??d? e??a?

1
??d? e??a?µ?t??

• Te?µ??? ???a?µa (88)
• ??e?t???? ???a?µa (6)
• ??µ??? ???a?µa (6)

2
????????????? - ?p?d?µ??????a

• St?? ???
• Ta ??e?t???? e??a?µata af????? 4-6,5 ???? t??
  e?sa????? se µ???de? e??a?µ?t??
• ? ??e?t??p????a e????eta? ??? 800 pe??p??
  ?a??t??? et?s???.

3
???a??sµ?? ß??ß??

• Se st??µ?a?a epaf? µe ??e?t???? a????,
  p???a?e?ta? ??tta???? ß??ß? (??a?s? ?a? ??s?
  ??tt????) µ? s?et???µe?? µe e?e?????s?
  ?e?µ?t?ta?.
• Se p?? pa?atetaµ??? epaf? p??st??eta? t? st???e??
  t?? ?e?µ???? e??a?µat??.
• ???a????? ?a??se??

4
?a fa???µe?a apat???....

• To f?sµa t?? ?a??se?? p?? µp????? ?a p?????????
  p?????e? ap? pe?????sµ??? de?µat??? ß??ß? µ????
  ßa?e?? p???s?st?µat??? ??s? ? ?µes? ???at?.
• ? s?ßa??t?ta ?a? ??tas? t?? ß?aß?? s????
  d?afe??e? ?at? t?? a????? e?t?µ?s?.
• ?p? ??e?t??p????a? ? eµfa??? de?µat??? ß??ß?
  e??a? ap??? ? ????f? t?? pa??ß?????. ?a?? ?a
  ?e??e?ta? ?at?a???? ?t? ???e ??µa ??e?t??p????a?
  ??e? d???t??? p???ap??? ß??ße? ??????? ?a? ?a
  a??????e?ta? ?p?? ?? p???t?a?µat?e?.

5
?µese? e????e?e?

• Ep? ??e?t??p????a?, p??t? e????e?a e??a? ? ?µes?
  d?a??p? t?? ?e?µat?? p??? ap? ?p??d?p?te epaf? µe
  t? ??µa.
• ?????
• ?p? a?a??p?? µp????µe ?a ????µe p???? ?e?t???????
  ap??at?stas? a??µa ?a? µet? ap? pa?atetaµ??e?
  p??sp??e?e? ?a?d??a?ap?e?st???? a???????.

6
????G????S ??? ??T??????? ??S S???????S ???
?????????? ?G???????S

• ??tas? t?? ?e?µat??.
• ?d?? d???e?s?? e?t?? t?? s?µat??
• ?????e?a epaf?? µe t? ?e?µa
• ?????e?a ???es??
• ??t??a?? ?a? p?????s? µ??a????? ß??ß??
• ??ad??µ? t?? ?e?µat?? st? s?µa
• ??s? t?? ?e?µat??
• ??tas? t?? ?e?µat??
• Ge????, ?? s???pe?e? ap? ?e?µa ?????? t?s??
  e??a? s?ßa??te?e?.

7
?µese? ???????? s???pe?e? ep? ??e?t??p????a?

• ?a????e?? ?????a??? a????µ?e?
• ??µ??? µ???a?d?a?? ß??ß?
• ???ße? ap? t? ?e?t???? ?e????? ?a? pe??fe????
  ?e??a
• ????????s?, ?aßd?µ????s?, µ??sfa????????a ?a?
  ??e?a ?ef???? a?ep???e?a
• S??d??µ? d?aµe??sµat??
• ???ße? a?ap?e?st???? µ???
• ??ata?a??? ?e?t????? ???µ?s?? a?ap????

8
??de??e?? e?sa????? se ????da ???a?µat??

• Te?µ??? ???a?µa se p??? ap? 20 t?? ep?f??e?a?
  s?µat??
• Te?µ??? ???a?µa se ????a, p?d?a, p??s?p?,
  pe???e?.
• ?p???a e?sp?e?st???? e??a?µat?? ? ??d?µa a??te???
  ae?a?????
• ?µes? epaf? µe ?e?µa p??? ap? 100 V ?a? 200 mA.
• ?st????? ap??e?a? s??e?d?s??
• ?a???????? e???µata ?at? t?? ?e????????? e??tas?
  (?e?t???? ?e????? ? pe??fe???? ?e??a)
• ?µf???s? d?ata?a??? ???µ?? e?te t?? st??µ? t??
  ??e?t??p????a? e?te a???te?a.
• ????µata ap? t? ??e?t???a?d?????f?µa
• ?a?d??a?ap?e?st??? a?a??p? e?te t?? st??µ? t??
  ??e?t??p????a? e?te a???te?a.
• ?p???a e??????? p??? s??d??µ? µ?????
  d?aµe??sµat??
• CPK gt 400 U / lit
• ??µ????µ????a (a?µ?sfa?????, µ??sfa?????) sta
  ???a
• ?st????? s?ßa??? µ??a????? ????s?? ?at? t??
  ??e?t??p????a.
• S?µe?a sp?a??????? ß??ß??

