,!t#t!,)r $e $ete't#re # !"'e!e! !)'#r$!'e "!,e&t!)#"e. O e/+re"!e #!

igura *. Arterele coronare + piese anatomice inectate cu su!stanta de contrast si

radiograiate: a) in vitro- !) la cadavru

#amenul coronaroangiograic permite vizualizarea vaselor coronariene si prezinta inormatii e#clusive

asupra prezentei, localizarii si severitatii leziunilor aterosclerotice. Coronarograia se e#ecuta indeose!i pentru

diagnosticul dierential as cardiopatiei ischemice ata de alte cardiomiopatii. Diagnosticul dierential al cardiopatiei

ischemice se ace cu toate cauzele sindromului miocardic.

igura (. a), !), c), d) Arterele coronare: coronarograie.

igura /. Coronarograie stanga a), dreapta !) stenoze multiple ateromatoase

Angiograia coronariana cu su!stanta de contrast eectuata la intervale de timp va arata gradul de

evolutivitate al o!structiei coronariene si modul de dezvoltare a circulatiei colaterale $Dr. 0. 0. 1ateescu, 233*).

ventricular dintre care i!rilatia ventriculara este cea mai grava sarsind de regula prin oprirea !atailor inimii care

este de regula atala- trom!oem!olii in care se ormeaza cheaguri in cavitatile inimii, iar ragmente din aceste

cheaguri sunt preluate de circulatia sanguina i#andu7se ulterior in vase din dierite teritorii anatomice cum ar iarterele cere!rale, renale, arterele mem!relor inerioare in cazul trom!ilor ormati in cavitatile stangi ale inimii si in

vasele pulmonare cu producerea trom!oem!olismului pulmonar in cazul trom!ilor ormati in cavitatile drepte $Dr.

0. 0. 1ateescu, 233*).

In sarsit complicatia cea mai de temut este moartea su!ita care se poate instala, dupa 8allavardin,

9dupa 3 de secunde sau dupa 3 de ani din momentul aparitiei primelor simptome;.

2. E')'#r$!)r#0!#

D#'# &!'! EG-, ,# e0)rt +r)re"!% & "t#b!,e"te $!#&)"t!', "e 0#'e ) e')r#0!e # !&!!!.E')'#r$!)r#0!# #r#t# ')&tr#'t!!,e "'!,! !&!!! "! )$!0!'#r!,e* !&$!'#&$ '# !& #'e# ()&#

& #?&e $e"t, )/!e& "# e"te ) !'# '!'#tr!'e.

9. S'!&t!r#0!#

I& "0#r"!t #"!"te&t# e$!'#,# treb!e "# '&)#"'# "! +r!e,e !&r!?!r! '#re re#(# "# 0!e

#')r$#te !& &e,e re&te '#r$!)%#"',#re.

S# '&)#"'# "e&e,e ")',! ')+e&"#t "! #"r!,e $e +r)0!,#/!e +e&tr # !+!e$!'# !&tr#re#

!& "t#$! $e')+e&"#t.

S# '&)#"'# +r!e,e !&r!?!r! '#re treb!e"' #')r$#te !&tr-) ,!+)t!!e "# "!&')+#* #"r! $e

re#&!#re &e'e"#re 7re"+!r#t!e Qr# ,# r#Q "# Qr# ,# &#"Q8.

R/%&% $3*3(,(,* * *5+*@*+,$ /%$*%/+ & $+*/'$(*, *3;,)*$7

-"e$#re# $rer!!*

-"+r#%eere# 0&'t!!,)r %!t#,e

-#"!r#re# &e! #,!e&t#t!! ")r $!er#b!,e

-#?t#re# +#'!e&t,! !& "#t!"0#'e#re# &e%)!,)r 0&$#e&t#,e

-+re#t!re# +#'!e&t,! +e&tr e/#!&#r! r#$!),)!'e

-re'),t#re# +r)$"e,)r b!),)!'e +e&tr ,#b)r#t)r

-#$!&!"tr#re# tr#t#e&t,! e$!'#e&t)" +re"'r!"

-e$'#t!# +#'!e&t,! +r!%!&$ +re%e&!re# re'!$!%e,)r

-+r)0!,#/!# !&0e't!!,)r +e&tr 'e! ' ,e(!&! %#,%,#re

CAPITOLUL III- DESCRIEREA TE"NICILOR IMPUSE DE AFECTIUNE

E,e'tr)'#r$!)r#0!# 7 EG 8 4& '#r$!)+#t!# 'r)&!' !"'e!' +r!& e/#!&#re#

')+,ee&t#r $e b#( 4& $!#&)"t!', 5! e%#,#re# '#r$!)+#t!e!* re+re(!&t ) et)$

!+)rt#&t 4& +)0!$# &e! "e&"!b!,!t3! #! re$"e ')+#r#t!% ' #,te et)$e

7 e')'#r$!)r#0!# * te&!'! &',e#re 8 * EG-, 4& 12 $er!%#3!! 0!!&$ te&!'# $e b#(.

