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KAZUISTIKA: Muž, 22let, nalezen doma po výstřelu z kulovnice v suicidiálním úmyslu. Vstřel pod bradou – výstřel v oblasti čelního laloku. Reflexy zachovány, hypoventilace, AS pravidelná. VF: TK 112/60, P 100´, SpO2 98%, GCS 3.
Zkuste navrhnout pracovní dg.,ošetření, terapii (i farmakologicky) v PNP, transport a případně směrování.
obrázek: 3D projekce – pro představu:

3D projekceŘešení:

Terapie RLP byla: odsátí DC, ETI (fixace obvazy),UPV, sterilní krytí ran. Farmaka: Fentanyl 300ug, Dormicum 15mg, SCCHJ 100mg, Arduan 4mg, NORA 2mg/20ml FR …4ml/hod., Voluven 500ml, RL 1/1 1000ml + MgSO4 2g – vše i.v…ztráta krve cca 1l. poté transport na OUP.

na OUP: zavedeny invazivní vstupy PMK, centrála (v.subcl. l. dx.) a.radialis l.dx., provedeno EKG (bez patologie) a diagnostické kolečko (CT mozku, RTG S+P), CT: velký epidurální hematom parietálně vlevo (10cmx28mm), fisura kalvy (až k bázi v oblasti střední jámy), SAH v oblasti bazálních cisteren, devastující poranění frontální kosti, front.dutin, orbit, jařmových oblouků, spodiny obou očnic, nosní dutiny, devastující poranění maxily a mandibuly a fisury báse lební.

indikováno operační řešení : neurochirurgie + stomatochirurgie – zkrátím to – pacienta dali do kupy, ale po 3 dnech na ARO se zhoupl jeho stav, kdy najednou přestal spontánně dýchat – bylo prvedeno CT mozku kde se rozvinula kontuze oboustraně frontálně ..a v levé mozkové hemisféře a v kmeni edém, v kmeni je nově patrný hematom, je přítomno stlačení komor a výrazný přesun struktur (až o 10mm) , nejsou patrny cisterny na bázi. NCH neindikuje OP. 4.den indikace AG mozku – kde potvrzena smrt mozku. Exit.letalis 4.den po OP v 18.18hod. Multiorgánový odběr indikován (lymfatické uzliny, ledviny a srdce) …játra pro steatosu neodebrána.

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