9
???µe? s???pe?e? ??e?t??p????a?

• ?e???µ???? p??ß??µata a) µ???? ???s?, ß)
  pe??fe????? ?e???p??e?e?, ?) ap??e?a ?st?? ap?
  ?e??????????? ?a?a??sµ???.
• ??s??t???????t???? ?e???p??e?e?, pa?a?s??s?e?,
  d?sa?s??s?e?, a?ta?a??ast??? s?µpa??t???
  d?st??f?a.
• ??sa?e??a st? ?????
• ?ata????t??
• ???µe? ?e?????????? d?ata?a???.
• ??ata?a??? p??s?p???t?ta?

10
?e?a???p????a

• St?? ??? 50-300 ???at?? et?s??? ?fe????ta? se
  ?e?a???p????a. ? a???µ?? t?? at?µ?? p?? ?f?stata?
  ?a??se?? ap? ?e?a??? p?? de? e??a? µ???a?e? e??a?
  4-5 f???? µe?a??te???.
• G?? ta ??µata ?e?a????, ? s?????ste?? a?t?a
  ?a??t?? e??a? ?a?d??a?ap?e?st??? a?a??p?. ?t?µa
  p?? de? pa?a????? ?µesa a?a??p?, sp???a
  ?ata??????.
• ?p? µa????? at???µ?t?? ap? ?e?a???, ?? p??te?
  p??sp??e?e? a?t?µet?p?s?? p??pe? ?a
  s???e?t?????ta? se ?t?µa ??? ta ?p??a ?p???e? ?
  e?t?p?s? a?a??p??, e?? ? a?t?µet?p?s? ??µ?t?? p??
  ????? d??? t??? a?ap??? µp??e? ?a ???e? se
  de?te?? ?????.

11
???T?????-???S??S

• ????µe ??? ?p??e?µ?a ?ta? ? ?e?µ???as?a t??
  p????a t?? s?µat?? e??a? ??t? ap? 35? C.
• ?a??? p??se???se?? t?? ?e?µ???as?a? st? es?te????
  t?? s?µat?? d??e? ? µ?t??s? st?? p?e?µ?????
  a?t???a, ??s?f???, ????d??? ??st? ? st? a???st???
  t?µpa??.
• ????p?st? ?e?µ?µ?t??s? p???p???te? ?t? st??
  ?????t?ta st?? ?p??a ???eta? ? µ?t??s? de?
  ???eta? ????s? ?e?µ?? ????? sta p?a?s?a
  epa?a???µa?s??.
• ?a s????? ?d?a??????? ?e?µ?µet?a ????? ??
  ?at?te?? ??de??? t??? 32?C - 34?C ?a? ?ts? de?
  e??a? ???s?µa ??? t?? pa?a???????s? t??
  ?e?µ???as?a? se ?p??e?µ????? as?e?e??. ?a
  ??e?t?????? ?e?µ?µet?a de? ????? t?t?????
  pe?????sµ???.

12
??????a µe t?? ?e?µ???as?a t?? p????a t?? s?µat??
d?a??????µe t?? ?p??e?µ?a se

• ?p?a (32-35 ?C)
• ??t??a (28-32?C)
• ?a?e?? (??t? ap? 28?C)

13
?p??e?µ?a - d?a???se?? µe ß?s? t?? µ??a??sµ?
p?????s??

• ????a???µe?? s??p?µ?? ??? ?e?pe?t????? s??p???
  (p? epeµß?se?? ?a?d??a?ap?e?st???? pa???aµ???)
• ???a?a ?p??e?µ?a.
• a) p??t?pa???
• ß) de?te??pa???

14
N?s???????? ??t?t?te? p?? e?????? t?? eµf???s?
?p??e?µ?a?

• ??d????????? ?a? µetaß?????? d?ata?a???
  ?p?????a?µ?a, ?pe??sµ?t??? ??µa ?a? d?aß?t???
  ?et????s?, µ????d?µat??? ??µa, ep??ef??d?a??
  a?ep???e?a, a?ep???e?a ade???p?f?s??.
• ??ata?a??? ??S
• ?a??se?? ??t?a??? µ?e???
• ?p?a ?p??e?µ?a µp??e? ?a eµfa??ste? se ßa????
  p?s???te? sta p???s?a s???? ? s?? ?a??? ?a? sta
  p?a?s?a ?e?ape?t???? pa?eµß?se?? (p? f??t??
  a?µ?d????s??).