ELECTROCARDIOGRAMA STANDARD

E,e'tr)'#r$!)r## "t#&$#r$ ' 12 $er!%#3!! 4&re!"tr#t 4& re+#" e"te &)r#, ,#

#+r)/!#t!% ?t#te $!& +#'!e&3!! ' #&!& +e't)r#, t!+!' * $#r +)t e/!"t# "e&e #,e &!

!&0#r't !)'#r$!' %e'! . C t)#te ' #&)#,!!,e $e re+),#r!(#re * #$!' )$!0!'r! #,e &$e! T

5! "ee&t,! ST 5! t,brr! #,e ')&$'er!! !&tr#%e&tr!',#re 4& re+#" * "&t "e"t!%e +e&tr

'#r$!)+#t!# !"'e!' * e,e "&t &e"+e'!0!'e * 4&tr'6t +)t 0! 4&t6,&!te 5! 4& b),! #,e +er!'#r$,! *

!)'#r$,! * b),! %#,%,#re "# 4& #&/!et#te * )$!0!'r! $e +)"tr * $r)r! "# b),!

e")0#!e&e. M)$!0!'r!,e t!+!'e #,e "ee&t,! ST

5! &$e! T '#re 4&")3e"' e+!")#$e,e $e #&!& +e't)r#, 5! $!"+#r $+ #'ee# "&t #!

"+e'!0!'e . M)$!0!'r!,e 'e,e #! '#r#'ter!"t!'e !&',$ $e&!%e,#re# "ee&t,! ST * '#re e"te

#"e&t)#re 4& t)#te '#(r!,e 4& t!+, &! te"t $e e0)rt . See&t, ST e"te $e )b!'e!

0!(!)+#t),)!' #! +3!& "e%er * !#r ,e(!&e# e,e'tr)'#r$!)r#0!' * re+re(e&t#t $e )$!0!'r!

#,e "ee&t,! ST * ) !"'e!e #! "e%er.

Abe,e t!+r! $e )$!0!'r! "&t 0re'%e&t '#r#'ter!(#te 4& +r#'t!' $re+t t,brr! $e

re+),#r!(#re * $e5! 4& +r)$'ere# #be,)r !&ter%!& 5! )$!0!'r! #,e $e+),#r!(r!! !)'#r$!'e.

D#t)r!t 0#+t,! ' #t6t )$!0!'r!,e "ee&t,! ST*'6t 5! #,e &$e! T tr#$' !"'e!#

!)'#r$!' * #be,e "&t 0re'%e&t $e&!te 4& +r#'t!' )$!0!'r! !"'e!'e * 0r 4&" # "e

0#'e !&t)t$e#&# +re'!(#re# +re(e&3e!

M$3&+$+,$ 3* /($+,$ +,3'*+$(*,*

De0!&!3!e@ - +r)'e", +r!& '#re "e re#,!(e#( "'!br!,e #()#"e.

St#b!,!re# $!#&)"t!',!.

E%#,#re# "tr!! b),&#%,!.

Ob"er%#re# e%),3!e! b),!!.

Ob"er%#re# e0e'te,)r e$!'#e&te,)r.

I&$!'! 4& #+#r!3!# &)r ')+,!'#3!!.

E,ee&te $e #+re'!#t@

A+re'!ere# 'e,)r,#,te e,ee&te #,e 0&'3!e! re"+!r#t)r!! "e 0#'e +r!& "!+,# )b"er%#re #

!5'r!,)r re"+!r#t)r!!.

N)t#re#@

1 ,!&!e +e 0)#!# $e te+er#tr 1 %#,)#re.

U&!re# %#,)r!,)r "''e"!%e CURBA RESPIRAWIEI.

& &e,e $)'e&te e$!'#,e &)t#re# "e 0#'e '!0r!' 4&")3!te $e '#r#'ter!"t!'!,e

re"+!r#3!e!.

L# $!"+&ee "e &)te#( )r#r,* !&te&"!t#te#* t!+,* e%),3!# 4& t!+.

I&ter+ret#re@

Re"+!r#3!# &)r#,@ "+,* #+,* re,#t* +r)0&$* "!etr!'.

