Related disorders that occur in severe cranio-cerebral trauma - Respiratory Disorders

Following a severe head trauma, some patients place a acute hypoxia. Neurogenic control of the respiratory act takes place in the bulbar segment, and cortical Pontin. Of these, Pontin segment bulbar and most important, there are nerve centers that coordinate respiratory automatism, involuntary. Cortical segment respiratory control voluntary act.If interested injuries Pontin and bulbar segments, then the effects on respiratory automatism are serious.
If politraumatizatilor if there thoraco-pulmonary lesions, where lesions are worse mutually worsens hypoxia becomes more severe. Peripheral respiratory failure will induce a cerebral hypoxia. It predominantly affects cerebral hypoxia areas already affected, as these areas face a lack of oxygen through the blood supply disturbance after trauma. Therefore, in the absence of adequate treatment, it enters a vicious circle, the patient passing away by acute respiratory failure.
Besides increased by hypoxia in the brain injury itself or peripheral, hypoxia can be installed as a result of aspiration pneumonia.Aspiration pneumonia occurs in the lungs from aspiration of gastric contents that reach the mouth through gastro-esophageal reflux. It meets comatose especially when examined by sphincters are not good.Aspiration pneumonia is a serious event which immediately endangers the life of the patient. It shows up especially by bronchopneumonia. Alveoli with gastric contents destroys enzymes and hydrochloric acid it contains. Pulmonary infection occurs rapidly in aspiration pneumonia, on the one hand due to structural damage of the lung's defense mechanisms and capacity, and on the other hand, by inoculation of germs that enter the mouth in the lung along with gastric contents. Alveoli will co, causing atelectaziei.
Gastric contents aspiration lung lesions, the infection and resulting atelectasis may be associated adult respiratory distress syndrome (ARDS). ARDS is manifested by acute respiratory failure with pulmonary edema. Impaired lung membrane plasma trains passing in the alveoli, resulting in cellular collapse and the development of interstitial fibrosis. All of these lesions will decrease the compliance lung causing severe hypoxemia and exitus. ARDS can be developed and disseminated vascular coagulopathy ago, fatty embolism, or neurogenic pulmonary edema following hypovolemic shock. It was noted that if given agents lining the gastric mucosa as sucralfate, reduced the incidence of aspiration pneumonia.
ARDS Treatment should be instituted as soon as possible. Acute pulmonary edema is a medical emergency, especially in terms of oligoanurie, life-threatening. Neurogenic pulmonary edema in pulmonary alveoli fill with fluid, just as in edema of congestive heart failure, with the difference that the pressure in left ventricle end diastolic remains normal. The sudden increases in intracranial pressure has been a rapid shift of plasma from the systemic circulation in pulmonary circulation, and this plasma extravazeaza in alveoli. Another cause plasma extravasation in the alveoli is represented by direct neurogenic influence hypothalamic function on pulmonary microvascular network. Treatment of ARDS is the classic, if you can add hiperhidratat and hemodialysis if the patient is suffering from kidney failure, acute or chronic.
Treatment involves:- High flow oxygen, administered by mask.- Loop diuretics like furosemide, administered in high doses. This therapeutic maneuver is especially useful in case of severe renal failure. Furosemide is administered intravenously in doses of 240-500 mg in 30-60 minutes.- Venodilatatoare administration and intravenous antihypertensive.Thus, it can be given nitroglycerin, calcium channel blockers and sodium nitroprusside. These drugs are administered in case of severe hypertension spurt. In patients with severe head trauma or meet plarou paroxysmal increases in blood pressure. These pressure changes are found especially in lesions affecting the fronto-temporal or diencephalon, comisurii earlier and spinal bulb.In the case of sodium nitroprusside administration will be given to monitoring blood pressure, the doctor when the patient was sitting next administration, because blood pressure can suddenly drop in a few seconds after dosing. Not be given ACE inhibitors because of the likelihood of intrarenal hemodynamic compromise, it can worsen acute renal failure.- Pulmonary edema can be improved by venesectie (cutting the veins on your wrist), thus decreasing its blood pressure rapidly. But this measure will only apply where there is specialized care or delay it. Venesectia can save the life of a patient with acute pulmonary edema and can be practiced by any doctor anywhere, if the patient is within a medical center.Atelectasis is treated by ventilation and respiratory physiotherapy on the mask with an appropriate current volume for each patient.Bedridden patients at high risk to develop venous thrombosis that can cause pulmonary embolism. Should be given special attention to this phenomenon, because it can lead trombozarea including the inferior vena cava. Therefore, these patients are given low doses of subcutaneous heparin mobilizes and legs regularly.