Protocolo de manejo de fracturas expuestas: guía de manejo quirúrgico y médico de las fracturas expuesta en el Hospital San Jaun de Dios
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2019
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Las fracturas expuestas son lesiones que tienen una gran variabilidad en la forma de presentación. El aumento de traumas de alta energía en pacientes jóvenes, principalmente debido a accidentes de tránsito, además del envejecimiento de la población que hace que las caídas en estas personas tengan como consecuencia, en algunas ocasiones, fracturas expuestas, ha incrementado la tasa de atenciones en los servicios de emergencias de esta patología. Esto sin tomar en cuenta las lesiones producidas por factores laborales. Un manejo protocolizado de estas lesiones representa un control adecuado de todas las variables modificables por el personal de salud, para obtener el mejor resultado para el paciente. El paciente debe abordarlo un equipo multidisciplinario del cual el personal de ortopedia y traumatología debe formar parte, con el fin de que las lesiones se traten de una manera más rápida y objetiva según su prioridad, para preservar la vida en primera instancia y con el menor grado de complicaciones posteriores. El manejo de las fracturas expuestas inicia en el servicio de emergencias, con la administración temprana de la terapia antibiótica como el pilar, con cefalosporinas de primera generación para las grado I, según clasificación de Gustilo-Anderson por 24 horas y la combinación con un aminoglucósido para las grado II y III por 72 horas, asociado con la profilaxis antitetánica de ser necesario. El abordaje de los tejidos blandos y las lesiones óseas en la sala de emergencias, constituyen un importante factor para el resultado final. La irrigación temprana con solución salina, los apósitos estériles y la inmovilización contribuyen a prevenir un daño mayor de estos y un menor riesgo de infección. El manejo de los tejidos blandos en sala de operaciones es de suma importancia. Se ha comprobado que la solución salina a flujo bajo o gravedad constituye la mejor forma de...
Inglés: The open fractures are injuries that have a high variability in the form of presentation and with increased high energy traumas in young patients mainly due to traffic accidents; in addition, the ageing of the population, which causes falls in these people to sometimes result in exposed fractures in their form of presentation, has increased the rate of attention in the emergency services if this disease. This does not take into account injuries caused by work factors. A protocol handling of these injuries leads to better control of all modifiable variables by health personnel to obtain the best outcome for the patient. The patient should be approached by a multidisciplinary team of which orthopedic and trauma personnel should be involved, so that, more quickly and objectively, all patient injuries are addressed according to their priority to preserve life at first instance and with the least degree of subsequent complications. The management of the exposed fractures begins in the emergency service, with early administration of antibiotic therapy as a fundamental pillar, with first-generation cephalosporins for grade I, according to the Gustilo-Anderson classification for 24 hours and combination with an aminoglucoside for grade II and III for 72 hours, associated with antitetanic prophylaxis if necessary. Tackling soft tissue and bone lesions in the emergency room are an important factor for the end result, early irrigation with saline solution, sterile dressmaking and immobilization help to prevent further damage to them and a lower risk of infection. Handling soft tissue in the operating room is of paramount importance and has found that low flow or gravity saline solution is the best way to wash, as it produces less damage from microtrauma to bone and soft tissue; in addition, soaps and other substances cause sell damage with the consequent death of these and contribution to infection, so their...
Inglés: The open fractures are injuries that have a high variability in the form of presentation and with increased high energy traumas in young patients mainly due to traffic accidents; in addition, the ageing of the population, which causes falls in these people to sometimes result in exposed fractures in their form of presentation, has increased the rate of attention in the emergency services if this disease. This does not take into account injuries caused by work factors. A protocol handling of these injuries leads to better control of all modifiable variables by health personnel to obtain the best outcome for the patient. The patient should be approached by a multidisciplinary team of which orthopedic and trauma personnel should be involved, so that, more quickly and objectively, all patient injuries are addressed according to their priority to preserve life at first instance and with the least degree of subsequent complications. The management of the exposed fractures begins in the emergency service, with early administration of antibiotic therapy as a fundamental pillar, with first-generation cephalosporins for grade I, according to the Gustilo-Anderson classification for 24 hours and combination with an aminoglucoside for grade II and III for 72 hours, associated with antitetanic prophylaxis if necessary. Tackling soft tissue and bone lesions in the emergency room are an important factor for the end result, early irrigation with saline solution, sterile dressmaking and immobilization help to prevent further damage to them and a lower risk of infection. Handling soft tissue in the operating room is of paramount importance and has found that low flow or gravity saline solution is the best way to wash, as it produces less damage from microtrauma to bone and soft tissue; in addition, soaps and other substances cause sell damage with the consequent death of these and contribution to infection, so their...
Descripción
Tesis (especialidad en ortopedia y traumatología)--Universidad de Costa Rica. Sistema de Estudios de Posgrado, 2019
Palabras clave
FRACTURAS ABIERTAS - CIRUGÍA - COSTA RICA, FRACTURAS ABIERTAS - TRATAMIENTO - COSTA RICA, Hospital San Juan de Dios (Costa Rica). Servicio de Emergencias, ORTOPEDIA - CIRUGÍA - COSTA RICA, TRAUMATOLOGÍA - COSTA RICA