15
?a?????e?a ?p??e?µ?a?

• Te?µ???as?a lt 36,5? C ?????, pe??fe????
  a??e??s?spas?, a???µ??? s?µpa??t??? d?ast????t?ta
• Te?µ???as?a lt 30-32? C staµat? t? ?????.
  ???a???? ?a? se pe?a?t??? ???? ??µa.
• Se ?aµ???? ?e?µ???as?e? eµfa?????ta? d?ata?a???
  ???µ??.
• Se ?e?µ???as?a lt 28? C ?????a?? µa?µa???? ?
  as?st???a e??a? s????e?? ?a? ap?te???? ?a? t??
  ?????te?? µ??a??sµ? ?a??t??.
• ?? ????? p?? s???de?e? µ?a ?p?a ?p??e?µ?a µp??e?
  ?a a???se? t?? ?ata????s? ???????? µ???? ?a? ?at?
  4 6 f????.
• ?ta? µe pe?a?t??? pt?s? t?? ?e?µ???as?a? t? ?????
  staµat?, a??????e? ta?e?a pt?s? t?? µetaß??????
  ???µ?? ?a? st??? 26 ?C ? ?ata????s? ????????
  µe???eta? st? µ?s? t?? ßas???? ?a? st??? 20?C st?
  1/ 4.
• ? µe???? µe??s? t?? µetaß?????? a?a???? ep?t??pe?
  ?a ???eta? s?????? ?a?? a?e?t? ? ?aµ??? pa????
  ?a? p?es? p?? s???de?e? t?? ?p??e?µ?a.

16
S???pe?e? t?? ?p??e?µ?a? se ep?ped? ??tt????

• ?p?ß??d??s? t?? µetaß?????? ?a? e???µ????
  d?e??as???.
• ??ata?a??? st?? d?ape?at?t?ta µeµß?a??? ?a?
  ap?d???????s? p??te???? p?? ?a?a?t??????? t??
  ??tta???? ???at?, pa?at?????ta? se e?a??et???
  ?aµ???? ?e?µ???as?e?, ?ta? a???se? p???µa se
  ep?ped? ?st??.
• ? ??tta???? ß??s?µ?t?ta e?a?t?ta? a) ap? t??
  ßa?µ? ?a? d????e?a t???? ?p??d?e?s?? ?at? t??
  ?p??e?µ?a ?a? ß) ap? t?? ep???e?a ?d?e?s?? ?a?
  pa????? µetaß?????? ?p?st??µ?t?? ?at? t??
  epa?a???µa?s?.

17
?p??e?µ?a ?a? ??S

• St??? 34?C a????e? ?a ep??e??eta? ?
  d?a???t???t?ta - p???de?t??? ?p????a
• ??µa se ?e?µ???as?e? ??t? ap? 28?C, µe pa???????
  µe??s? t?? ??e?t??e??efa????? d?ast????t?ta?
• Se ?e?µ???as?e? ??t? ap? 26?C - 28?C?C ??e?
  pa?at????e? ??e?t??e??efa????af??? s???.
• ?? µetaß???? a?t?? e??a? p????? a?ast????µe? ep?
  epa?a???µa?s??, ?a??? ? ???? pe????????ta? t??
  µetaß?????? d?ast????t?te? p??state?e? t??
  e???fa??.
• Se ?e?µ???as?a lt 20?C ?a?d?a??e?a?? a?a??p?
  d????e?a? µ?a? ??a? e??a? d??at? ?a µ??
  s???de?eta? ep? epa?a???µa?s?? ap? e??e?µata e?
  t?? ??S.

18
?p??e?µ?a ?a? a?ap?e?st???

• ? ?p??e?µ?a s???de?eta? ap? ?p?p???a (????te?e?
  ap? 5 a?ap???? / ?ept? st??? 25?C) e?f???e?
  p??t?st?? t?? µe??µ??e? apa?t?se?? t?? ???a??sµ??
  ?a? ??? ?atast??? t?? a?ap?e?st???? ???t???
• Se ?e?µ???as?e? ?aµ???te?e? t?? 24?C ??e?
  pa?at????e? ?a? ?p???a.
• ?µes? ep?d?as? t?? ?p??e?µ?a? st?? µ??a???? t??
  a?ap???? ?a? st?? a?ta??a?? t?? ae???? de?
  pe?????feta?.
• ?? d?ata?a?µ??? ep?ped? s??e?d?s?? ep? ?p??e?µ?a?
  e???e? t?? eµf???s? p?e?µ???a? ap? e?s??f?s?.

