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Fases pre-trans-post operatorio

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Fases pre-trans-post operatorio

  1. 1. 2do. Semestre E.E.Q Mirna Ramírez Alumnas: Karla Martínez Marlene Betance Belinda Flores Guadalupe Romero Isaura Chávez Ana Franco
  2. 2. <ul><li>INTERVENCION QUIRURGICA ELECTIVA </li></ul><ul><li>Se recomienda pero el paciente decide, el paso de horas o días no es determinante para la vida o la función </li></ul><ul><li>Ejem: estética, hernia. </li></ul>
  3. 3. <ul><li>INTERVENCION QUIRURGICA URGENTE </li></ul><ul><li>La función de un órgano o la vida depende de la prontitud con que se realice </li></ul><ul><li>Ejem: estallamiento de víscera, oclusión arterial </li></ul>
  4. 4. Definición: Antecede al acto quirúrgico, el cual se planifica por el anestesiologo , evaluando al paciente uno o varios días antes de la cirugía, para determinar necesidades especificas y factores de riesgo. Esta fase empieza en la primera consulta con el cirujano y termina cuando el paciente ingresa al quirófano.
  5. 5. <ul><li>FASE DIAGNOSTICA. </li></ul><ul><li>HISTORIA CLINICA </li></ul><ul><li>Que consta de... </li></ul><ul><li>Interrogatorio eficiente </li></ul><ul><li>Exploración física completa </li></ul><ul><ul><li>Signos vitales </li></ul></ul><ul><ul><li>Peso </li></ul></ul><ul><ul><li>Talla </li></ul></ul>
  6. 6. Estudios pre-operatorios <ul><ul><li>Preoperatorios completos </li></ul></ul><ul><ul><li>(Exámenes de laboratorio) </li></ul></ul><ul><li>Telerradiografía de tórax, Electocardiograma, Valoración cardiológica, Enema evacuante (si se requiere) </li></ul><ul><li>Pre medicación anestésica </li></ul><ul><li>GENERAL </li></ul><ul><li>Ayuno de 4 a 8 hrs </li></ul><ul><li>Aseo general </li></ul><ul><li>Tricotomía (máximo 2 hrs antes) </li></ul><ul><li>Vestido (prótesis dentarias, alhajas, cosméticos, vendaje o medias elásticas) </li></ul><ul><li>Acceso a una vía intravenosa </li></ul>
  7. 7. FACTORES DE RIESGO QUIRURGICO Son elementos que acentúan la agresión quirúrgica o que limitan la respuesta del organismo.
  8. 8. <ul><li>Factores de riesgo originados en el paciente </li></ul><ul><li>Edad </li></ul><ul><li>Obesidad </li></ul><ul><li>Desnutrición </li></ul><ul><li>Embarazo </li></ul><ul><li>Inmunosupresión </li></ul><ul><li>Urgencia de la cirugía </li></ul><ul><li>Enfermedades concomitantes ( diabéticos, hipertensos) </li></ul><ul><li>Trastornos de vías respiratorias </li></ul><ul><li>Adicciones </li></ul><ul><li>Temor </li></ul>
  9. 9. <ul><li>Anestésicos </li></ul><ul><li>(alergias) </li></ul><ul><li>Acto quirúrgico </li></ul><ul><ul><li>Indicación </li></ul></ul><ul><ul><li>Técnica </li></ul></ul><ul><ul><li>Cirujano </li></ul></ul><ul><ul><li>Tiempo quirúrgico </li></ul></ul><ul><li>Ámbito hospitalario </li></ul><ul><ul><li>Tiempo de hospitalización </li></ul></ul>Dependientes de la cirugía
  10. 11. Escala de Glasgow La escala de coma de Glasgow es una escala de valoración que se suele usar en soporte vital básico y que siguiendo un procedimiento trata de medir el nivel de conciencia de una persona cuando se presupone que ha sufrido un traumatismo cráneo-encefálico (TCE). Esta escala de conciencia examina la capacidad neurológica del momento y su perfil evolutivo. Los parámetros que evalúa la escala de Glasglow son las respuestas a la apertura de ojos, la respuesta verbal y la respuesta motora y según cómo responda el paciente con traumatismo le otorgaremos una puntuación.
  11. 12. Par á metros y puntuaciones de la escala de Glasgow Espontánea 4 A la voz 3 Al dolor 2 Ninguna 1 Orientado 5 Confuso 4 Inapropiada 3 Incomprensible 2 Ninguna 1 A ordenes 6 Localiza el dolor 5 Retirada ante dolor 4 Flexión inapropiada 3 Extensión 2 Ninguna 1
  12. 13. Categor í as del grado de estado del paciente seg ú n la escala de Glasgow Glasgow entre 14-15 Glasgow leve Glasgow entre 9-13 Glasgow moderado Glasgow de 8 o menos Glasgow grave
