Monitorizarea noninvaziva la pacientul coronarian critic

Dr.Ovidiu Chioncel

Bucuresti

Suport volemic droguri

IOT Monitorizare Hemodinamica???? EKG

Oxi

Debit urinar

IABP

Defibrilator

 "Repeated or continuous observations or measurements of the patient, his or her physiological function, and the function of life support equipment, for the purpose of guiding management decisions, including when to make therapeutic interventions, and assessment of those interventions.
Medicare 2007

Monitoring is an integral part of the care process together with the administration of therapy. The primary aim of monitoring is to ensure that appropriate care or therapy can be given prior to the onset of complications. Monitoring is therefore a tool that provides early indication of changing patient status, and allows for early intervention, but is also a means by which the effect of interventions and therapies may be recorded, evaluated and controlled.
RCP 2008

Etapele monitorizarii
Prespital
Transport UPU/CG/ODU

In Spital
Evaluarea initiala Monitorizarea pre interventie Monitorizarea in timpul interventiei Monitorizarea post interventie

Telemedicina

Tipul monitorizarii
Noninvaziva Semiinvaziva Invaziva
Continua Intermitenta Alarm based NonAlarm based

Componentele monitorizarii
Clinica EKG Biochimica Biomarkeri ECHO Clinicohemodinamica

Scenarii clinice
Durere toracica si Sindroame de Insuficienta Cardiaca Acuta Durere toracica si Criza hipertensiva Durere toracica si Insuficienta respiratorie Durere toracica si TahiAr sau BradiAr

Scenarii Fiziopatologice
IMA intins IMA Complic mecanice Ischemie tranzitorie disfunctie VS preexistenta Zone de Miocard Hibernant TahiAR BradiAR F.Extracard
Anemia Pneumonia Diselectrolitemie Tulb EAB I Ren ac AVC Etc

Evaluare si suport functii vitale MONITORIZARE Tratament ischemie si F agravanti Definirea precoce a anatomiei coronariene Intinderea zone ischemice la risc

Evaluare miocard viabil

Posibilitati tehnice de revascularizare

Evaluarea , Monitorizarea si Suportul functiilor vitale

Recunoasterea bolii Evaluarea initiala Internare

MONITORIZARE

Tratament (stabilizare clinicobiologica) Stabilirea etiologiei si a factori precipitanti Identificare factori corectabili Tratament Farmacologic/nonfarmacologic Evaluarea raspunsului la trat Stabilizare

Monitorizarea clinicohemodinamica
Etape ale managementului pacientului cu IC Acuta

C.Macarie, O.Chioncel 2008

Monitorizarea clinicohemodinamica
Relatia dintre patternul hemodinamic, profilul clinico hemodinamic (congestie si hipoperfuzie), profilul clinic (umed,rece) si forma clinica a ICA NORMAL

Index cardiac L/min/m2

IC>2.2 L/min/m2 PCWP<18mmHg Fara congestie (uscat) Fara hipoperfuzie (cald)

IC>2.2 L/min/m2 PCWP>18mmHg Congestie (umed) Fara hipoperfuzie (cald)

IC HTA DAICC

2,2
IC<2.2 L/min/m2 PCWP>18mmHg Congestie (umed) Hipoperfuzie (rece)

Edem pulmonar

IC<2.2 L/min/m2 PCWP<18mmHg ICA dreapta izolata Fara congestie (uscat) Hipoperfuzie (rece) Soc hipovolemic

Soc cardiogen

18
Presiune blocata capilar pulm (PCWP)
C.Macarie, O.Chioncel 2008

hTA PVC PVC PVC N RHJ,edeme S3,S4,raluri S3,S4,raluri NU DA NU DA

ECHO
ST V3R

EKG
microV Q3S1T3

hipovolemie

mixta: Card+hipovol Card+septic Valvulopatii

ECHO
IMA VD Tamponada TEP IVS IMA Valv CMD

Tratament