19
?p??e?µ?a ?a? d?ata?a??? ???µ??

• ??a ap? ta p???µ? e???µa, p?? p????e?ta? t??
  eµf???s?? a????µ??? e??a? ? eµf???s? a??spas??
  t?? ST (??µß?? J), se ?e?µ???as?e? ??t? t?? 33?C.
• ?p??e? ?a eµfa??ste? pa??tas? QT, ???p??????a???
  ap???e?sµ??, ? f?eß???µß??? ß?ad??a?d?a. Se
  ßa?e?? ?p??e?µ?a eµfa???eta? as?st???a.
• Se ?e?µ???as?e? ??t? t?? 33?C ?a? µ???? ?a? t???
  28 ?C ? ?a? ?aµ???te?a, ? ?a?d?? ???eta?
  e?a??et??? e?e????st? ?a? µp??e? ?a eµfa??ste?
  ?????a?? µa?µa???? e?te µet? ap? µ??a???? (p?
  t?p???t?s? ?e?t????? ??aµµ??), ?e?µ???
  (epa?a???µa?s?) ? ß????µ??? e????sµa (p?
  s???pe?e? epa??d?e?s?? ?s?a?µ???? µ?????)
  e????sµa ? ?a? a?t?µata.
• ? a??ta?? ?????a??? µa?µa????? e??a? d?s?e??? ?s?
  ? ?e?µ???as?a pa?aµ??e? ?aµ???te?? t?? 30?C.
  Ost?s? ?a? ? ??????s? a?t?a????µ???? p??f??a???
  de? e??a? ap?te?esµat???. ?ts? ? ?a??te?? ta?t???
  e??a? ? ???a??? a????e?s? ?a? ap?pe??a a??ta???,
  e?? s??e???eta? ? p??sp??e?a epa?a???µa?s??.

20
?p??e?µ?a st???? ?e?ape?a?

• ?pa?a???µa?s?
• ??????? ?a? a?t?µet?p?s? ??e?t??f?s????????? ?a?
  a?µ?d??aµ???? d?ata?a???.
• S?????? ?? d?ata?a??? ap? ???a ???a?a de?
  apa?t??? e?d??? a?t?µet?p?s? a??? a?tap???????ta?
  st?? epa?a???µa?s?.
• ?p?a ?p??e?µ?a ?a??t??? e??te???? epa?a???µa?s?
  - ßas??eta? ?????? st?? eµf???s? ?????? ?a?
  pa?a???? ?e?µ?t?ta? ap? t?? ?d?? t?? as?e??.
• ??s?? ßa??t?ta? ?p??e?µ?a e?e???t??? e??te????
  epa?a???µa?s? t?? d??µat??
• ?a?e?? ?p??e?µ?a epeµßat???? µ???d?? µe st???
  t?? e?e???t??? epa?a???µa?s? t?? p????a t??
  s?µat??.

21
?at?e????st? s?st????ta? ta a??????a

• ?µes? ap?µ?????s? ap? t? ????? pe??ß?????. ??a???
  ? ap?t?µ?? ?e???sµ?? st?? µetaf??? p??pe? ?a
  ap?fe????ta? - ?????a?? µa?µa????.
• ? as?e??? p??pe? ?a d?at??e?ta? ste???? ?a?
  ?a??µ???? µe ?e?µ?? ???ß??te?, ?ste ?a
  pe??????eta? ? ap??e?a ?e?µ?t?ta?. ?a?? ?a
  ?a??pteta? ?a? t? t????t? t?? ?efa??? (e? a?????
  µe p?ast??? sa????a), ?a??? ??e? ?d?a?te?a
  p???s?a a?µ?t?s?, µe ap?t??esµa s?µa?t????
  ap??e?e? ?e?µ?t?ta?.
• ? eµß?pt?s? se ?est? ?e?? e??a? ap?de?t?
  p??s????s? µ??? se ?p?a ?p??e?µ?a, ?a??? se
  eµf???s? ep?p????? e??a? d?s???? ? ?µes?
  pa??µßas?.
• ???pe? ?a ?e?µa????ta? ta e?d?f??ß?a ????
  (40-42?C), ?ste ?a µ?? p???a???? ep?p???? pt?s?
  t?? ?e?µ???as?a?.
• Se d?as?????µ????? as?e?e??, e?sp??? µe??µat??
  a??a p?? ?e?µa??eta? st??? 40-45?C ?a? e??a?
  ???esµ??? se ?d?atµ???.

