Trauma cervical
-
Upload
hospital-universitario-de-maracaibo -
Category
Documents
-
view
16.802 -
download
3
Transcript of Trauma cervical
![Page 1: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/1.jpg)
Dr. Rafael A. Delgado M.R III Cirugía General
Unidad 4
MARZO, 2010
Hospital Universitario de MaracaiboUniversidad del Zulia
Postgrado de Cirugía General
![Page 2: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/2.jpg)
![Page 3: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/3.jpg)
![Page 4: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/4.jpg)
TRIÁNGULO CERVICAL ANTERIOR
![Page 5: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/5.jpg)
![Page 6: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/6.jpg)
![Page 7: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/7.jpg)
![Page 8: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/8.jpg)
![Page 9: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/9.jpg)
Fascia Superficial
Fascia Profunda:• Capa de Revestimiento
• Capa Media o Pretraqueal
• Capa Prevertebral
![Page 10: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/10.jpg)
![Page 11: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/11.jpg)
![Page 12: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/12.jpg)
![Page 13: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/13.jpg)
![Page 14: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/14.jpg)
![Page 15: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/15.jpg)
![Page 16: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/16.jpg)
![Page 17: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/17.jpg)
![Page 18: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/18.jpg)
![Page 19: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/19.jpg)
![Page 20: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/20.jpg)
ZONA I
![Page 21: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/21.jpg)
ZONA II
![Page 22: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/22.jpg)
ZONA III
![Page 23: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/23.jpg)
Epidemiología• Corresponde al 5 % de todos los traumas
• 30% de los casos tienen lesiones asociadas
• 11% de mortalidad
• Hasta 55% de morbilidad
• Trauma Vascular es la principal causa de Morbilidad y Mortalidad
• 50% de las muertes son debido a trauma vascular y trauma del cordón espinal
![Page 24: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/24.jpg)
Clasificación• TRAUMA CERVICAL PENETRANTE
95% de los casos
• TRAUMA CERVICAL CERRADO
5% de los casos
![Page 25: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/25.jpg)
95 % de los Traumas CervicalesPerspectiva Histórica:
• Primera Guerra Mundial: Tratamiento Expectante o Quirúrgico diferido (Mortalidad 36%)
• Segunda Guerra Mundial: Exploración Quirúrgica es la regla ( Mortalidad 9%)
• Actualidad: Manejo Selectivo ( Estudios Diagnósticos)
Mecanismo del Trauma:• Arma Blanca vs Arma de Fuego
Examen Físico: Sensibilidad 69%
![Page 26: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/26.jpg)
5% de los Traumas CervicalesMayor morbimortalidad que los traumas
penetrantesCinemática del trauma:
• Accidentes de tránsito
• Accidentes deportivos
• Estrangulación o Ahorcamiento
![Page 27: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/27.jpg)
LESIÓN CLÍNICA
Esófago-Faringe Enfisema Subcutáneo, Disfagia, Odinofagia, Hematemesis
Vascular Hematoma, Hemorragia, shock, ausencia de pulso, soplo, trastornos neurológicos y/o periféricos
Laringe-Tráquea Dificultad respiratoria, Estridor, Enfisema Subcutáneo, Ronquera, Disfonía, Hemoptisis.
![Page 28: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/28.jpg)
![Page 29: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/29.jpg)
Radiografía Simple de Columna CervicalTomografía Axial ComputarizadaEsofagogramaEsofagoscopia Rígida vs FlexibleBroncoscopia y NasolaringeofibroscopiaArteriografíaEco Doppler color
![Page 30: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/30.jpg)
![Page 31: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/31.jpg)
![Page 32: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/32.jpg)
Ventajas Desventajas
Sensibilidad 99%-100% Difícil evaluación de las porciones vasculares distales en zona I y III
No Invasivo Requiere Personal Entrenado
Económico No Terapéutico
No se obtiene Mapa Arterial
Eco Doppler
![Page 33: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/33.jpg)
![Page 34: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/34.jpg)
![Page 35: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/35.jpg)
![Page 36: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/36.jpg)
Penetrating and blunt neck trauma, in Moore EE, Mattox KL, Feliciano DV (eds): Trauma, 4th ed. New York:
McGraw-Hill, 2000, p 443.]
![Page 37: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/37.jpg)
![Page 38: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/38.jpg)
Fuente:From Britt LD, Cole FJ. "Alternative" surgery in trauma management. Arch Surg1998, 133:1177-1181;
![Page 39: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/39.jpg)
Fuente: Manejo del Paciente Politraumatizado: Rodriguez Montalvo, Fernando; Vivas Rojas,Luis; Ottolino Pablo; 3 Edicion, 2008; Editorial DISINLIMED
![Page 40: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/40.jpg)
![Page 41: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/41.jpg)
![Page 42: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/42.jpg)
![Page 43: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/43.jpg)
![Page 44: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/44.jpg)
![Page 45: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/45.jpg)
![Page 46: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/46.jpg)
![Page 47: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/47.jpg)
![Page 48: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/48.jpg)
INDICACIONES ABSOLUTAS DE CERVICOTOMIA EXPLORADORA:• Inestabilidad Hemodinámica
• Signos duros de lesión vascular
• Burbujeo a través de la herida
• Enfisema Subcutáneo
• Déficit Neurológico (Trauma Penetrante)
• Pérdida importante de tejidos Blandos
![Page 49: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/49.jpg)
Incidencia: 9%Pacientes asintomáticos: 35%Mortalidad ‹ 12 horas: 9%Mortalidad › 12 horas: 40 %Conducta terapéutica varía según el
tiempo de evolución:• Reparación Primaria
• Reparación Diferida
![Page 50: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/50.jpg)
Incidencia 16%Mortalidad 35%Conducta:
• Cirugías complejas con alto porcentajes de complicaciones
![Page 51: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/51.jpg)
Incidencia:• Lesión Arterial: 13%
• Lesión Venosa: 18%
Mortalidad: 45%Pacientes Asintomáticos: 45%Conducta:
• Pacientes Inestables
• Pacientes Estables
![Page 52: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/52.jpg)
![Page 53: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/53.jpg)
![Page 54: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/54.jpg)
Thoma ,Mike: Trauma Center, Groote SchuurHospital and Faculty of Health Sciences,
University of Cape Town, Anzio Road, - World J Surg - 01-DEC-2008; 32(12): 2716-23
![Page 55: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/55.jpg)
OBJETIVOS
![Page 56: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/56.jpg)
Materiales y Métodos:• Estudio Prospectivo
• Muestra de 203 pacientes
• Periodo de 13 meses( 12-2006 al 12-2007)
![Page 57: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/57.jpg)
Resultados:• Del total de pacientes estudiados ( 203): 159 (78.3%)
fueron por arma Blanca y 42 (21.7%) por arma de fuego.
• 158 (77.8%) pacientes se manejaron de forma expectante
• Lesiones Encontradas: Trauma Vascular: 27 (13.3 %) pacientes
Trauma Faringoesofagico: 18 (8.9%) pacientes
Trauma Traqueal: 8 (3.9%) pacientes.
• Seguimiento de 12 meses sin morbimortalidad asociadas
![Page 58: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/58.jpg)
CONCLUSIONES
![Page 59: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/59.jpg)
![Page 60: Trauma cervical](https://reader034.fdocumento.com/reader034/viewer/2022050613/55abba481a28abf61b8b45fe/html5/thumbnails/60.jpg)