embolismo graso
DESCRIPTION
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SINDROME DE EMBOLIA GRASA
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EMBOLISMO GRASO
90% PACIENTES POLITRAUMATIZADOS
GRASA EN LA CIRCULACION ASOCIADO CON
1 PATRON CLINICO DE SINTOMAS Y SIGNOS
TRIADA 12 – 72 HORAS
INSUFICIENCIA RESPIRATORIA PROGRESIVA
ALTERACIONES NEUROLOGICAS
PETEQUIAS
SINDROME DE EMBOLISMO GRASO
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INCIDENCIA
1 - 10 %
30 % FX PELVIS – FEMUR – TIBIA
LA FRACTURA DE FEMUR ES LA MAS FRECUENTE
MORTALIDAD 10 %
SINDROME DE EMBOLISMO GRASO
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OTRAS QUEMADURAS PANCREATITIS
DISRUPCION MECANICA DE LA BONE MARROW TRAUMA BX - TRASPLANTE MO
SEG
GRASA EXOGENA NUTRICION PARENTERAL TOTAL INFUSION DE PROPOFOL
DISRUPCION MECANICA DE LOS ADIPOSITOS LIPOSUCCION TRAUMA DE TEJIDOS BLANDOS
ETIOLOGIA
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FACTORES DE RIESGO
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MECANICA OBSTRUCCION DE MICROVASCULATURA
PULMON - CEREBRO – PIEL – OJOS
FISIOPATOLOGIA
BIOQUMICA
HIDRÓLISIS X LIPASA RADICALES LIBRES
REACCION INFLAMATORIA SEVERA
LESION NEUMOCITOS - SURFACTANTE
LLEVANDO A HIPOXEMIA SEVERA
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FISIOPATOLOGIA
BIOQUIMICA HIDRÓLISIS X LIPASA RADICALES LIBRES
REACCION INFLAMATORIA SEVERA
LESION NEUMOCITOS - SURFACTANTE
DESTRUCCION ARQUITECTURA ALVEOLAR
> PERMEABILIDAD CAPILAR - EDEMA - HEMORRAGIA
HIPOXEMIA SEVERA
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2 MAYORES
O 1 MAYOR
3 MENORES
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CRITERIOS DE LINDEQUE
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INDICE SCHONFELD
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CONTUSION PULMONAR
BRONCOASPIRACION
EDEMA PULMONAR
SDRA
TROMBOEMBOLISMO PULMONAR
TRALI
DIAGNOSTICO DIFERENCIAL
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CONTUSION PULMONAR
BRONCOASPIRACION
EDEMA PULMONAR
SDRA
TROMBOEMBOLISMO PULMONAR
TRALI
DIAGNOSTICO DIFERENCIAL
DE EXCLUSION
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CONTUSION PULMONAR
BRONCOASPIRACION
EDEMA PULMONAR
SDRA
TROMBOEMBOLISMO PULMONAR
TRALI
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RADIOGRAFIA DE TORAX
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RADIOGRAFIA DE TORAX
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OPACIDADES EN VIDRIO DESLUSTRADO
CONSOLIDACION FOCAL - DIFUSA
NODULOS DE VARIOS TAMAÑOS < 10 MM
DISTRIBUCION PERIFERICA - PERIHILIAR
DIÁMETRO DE BRONQUIOS Y ARTERIAS
TAC HALLAZGOS RADIOLOGICOS
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OPACIDADES VIDRIO ESMERILADO ENGROSAMIENTO SEPTAL
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DISTRIBUCIÓN PARCHEADA-GEOGRÁFICA
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CONSOLIDACION
FOCAL DIFUSA
AREAS DIFUSAS DE
NODULOS DE VARIOS TAMAÑOS < 10 MM
HEORRAFIA ALVEOLAR DIFUSA – INTERSTICIAL
EDEMA - NEUMONITIS QUIMICA
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CONSOLIDACION - DERRAME PLEURAL
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NODULOS CENTROLOBULILLARESNODULOS SUBPLEURALES
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PATRON NODULAR
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PATRON NODULAR
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EL INICIO DE LA APARICIÓN DE LAS IMÁGENES
1 - 3 DIAS
LA RESOLUCIÓN
ENTRE LOS 7 - 25 DIAS
CAMBIOS RADIOLOGICOS
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TAC CON CONTRASTE
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TAC CON CONTRASTE
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RESONANCIA MAGNETICA
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RESONANCIA MAGNETICA
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ECOCARDIOGRAMA TRANSESOFAGICO
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> 30 % MACROFAGOS ALVEOLARES
INCLUSIONES LIPIDICAS
EN LAS PRIMERAS 24 HORAS
LAVADO BRONCOALVEOLAR
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TRATAMIENTO ES PREVENCION Y DE SOPORTE
SOPORTE VENTILATORIO
MANEJO DEL SHOCK ESTABILIDAD HEMODINAMICA
ALBUMINA 1G LIGA 100 MG ACIDOS GRASOS
CHOQUE OBSTRUCTIVO - FALLA VENTRICULO DERECHO
SOPORTE CON DOBUTAMINA
EXAMEN NEUROLOGICO EDEMA CEREBRAL
MANEJO
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PREVENCION DE SEG PTE FX HUESO LARGO
6 ADECUADOS ANALISIS
REDUCEN EL RIESGO 77 % IC 40 – 91
7 PACIENTES TRATADOS PARA PREVENIR 1 CASO
NO ENCONTRARON DIFERENCIAS EN
MORTALIDAD – INFECCION – CONSOLIDACION
> 1970
POLITRAUMATIZADOS EXCLUIDOS
CORTICOIDES
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FIJACION TEMPRANA DE LA FRACTURA < 24 HORAS
REDUCE LA LIBERACION DE GRASA MOVILIDAD
REDUCCION 70 % DE COMPLICACIONES PULMONARES
FIJACION EXTERNA INICIAL
PREVENCION .. DESDE EL TRASLADO
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CIRUGIA DE CONTROL DE DAÑOS
TECNICAS INTRAMEDULARES > RIESGO SEG
CLAVOS NO FRESADOS EMBOLIZAN MENOS
VENTILAR EL CANAL ANTES DE CEMENTAR
CEMENTO PREPARADO AL VACIO
LAVADO DEL CANAL MEDULAR
PREVENCION
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PARA RECORDAR
• SINTOMAS USUALMENTE INICIAN < 72 HORAS
INSUFICIENCIA RESPIRATORIA TRIADA ALTERACIONES NEUROLOGICAS PETEQUIAS
• COMPLICACION DEL POLITRAUMATIZADO CON FX DE HUESOS LARGOS
• LA FIJACION TEMPRANA DE LA FRACTURA < RIESGO
• TRATAMIENTO ES DE SOPORTE
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