22
Yp??e?µ?a ?a? ?a?d??a?ap?e?st??? a?a??p?

• Aµes? ap?pe??a ?a?d??a?ap?e?st???? a?a???????s??
  e?? pa??????a ?e???? p??sp??e?a epa?a???µa?s??.
• ??e? a?afe??e? ep?t???? a?????? se ?t?µa µe
  ?e?µ???as?a ??t? t?? 20?C p?? eµf????a? a?a??p?
  ??? d??st?µa p??? ap? d?? ??e?.
• ??p?ta de? µp??e? ?a ap???e?se? t?? ep?t???
  a?????? se ?at? ta fa???µe?a ????? as?e?? µe
  ?p??e?µ?a.
• ? ???at?? p??pe? ?a ?e??e?ta? te?es?d???? µ??? se
  ?e?µ???as?a gt 30?C.
• Se as?e?e?? ????? ???af?t? sf??µ? a??? µe
  f?eß???µß??? ???µ? ?a? µe ?e?µ???as?a lt 28?C, ??
  ?a?d?a??? µa???e?? µp????? ?a p???d?t?s???
  ?????a?? µa?µa???? ?a? e??a? p??t?µ?te?? ?a
  ap?fe????ta?.
• S?????? t? ?p??e?µ??? µ?????d?? de?
  a?tap?????eta? se ß?µat?d?t?s? e?? ap?pe??a
  ß?µat?d?t?s?? µp??e? ?a p???d?t?se? ?????a??
  µa?µa????.

23
??????s?

• ??a?t?ta? ap? t?? ßa??t?ta t?? ?p??e?µ?a?, t??
  pa???s?a ?p??e?µe??? d?ata?a???, ?a? t?? ?????
  p?? µes??aße? ?? t?? ??a??? a?????.
• Se µe????? se???? ???t?t?ta ??? 70.
• ?a??te?? p?????s? se ?p??e?µ?a ???? t??a?a?
  ???es?? se ?aµ???? ?e?µ???as?e?, pe???aµßa??µe???
  µe??sµ???? ? a?????????.
• ?a?? p?????s? se p???t?a?µat?e? ? s?pt?????
  as?e?e?? µe ?p??e?µ?a.
• ?p??e? ?a pa?aµe??e?, ?????? se ??????µ?????
  as?e?e??, µ???µ? d?ata?a?? t?? ?e?µ?????µ?s?? p??
  p??d?a??te? se ??a epe?s?d?a ?p??e?µ?a?

24
??????G?????

• ?a ????pa??µata e??a? ?e???t???? ß??ße? t??
  pe??fe????? ap????e?? t?? s?µat?? (????, p?d?,
  a??? ?a? µ?t?, a?t??) ap? t? ?????.
• ????pa??µata eµfa?????ta? ?ta? ? ?e?µ???as?a t??
  ?st?? p?se? ??t? ap? 0 ?C.

25
????pa??µata- p??d?a?es???? pa?????te?

• ?a?atetaµ??? d????e?a ???es??
• S??d?asµ?? t?? ?????? µe a??a ?a? ???as?a (p?
  ????? ???tse?, ß?e?µ??a ?p?d?µata)
• ?µes? epaf? µe µ?ta???, ?e?? ?a? pt?t??? ????
• ?p??s?a e????µat?sµ?? se ????? pe??ß?????
• ? ?ata????s? a??a?????, p???a???ta?
  a??e??d?ast??? e???e? t?? ap??e?a ?e?µ?t?ta? ?a?
  t?? eµf???s? ????pa??µ?t??
• ?????s?a, sf??t? ????a ? ?p?d?µata.
• ???e??s?spast???? ??s?e?, pe???aµßa??µe??? t??
  ????t????
• ?p?tas?, a??e?a??? d?ata?a??? (d?aß?t??,
  a?t????s??????s?, fa???µe?? Raynaud).
• ?a?a??te?e? ß??ße? e? ?????? µp????? ?a
  p???a??s??? d?ata?a??? t?? a?t???µ?? ?e???s??,
  e?????ta? ??e? ß??ße? ep? ???es?? st? ?????.

26
????pa??µata - f?se??

