E2 Acute complexe
zorg
SAMENVATTING
Lieke Schönberger
,Inhoud
Acute complexe zorg en organisatie van zorg ......................................................................................7
Afkortingen in de acute zorg ...........................................................................................................7
Organisatie van acute zorg ..............................................................................................................8
Definities acute zorg....................................................................................................................8
Organisatie van acute zorg ..........................................................................................................9
Acute zorg in de eerste lijn ..........................................................................................................9
Acute zorg in de tweede lijn ...................................................................................................... 10
Acute zorg in de derde lijn ......................................................................................................... 11
Transport van acute zorgpatiënten ............................................................................................ 12
Crew resource management ......................................................................................................... 13
Intensive care ................................................................................................................................... 14
Intensive care ............................................................................................................................... 14
Monitoring .................................................................................................................................... 14
Circulatie................................................................................................................................... 14
Respiratie.................................................................................................................................. 15
Bewustzijn................................................................................................................................. 15
Medical emergency team (MET).................................................................................................... 16
Bloedgasanalyse ........................................................................................................................... 17
Centraal veneuze catheter (CVC) ................................................................................................... 17
Cardiac output meting .................................................................................................................. 17
Sepsis............................................................................................................................................ 18
Nierinsufficiëntie op IC .................................................................................................................. 19
Delier ............................................................................................................................................ 20
Prognose....................................................................................................................................... 21
Beademing........................................................................................................................................ 22
Beademing/mechanische ventilatie .............................................................................................. 22
Vormen van beademing ............................................................................................................ 22
Beademingsmodus .................................................................................................................... 23
Complicaties ............................................................................................................................. 25
Aandachtspunten bij ouderen ........................................................................................................... 26
Aandachtspunten bij kinderen .......................................................................................................... 27
Relevante verschillen tussen kinderen en volwassenen ................................................................. 27
2
, ABCDE........................................................................................................................................... 29
Resuscitaties ................................................................................................................................. 30
Pijnbestrijding ................................................................................................................................... 32
Nociceptie..................................................................................................................................... 32
Farmacologische behandeling van acute pijn ................................................................................ 33
Paracetamol (acetaminophen) .................................................................................................. 37
Metamizol (dipyron).................................................................................................................. 37
NSAID’s ..................................................................................................................................... 37
Tramadol (zwak opiaat) ............................................................................................................. 38
Opioïden ................................................................................................................................... 39
Co-analgetica ............................................................................................................................ 41
Anesthetica....................................................................................................................................... 43
Werking .................................................................................................................................... 43
Opbouw .................................................................................................................................... 43
Ionisatie .................................................................................................................................... 44
Zenuw conductie fysiologie ....................................................................................................... 45
Bloedconcentratie ..................................................................................................................... 46
Spinale en epidurale anesthesie .................................................................................................... 46
Spinale anesthesie .................................................................................................................... 47
Epidurale anesthesie ................................................................................................................. 48
Shock ................................................................................................................................................ 49
Fysiologie circulatie ....................................................................................................................... 49
Hartcyclus ................................................................................................................................. 50
Preload ..................................................................................................................................... 50
Afterload................................................................................................................................... 51
Contractiliteit ............................................................................................................................ 51
Slagvolume ............................................................................................................................... 51
Cardiac output .......................................................................................................................... 52
Bloeddruk ................................................................................................................................. 52
Autonome zenuwstelsel ............................................................................................................ 53
Cardiogene shock .......................................................................................................................... 54
Oorzaken .................................................................................................................................. 55
Diagnostiek ............................................................................................................................... 55
Behandeling .............................................................................................................................. 55
3
, Distributieve shock ....................................................................................................................... 56
Obstructieve shock ....................................................................................................................... 56
Hypovolemische shock .................................................................................................................. 57
Fractuurleer ...................................................................................................................................... 58
Trauma mechanismen................................................................................................................... 58
Hoog energetisch trauma (HET) ................................................................................................. 58
Gevolgen................................................................................................................................... 58
Soorten fracturen ......................................................................................................................... 59
Descriptieve beschrijving van fracturen ..................................................................................... 59
Opbouw diagnostiek fracturen ...................................................................................................... 61
Anamnese ................................................................................................................................. 61
Lichamelijk onderzoek ............................................................................................................... 61
Aanvullend onderzoek............................................................................................................... 62
Fractuurgenezing .......................................................................................................................... 62
Secundaire fractuurgenezing ..................................................................................................... 62
Primaire fractuurgenezing ......................................................................................................... 63
Behandeling .................................................................................................................................. 64
Repositie ................................................................................................................................... 64
Fixatie ....................................................................................................................................... 64
Conservatieve behandelingen (niet-operatief) .............................................................................. 65
Functionele behandeling ........................................................................................................... 65
Steunverband/tape ................................................................................................................... 65
Spalk ......................................................................................................................................... 65
Scharnierbrace .......................................................................................................................... 66
Tractie....................................................................................................................................... 66
Operatieve technieken .................................................................................................................. 66
Percutane Kirschner (K)-draad fixatie ........................................................................................ 66
Schroeffixatie ............................................................................................................................ 67
Plaat-osteosynthese .................................................................................................................. 67
Intra-medullaire fixatie.............................................................................................................. 68
Fixateur externe ........................................................................................................................ 68
Resectie artoplastiek ................................................................................................................. 68
Endoprothese ........................................................................................................................... 68
Amputatie ................................................................................................................................. 69
4
zorg
SAMENVATTING