Re"+!r#3!# +#t),)!'@ $!"+&ee* r!t &ere,#t* "+er0!'!#,* 4&'r'#t* ())t)#".

Fre'%e&3# &)r#, 4& 0&'3!e $e %6r"t.

Fre'%e&3# +#t),)!'@

T#!+&ee 7+),!+&ee8 0re'%e&3 're"'t.

Br#$!+&ee 0re'%e&3 "'(t.

A+&ee #b"e&3# re"+!r#3!e!.

D!"+&ee re"+!r#3!# re)#!e* $!0!'!, 7"ete $e #er8.

M$3&+$+,$ 3* /($+,$ '&%3&%&*

De0!&!3!e@

Re+re(!&t "e&(#3!# $e 5)' #rter!#, +er'e+t ,# +#,+#re# &e! #rtere "+er0!'!#,e +e &

+,#& $r.

Pre"!&e# e/er'!t#t $e '),)#&# $e "6&e "!&'r)& ' #'t!%!t#te# !&!!! +er'e+t "b

0)r $e 5)' "# +,"#3!e

Ob3!&ere# $e !&0)r#3!! +r!%!&$ "t#re )r0)-0&'3!)&#, # !&!!! 5! %#"e,)r. St#b!,!re#

$!#&)"t!',!.

E%#,#re# e%),3!e! b),!!* # "tr!! e&er#,e.

E,ee&te $e #+re'!#t@

R!t!'!t#te 7re,#r!t#te8.

Fre'%e&3 7r#+!$!t#te8.

Ce,er!t#te.

A+,!t$!&e 7!&te&"!t#te8.

Te&"!&e 7%),8.

L)', "rr!!@

P"!!'.

F!(!' re+#" 0!(!' 5! +"!!' 1: !&te.

Te&!'#@

Se "+#, 6!&!,e. Se 0!/e#( %6r0, $eete,e +#,+#t)#re #,e 6!&!! $re+te 7!&$e/*

e$!"* !&e,#r8 +e tr#!e't, #rtere! r#$!#,e 4br3!56&$ #&tebr#3, ' +),!'e,e.

Se e/er'!t ) 5)#r +re"!&e #"+r# +erete,! #rter!#, 5! "e +er'e+ (%6'&!tr!,e +,!&e

#,e +,",! t!+ $e 1 !&t 7"e +)#te "r# 5! &#! 1: "e'&$e +,", re,#t* %#,)#re# "e

4&,3e5te ' 5! "e )b3!&e %#,)#re# &)r#,8.

N)t#re@

C!0r!' 4& '#!et > "e &)te#( !&',"!% )r#* $#' +,", # 0)"t "r#t 4& 0r!")&* 0#'!e",

er# r)5 et'.

Gr#0!' 4& 0)#!# $e te+er#tr 8+e&tr 0!e'#re ,!&!e )r!()&t#, "e ")')te"' +,"#3!! >

#$!' %#,)r! +tr#t8.

U&!re# +&'te,)r CURBA PULSULUI.

I&ter+ret#re@

N)r#,@ +," re,#t* b!&e btt* r!t!'* "!&'r)&* 'e,er!'.

P#t),)!'@ +," ",#b* !+er'e+t!b!,* #r!t!'* #"!&'r)&

M$3&+$+,$ 3* /($+,$ (,3*&** $+(,+*$%,

De0!&!3!e@

TA +re"!&e# e/er'!t#t $e "6&e,e '!r',#&t #"+r# +ere3!,)r #rter!#,!.

S')+@ - E%#,#re# 0&'3!e! '#r$!)%#"',#re* e%),3!e! b),!!* # "tr!! e&er#,e.

L)', "rr!!@ - Arter# er#,.

M#ter!#,e@

Te&"!)etr ' er'r 7R!%#-R)''!8* "0!)#&)etr* te&"!)etr e,e'tr)&!'*

)"'!,)etr P#')&.

Stet)"')+ b!#r!',#r. T#+)& ' #,')), 7+e&tr $e(!&0e'3!e ebr#&e! "tet)"')+,!

5! # ),!%e,)r.

F)#!e $e te+er#tr. Cre!)& r)5.

Met)$e@ - P#,+#t)r!e. A"',t#t)r!e. E,e'tr)&!'.

Pret!re# b),&#%,!@

P"!!' "e #&&3 b),&#%, 5! "e e/+,!' te&!'# 74& tere&! "''!&3! 5! +e 4&3e,e",

,!K "e e/+,!' et#+e,e te&!'!!8.