• ???d??µ? f?s? µe ???? t?? ep?p???? ?st??. ?
  ?e?µ???as?a t?? ?st?? e??a? ?aµ???te?? t?? 10?C,
  ?p??e?a t?? ep?p???? a?s??t???t?ta?. ?a?at??e?ta?
  a??e??s?spas? st?? µ?????????f???a, a???µ???
  a??e?a?? d?ape?at?t?ta ?a? a???s? t?? ???d??? t??
  a?µat??.
• ???????e?, se ?e?µ???as?e? d??µat?? ??t? ap? 0
  ?C, s??µat?sµ?? ???st????? p????, ?????? st??
  e????tt???? ????. S???pe?e? e??a? ?sµ?t???
  µeta????s? ????? p??? t?? e????tt???? ????, ?a?
  ??tta???? af?d?t?s?. ?p??e?a pe??p?? 1 / 3 t??
  ??tta????? ????? ?d??e? se ??tta???? ß??ß? ?a?
  ???at?. ?a?t?????a, t? ??d?µa st?? e????tt????
  ???? µp??e? ?a pe?????se? t?? a?µat??? ?d?e?s?.
  Se t????e?d??? ep?ped? ????µe ep?ß??d??s? t??
  a?µat???? ????. ?p?p????, ?? ???sta???? µp?????
  ?a p???a??s??? ?a? ?µes? ß??ß? st?? a???te?t?????
  d?µ? t?? ?st??.
• ???t? f?s? p???de?t??? ß??ß? t??
  µ?????????f???a? µe s???????s? e?????? ?a?
  s??µat?sµ? µ???????µß?se??. ? t?p??? ?st???
  ?s?a?µ?a µp??e? ?a e?e????e? se ?????s?.

27
???????? e?d???se??

• M??d?asµa t?? µ?????.
• E??e?µµata ep?p???? a?s??t???t?ta?. ?????? ??e?a
  ap??e?a a?s??t???t?ta? se ep?d??? d??t???
  ?p?d????e? ßa?e?? ß??ß?.
• ?pa?a?µ?t?s? ?at? t?? epa?a???µa?s? µp??e? ?a
  s???de?eta? ap? e?a??et??? ??t??? p???.
• F?s???????? a?s??t???t?ta, ?e?µ?t?ta ?a? ???µa
  ap?te???? e??a????t??? s?µe?a.
• ?? pa??µ???? ?st?? s???? eµfa?????? pe???s?,
  ??????t???? ? ????de? ???µa ? ??de?? ?a? ?e???p??
  ap????se??.

28
???????? e?d???se??

• ? epa?a???µa?s? s???de?eta? ap? a????? ?pe?a?µ?a
  a??µa ?a? se ßa?e??? pe??pt?se??. ?p??e? ep?s??
  ?a pa?at????e? µe???? ep???d?? t??
  a?s??t???t?ta?. ?p??e?µµat??? ??d?? ap????s?
  µet? t?? epa?a???µa?s? ap?te?e? e?a??et??? ?a??
  p?????st??? s?µe??.
• ? p???µ?? s??µat?sµ?? µe????? f?sa??d?? µe
  d?a???? pe??e??µe?? p?? e?te????ta? ?? t?? ???e?
  t?? e???d?µ???? da?t????, e??a? p?? e??????
  e???µa ap? t?? ?a??ste??µ??? eµf???s?
  a?µ???a????? f?sa??d??
• Se ßa?e??? pe??pt?se??, t? d??µa st?? pe??????
  t?? ????pa??µ?t?? s??µat??e? µ?a µa??? ?a? ????
  es???a. ???????e? µ?µ??p???s? ?a? d?a????sµ??
  µeta?? ß??s?µ?? ?a? ?e???? ?st??.

29
?a?µ?? ????pa??µ?t??

• 1?? ßa?µ??. ??a?s??s?a ?a? e????µa.
• 2?? ßa?µ??. F?sa??de? p?? pe??ß?????ta? ap?
  e?????t?ta ?a? ??d?µa
• 3?? ßa?µ??. ??µ???a???? ??st?d?a ?a? f?sa??de?
• 4?? ßa?µ??. ???ße? p?? e?te????ta? st? ?p?d????,
  ?st? ?a? µ?e?.

30
????pa??µata
31
??t?µet?p?s?

• ?at? t?? µetaf??? ????a p?? sf?????? ? e??a?
  ß?e?µ??a p??pe? ?a afa?????ta?.
• ?? µ???? t?p??ete?ta? se p??state?µ??? ??s?, a???
  µa???? ap? p???? ????? ?e?µ?t?ta?, ?ste ?a
  ap?fe???e? ? ßa?µ?a?a µe???? epa?a???µa?s?.
• ?as?? st? p??sß??µ??? µ????? de? p??sf??e? t?p?ta
  ?a? µp??e? a?t??eta ?a a???se? t?? ap??e?a ?st??.
• ?µß?pt?s? se ?e?? ?e?µ???as?a? 40-42?C (10-30
  ?ept?) S?st????ta? ?p?e? e?e???t???? ????se?? t??
  µ????? ?at? t?? epa?a???µa?s? a??? ??? µas??.
• ?et? t?? epa?a???µa?s? a?????p? ??s? ???
  pe?????sµ? t?? ??d?µat??.
• ?e????????? e?t?µ?s?.
• ?e e?a??es? p??? ?p?e? pe??pt?se?? (?????? a?t??,
  µ?t?), pa?a???????s? ??? t??????st?? 24-48 ??e?
  st? ??s???µe??, ??? ????????µ??? e?t?µ?s? t??
  ??tas?? t?? ß??ß??.