Lieke Schönberger
,Inhoud
Acute complexe zorg en organisatie van zorg ......................................................................................7
Afkortingen in de acute zorg ...........................................................................................................7
Organisatie van acute zorg ..............................................................................................................8
Definities acute zorg....................................................................................................................8
Organisatie van acute zorg ..........................................................................................................9
Acute zorg in de eerste lijn ..........................................................................................................9
Acute zorg in de tweede lijn ...................................................................................................... 10
Acute zorg in de derde lijn ......................................................................................................... 11
Transport van acute zorgpatiënten ............................................................................................ 12
Crew resource management ......................................................................................................... 13
Intensive care ................................................................................................................................... 14
Intensive care ............................................................................................................................... 14
Monitoring .................................................................................................................................... 14
Circulatie................................................................................................................................... 14
Respiratie.................................................................................................................................. 15
Bewustzijn................................................................................................................................. 15
Medical emergency team (MET).................................................................................................... 16
Bloedgasanalyse ........................................................................................................................... 17
Centraal veneuze catheter (CVC) ................................................................................................... 17
Cardiac output meting .................................................................................................................. 17
Sepsis............................................................................................................................................ 18
Nierinsufficiëntie op IC .................................................................................................................. 19
Delier ............................................................................................................................................ 20
Prognose....................................................................................................................................... 21
Beademing........................................................................................................................................ 22
Beademing/mechanische ventilatie .............................................................................................. 22
Vormen van beademing ............................................................................................................ 22
Beademingsmodus .................................................................................................................... 23
Complicaties ............................................................................................................................. 25
Aandachtspunten bij ouderen ........................................................................................................... 26
Aandachtspunten bij kinderen .......................................................................................................... 27
Relevante verschillen tussen kinderen en volwassenen ................................................................. 27
2
, ABCDE........................................................................................................................................... 29
Resuscitaties ................................................................................................................................. 30
Pijnbestrijding ................................................................................................................................... 32
Nociceptie..................................................................................................................................... 32
Farmacologische behandeling van acute pijn ................................................................................ 33
Paracetamol (acetaminophen) .................................................................................................. 37
Metamizol (dipyron).................................................................................................................. 37
NSAID’s ..................................................................................................................................... 37
Tramadol (zwak opiaat) ............................................................................................................. 38
Opioïden ................................................................................................................................... 39
Co-analgetica ............................................................................................................................ 41
Anesthetica....................................................................................................................................... 43
Werking .................................................................................................................................... 43
Opbouw .................................................................................................................................... 43
Ionisatie .................................................................................................................................... 44
Zenuw conductie fysiologie ....................................................................................................... 45
Bloedconcentratie ..................................................................................................................... 46
Spinale en epidurale anesthesie .................................................................................................... 46
Spinale anesthesie .................................................................................................................... 47
Epidurale anesthesie ................................................................................................................. 48
Shock ................................................................................................................................................ 49
Fysiologie circulatie ....................................................................................................................... 49
Hartcyclus ................................................................................................................................. 50
Preload ..................................................................................................................................... 50
Afterload................................................................................................................................... 51
Contractiliteit ............................................................................................................................ 51
Slagvolume ............................................................................................................................... 51
Cardiac output .......................................................................................................................... 52
Bloeddruk ................................................................................................................................. 52
Autonome zenuwstelsel ............................................................................................................ 53
Cardiogene shock .......................................................................................................................... 54
Oorzaken .................................................................................................................................. 55
Diagnostiek ............................................................................................................................... 55
Behandeling .............................................................................................................................. 55
3
, Distributieve shock ....................................................................................................................... 56
Obstructieve shock ....................................................................................................................... 56
Hypovolemische shock .................................................................................................................. 57
Fractuurleer ...................................................................................................................................... 58
Trauma mechanismen................................................................................................................... 58
Hoog energetisch trauma (HET) ................................................................................................. 58
Gevolgen................................................................................................................................... 58
Soorten fracturen ......................................................................................................................... 59
Descriptieve beschrijving van fracturen ..................................................................................... 59
Opbouw diagnostiek fracturen ...................................................................................................... 61
Anamnese ................................................................................................................................. 61
Lichamelijk onderzoek ............................................................................................................... 61
Aanvullend onderzoek............................................................................................................... 62
Fractuurgenezing .......................................................................................................................... 62
Secundaire fractuurgenezing ..................................................................................................... 62
Primaire fractuurgenezing ......................................................................................................... 63
Behandeling .................................................................................................................................. 64
Repositie ................................................................................................................................... 64
Fixatie ....................................................................................................................................... 64
Conservatieve behandelingen (niet-operatief) .............................................................................. 65
Functionele behandeling ........................................................................................................... 65
Steunverband/tape ................................................................................................................... 65
Spalk ......................................................................................................................................... 65
Scharnierbrace .......................................................................................................................... 66
Tractie....................................................................................................................................... 66
Operatieve technieken .................................................................................................................. 66
Percutane Kirschner (K)-draad fixatie ........................................................................................ 66
Schroeffixatie ............................................................................................................................ 67
Plaat-osteosynthese .................................................................................................................. 67
Intra-medullaire fixatie.............................................................................................................. 68
Fixateur externe ........................................................................................................................ 68
Resectie artoplastiek ................................................................................................................. 68
Endoprothese ........................................................................................................................... 68
Amputatie ................................................................................................................................. 69
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