F!(!' re+#" 0!(!' 5! +"!!' 1: !&te. B),&#%, "e #5e#( 4& +)(!3!e '))$* '

br#3, re,#/#t. De +re0er# "r#re# "e %# 0#'e 4&#!&te# "er%!r!! e"e!* "# ,# 9 )re $e ,#

E%!$e&3!#( #+,!t$!&e# )"'!,#3!!,)r #rter!#,e 'e "e )b"er% +e '#$r#&, r#$#t #,

)"'!,)etr,! P#')&.

Se $e"')+er ebre,e "+er!)#re 5! !&0er!)#re > 4br'!&te# & treb!e " 0!e

"tr6t.

M#&5et# "e 0!/e#( ,# &!%e,r!,e $)r!te +e ebre,e b),&#%,!* $e &$e +,"#3!!,e "e

tr#&"!t ,# #&)etr.

Se +)+e#( #er 4& #&5et +6& ,# $!"+#r!3!# +,",! +er!0er!' > '6&$ +re"!&e#

$e+5e5te te&"!&e# #rter!#, #/!.

Se '!te5te )"'!,#3!!,)r +e '#$r#&, #&)etr,!.

Se "'#$e +re"!&e# $!& #&5et ' 1= H 5! "e '!te5te $!& &) %#,)#re# )"'!,#3!!,)r

#rter!#,e.

Se 0#' "'$er! 5! '!t!r! "''e"!%e +6& "e "e5te %#,)#re# #/! # #+,!t$!&!!* 'ee#

'e "e &e5te !&$!'e )"'!,)etr!'.

Se #+re'!#( %#,)r!,e &)r#,e 4& ,!!te 0)#rte ,#r! > %#r!#b!,e $e ,# !&$!%!$ ,# !&$!%!$.

V#,)r! &)r#,e@

Y 9-< $!%!(!&! ,# ')#+".

Y 2- $!%!(!&! 4& 19 "+er!)#r #b.

A$,t 12== H + !&t.

F#'t)r!! '#re !&0,e&3e#( te&"!&e# #rter!#,@

F#'t)r! b!),)!'!@

Y V6r"t# > ,# ')+!,, !' TA e"te #! !' $e'6t ,# #$,t.

Y Deb!t, '#r$!#'* 0)r3# $e ')&tr#'3!e # !&!!!* e,#"t!'!t#te# 5! '#,!br, %#"e,)r*

%6"')(!t#te# "6&e,!.

Y S)&, > "'#$e TA #rter!#,. E0)rt, 0!(!' > 're5te TA.

Y A,!e&t#3!# > 4& t!+, $!e"t!e! TA 're5te 5)r.

F#'t)r! +"!),)!'! > e)3!!* "tre"* #&/!et#te.

F#'t)r! ")'!#,! > e$!, #b!#&t* 0r!, "# ',$r# e/'e"!% 70r!, +r)$'e

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TE"NICA RESPIRATIEI ARIFICIALE

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REGULI DE ADMINISTRARE A MEDICAMENTELOR

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IN!ECTIA INTRAMUSCULARA

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233/T.A 6uls 0esp. T°C Diureza Scaun

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Data 1edicamente 1od de administrare

&(.3*Dipiridamol

Diazepam

1ialgin

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2ml iv

eparina &33 @I<

Aspirina

Betaloc

Trom!ostop

Diazepam

E oral

37372 oral

3737& seara oral

Betaloc

Aspirina

Trom!ostop

=iedipin

&33 mg

E oral

37372 oral

2& oral

Captopril

Betaloc

Trom!ostop

Diazepam

&3mg oral

37372 oral

3737& seara oral

Betaloc

Trom!ostop

Diazepam

37372 oral

3737& seara oral

INVESTIGATII PARACLINICE

Data #amene curente 6regatire pt e#amen Ingriiri dupa e#amen

&(.3* F8

Bolnavul va i asezat in decu!it dorsal,isi varela#a musculatura.

1ontarea electrozilor:

-pe membre:rosu7mana dreapta

gal!en7mana stanga

negru7picior drept,verde7picir stang.

7precordial

5I7sp > intercostal drept

527sp > intercostal stang

57intre 52 si5>

5>7sp * intercostal,pe linia medioclavicularastg

5*7sp * intercostal stg pe linia a#ilaraanterioara

5(7sp * intercostal stg pe linia a#ilaramilocie.

=u necesita ingriiri speciale.

0tg toracic

&4.3* F8

0tg toracic

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re+et#r!* %# #?&e ,# 2= !&te.

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