32
Te?µ??? ???a?µa. ??a??????µe

• ???? ?????s??
• (coagulation)
• ???? st?s?? (stasis)
• ???? ?pe?a?µ?a? (hyperemia)

33
Te?µ??? ???a?µa-ep?d?µ??????a

• To 67 t?? e??a?µ?t?? se ?t?µa 16-64 et??
• ?? 53 e??a? e?af?? e??a?µata (lt 10), e?? t? 15
  ßa?e?? e??a?µata (gt 30 TBSA)
• ????? ep?pt?s? se pa?d?? lt 10 et??. S??????
  e??????ta? ?a?t? ???? (?eµ?t?sµa)
• St?? ??t???? ???e? ep?pt?s? 20/100000. St??
  a?apt?ss?µe?e? 50/100000
• Se e?????e? s????te?a e????eta? ? ?µes? ep?d?as?
  t?? f???a?
• ?? 1/3 t?? ?e?µ???? e??a?µ?t?? pa?at??e?ta? st?
  ???? e??as?a? ?a? ta 2/3 st? ????a?? pe??ß?????

34
E??a?µata ap? ???? ?e?µ?t?ta

• F???a
• ??f?e?ta ???? (pet???a??, ????p?e?µa, ?t?)
• Te?µ?st?a
• ?????
• F?????? µ??????µ?t??
• ??atµ?se?? a?t?????t??

35
?????µata ap? ???? ?e?µ?t?ta

• ??ast? ?e??
• ?tµ??
• ?a?t? ??d?
• ???? µ?ta??a

36
??tas? e????µat??-?a???a? t?? 9
37
?a??? e??a?µat??
38
??t?µ?s? ß????? e??a?µat???? ep?f??e?a?


  Superficial Superficial dermal Deep dermal Full thickness
Bleeding on pin prick brisk brisk delayed none
Sensation painful painful Dull (non-painful sensation) none
appearance Red, glistening Dry, whiter Cherry red Dry, white, leathery
Capillary refill Blanching to pressure Yes, brisk return Yes, slow return no no
39
1?? ßa?µ??
40
?????? p????? ???a?µa
41
? a????? a?t?µet?p?s? t?? e??a?µat???? ep?f??e?a?

• ?µß?pt?s? se ???? ?e?? (1-5 ?C) ??? pe??p?? 30
  ?? de? e??a? d??at? ? ?µes? µetaf???. ??p???t?s?
  p???? ep?te??e? t?? ?st??? ß??ß?.
• ? as?e??? ?at? t?? µetaf??? t?p??ete?ta? p??? se
  ?a?a?? se?t??? ?a? ?a??pteta? µe ??a de?te??
  se?t???. ???? ap? t? se?t??? ?a?a??? ???ß??te? -
  e?a??st?p???s? ap??e?a? ?e??? ?a? ?e?µ?t?ta? ap?
  t?? e??a?µat???? ep?f??e?e?.
• ?e?????sµ???? ??tas?? e??a?µata f?s?????????
  ????.
• F?sa??de? ?ta? e??a? a??et? µe???e? ?ste ?a µ??
  e??a? d??at? ? epa???? ?a???? µe ep?desµ???
  ?????, p??pe? ? ?a a?a???f??ta? ?p? ste??e?
  s?????e? ? ?a ?a?a?????ta? ?e?????????.
• ??? p????pt??? a?t?ß??s? se e??a?µata
  pe?????sµ???? ??tas??.
• T?p??? a?t?ß??t??? ?ta? ???s?µ?p?????ta? p??pe?
  apa?a?t?ta ?a afa??e?ta? t? p??????µe?? st??µa
  a???f?? p??? ap? ???e ??a ep??e???.

42
?e?????sµ??a e??a?µata t?p??? a?t?µet?p?s?

• ?????t? te????? (e??a?µata p??s?p??). ??? 6???,
  µet? ap? p??s?µ?, a?t?ß??t??? a???f?.
• ??e?st? a?t?µet?p?s?.
• a?????? ?a?a??sµ??
• st??µa ap?ste???µ???? ???a? d?ap?t?sµ??? µe
  f?s???????? ???. ?? st??µa a?t? ?a??pteta? µe
  ste???? ?a? ????te?? ?ept?? ???e?.
• ??????p? ??s? µ????? ?a? p???µ? ????t?p???s?
  (µet? t?? p??te? 24 ??e?)
• ???a?? se 2-3 ?µ??e?. ?p?µa??????ta? ?p? ?s?pte?
  s?????e? ?? e??te????? ???e? ?a? ep?s??pe?ta? ?
  ß??ß? ????? ?a ?????ta? ?? ?ept?? ???e? p??
  ?a??pt??? t? ???a?µa. ?? t? t?a?µa e??a? s?et???
  ste??? ?a? ??da??, ?a??pteta? e? ???? ?a? ???eta?
  epa?e?t?µ?s? se 5-7 ?µ??e?.