  13. 14. American Society of Anesthesiologists Paciente en peligro inminente de muerte. La cirugía es el último recurso para salvar la vida, no se espera que el individuo sobreviva. ASA V Con enfermedad grave incapacitante, mal controlada o en etapa terminal. ASA IV Enfermedad de múltiples aparatos y sistemas pero bien controlado. Limita sus actividades diarias pero no hay peligro inminente de muerte. ASA III Con enfermedad en algún aparato, bien controlado y que no altera sus actividades diarias. Factores como obesidad, alcoholismo y tabaquismo. ASA II Sujeto sano sin enfermedad sistémica, cirugía planeada. No se encuentra en los extremos de la edad. ASA I
  14. 15. VALORACION DE GOLDMAN 4 3 3 3 <ul><li>Urgente </li></ul><ul><li>Torácica no cardiaca </li></ul><ul><li>Intraperitoneal </li></ul><ul><li>Neurocirugía </li></ul>Tipo de intervención 3 3 3 3 3 3 3 <ul><li>PaO2 <60 mmHg </li></ul><ul><li>PaCO2>50 mmHg </li></ul><ul><li>K<3 mEq/L </li></ul><ul><li>HCO3<20 mEq/L </li></ul><ul><li>Creatinina>3mg/dl </li></ul><ul><li>TGO anormal </li></ul><ul><li>PFH anormales </li></ul>Estado general 5 10 11 3 7 7 <ul><li>>70 años </li></ul><ul><li>IAM (6 meses) </li></ul><ul><li>Galope o 3er. Ruido </li></ul><ul><li>Estenosis aórtica </li></ul><ul><li>>5extrasístoles/min ECG </li></ul><ul><li>Ritmo no sinusal ECG </li></ul>Estado cardiovascular PUNTOS FACTORES DE RIESGO CRITERIO
  15. 16. Inicia en la inducción de anestesia y termina al finalizar el acto quirúrgico.
  16. 17. <ul><li>Respiratorio </li></ul><ul><ul><li>Permeabilidad </li></ul></ul><ul><ul><li>Frecuencia </li></ul></ul><ul><ul><li>Admon. de O2 </li></ul></ul><ul><ul><li>Ventilación asistida </li></ul></ul><ul><ul><li>Oximetría </li></ul></ul><ul><ul><li>Capnometría </li></ul></ul><ul><ul><li>Capnografía </li></ul></ul><ul><li>Circulatorio </li></ul><ul><ul><li>Frecuencia </li></ul></ul><ul><ul><li>Ritmo e intensidad </li></ul></ul><ul><ul><li>Pulso </li></ul></ul><ul><ul><li>Presión arterial </li></ul></ul><ul><ul><li>Llenado capilar </li></ul></ul><ul><ul><li>Temperatura </li></ul></ul>
  17. 18. <ul><li>Neurológico </li></ul><ul><ul><li>Edo. de conciencia </li></ul></ul><ul><ul><li>Diámetro pupilar </li></ul></ul><ul><ul><li>Reflejo palpebral y fotomotor </li></ul></ul><ul><ul><li>Reflejo consensual </li></ul></ul><ul><ul><li>Reflejos osteotendinosos </li></ul></ul><ul><li>Líquidos y electrolítos </li></ul><ul><ul><li>Cuantificación de ingresos y egresos </li></ul></ul>
  18. 19. <ul><li>Inicia una vez que el paciente egresa del quirófano e ingresa a sala de recuperación. </li></ul><ul><ul><li>Inmediato </li></ul></ul><ul><ul><li>Mediato </li></ul></ul><ul><ul><li>Tardío </li></ul></ul>
  19. 20. RECUPERACION Al recuperar la conciencia pueden observarse movimientos , sin embargo los anestésicos mas actuales permiten una rápida recuperación de la conciencia, comienza a respirar sin necesidad de asistencia respiratoria y se retira el tubo endotraqueal (extubación).
  20. 21. Signos Movilidad Respiración Movimiento o capacidad de mover las 4 extremidades Movimiento de solo 2 extremidades Inmovilidad Profunda o prescencia de tos Disnea aparente Apnea 2 1 0 Circulación determinada en porción de la presión sistólica pre~anestesia P. sist. Det. antes de anestesia con variación media de 20% P. sist. del 50% de la pre~anest. Del 50% de la pre~anest. Conciencia Atiende a las preguntas Atiende al escuchar su nombre No responde Coloración Normal Palidez o cianosis discreta Cianosis Franca
  21. 23. <ul><li>INMEDIATO </li></ul><ul><li>Post extubación </li></ul><ul><ul><li>Traslado </li></ul></ul><ul><ul><li>Posición </li></ul></ul><ul><ul><ul><li>Fowler Decúbito dorsal </li></ul></ul></ul><ul><ul><ul><li>Semifowler </li></ul></ul></ul><ul><ul><ul><li>Decúbito lateral </li></ul></ul></ul>
  22. 24. <ul><li>MEDIATO </li></ul><ul><li>Una vez que el paciente se recupera de la anestesia aproximadamente 1 hora. </li></ul><ul><li>TARDIO </li></ul><ul><li>Cuando el paciente egresa de recuperación hasta recuperarse en su estancia hospitalaria y finalmente en su domicilio. </li></ul>
  23. 25. <ul><ul><li>Monitoreo constante </li></ul></ul><ul><ul><li>Oxigenoterapia </li></ul></ul><ul><ul><li>Vigilancia de edema, cianosis, arritmias, presión compartamental, sangrado </li></ul></ul><ul><ul><li>Mantener vía permeable </li></ul></ul><ul><ul><li>Vigilancia de Sondas y drenaje </li></ul></ul>
  24. 26. <ul><li>Analgésicos </li></ul><ul><li>Antieméticos </li></ul><ul><li>Antibióticos </li></ul>MEDICACION POSQUIRURGICA Por orden o prescripción medica

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