43
? a?t?µet?p?s? t?? e??a?µat????
ep?f??e?a?-e?tetaµ??a e??a?µata

• ?????? µe s???et??? ????? p?? e?asfa?????? ????
  pe??ß????? p?? d?e??????e? t?? a?a?????s? t??
  ep?de?µ?da?.
• ?a?t??? ???t?? - ????se?? ????? µ?sa st? ?e?? ???
  ap?f??? a?????se??.
• ? p???µ?? ?e?????????? ?a?a??sµ?? ?a? ? ??????
  t?? e??a?µat???? ep?fa?e??? µe te???t? d??µa ?
  a?t????? µ?s?e?µa µe???e? t?? ap??e?e? ?????,
  pe??????e? t?? p??a??t?ta ???µ???? ?a? ße?t???e?
  t?? ep?ß??s?.
• Se ?????? p????? e??a?µata, µp??e? ?a apa?t?????
  es?a??t?µ?? p?? pe??ß?????? ?????te??? ????,
  t??????, ???µ?.

44
???a?µa a?µ?d??aµ??? ast??e?a

• ?? ???a?µa s???de?eta? ap? a???µ??? t????e?d???
  d?ape?at?t?ta, t?p??? a??? - ep? e?tetaµ????
  e??a?µ?t?? - ?a? se s?st?µat??? ep?ped?, µe
  ap?t??esµa d?aµat??? e?a??e??s? ????? ?a?
  p??te???? ?a? ?e???e?µ??? ??d?µa.
• ???a?µata p?? af????? p??? ap? 20 t?? ep?f??e?a?
  s?µat?? s???de???ta? ap? s??, p?? e??a?
  ap?t??esµa ????t?p???s?? t?? ?ata????t? t??
  f?e?µ???? ?a? ?p????a?µ?a?.
• ? ?p????a?µ?a ?fe??eta? se a) e?a??e??s? st??
  t??t? ????, ß) e??tµ?s? ap? t?? e??a?µat????
  ep?f??e?e?, ?)e??e?.
• ?pa?te?ta? ta?e?a ??????s? ?????(???sta???e?d?,
  ?????e?d?), µe st??? t?? a?µ?d??aµ???
  sta?e??p???s? ?a? t?? e?asf???s? epa?????
  d?????s??.

45
???a?µa s?st?µat???? s???pe?e?

• ?p??e?µ?a
• ??µ???s? e??????.
• ??ata?a??? a?µ?stas?? -d????t? e?da??e?a?? p???.
• ??e?a ?ef???? a?ep???e?a sta p?a?s?a t?? s?? ?
  ap? s?ßa??? a?µ???a??e? ap? t? pept???
• ?? s?pt???? ep?????? e??a? t? ßas??? p??ß??µa
  µet? t?? p??t? eßd?µ?da ap? t? ???a?µa ?a? se
  a?t?? ?fe??eta? p??? ap? t? 50 t?? ???t?t?ta?
  t?? e?tetaµ???? e??a?µ?t??.
• ?? e??a?µat?e?, e??a? ?pe??ataß?????? as?e?e??
  ?a? eµfa?????? p??? a???µ??? ßas??? µetaß???sµ?.
  ?p?ßeß??µ??? ? ?????? t?? a?a???? t??? se
  ?e?µ?de? ?a? ?e???µa.
• ?a?? a?a???s?a. ?? s?µe???e? ?t? ? p????
  ep?te??eta? ?a? ?? apa?t?se?? se a?a???t???
  a??????? µet? t?? p??te? ?µ??e? t?? e??a?µat??

46
??sp?e?st??? ???a?µa, e?sp??? ?ap??? ?a? t??????
??s???-µ??a??sµ?? ß??ß??

• ?µes? ?e?µ??? ß??ß? (p? e?sp??? atµ??)
• ??µ??? ß??ß? ap? e?sp??? ?ap???. ?????e? t??
  ???t?t?ta ?at? 30-40 ?a? t??p?as???e? t??
  d????e?a ??s??e?a? .
• ??sp??? t?????? p?????t?? ?a?s?? µe s???pe?e? st?
  a?ap?e?st??? (??e?d?a a??t??, aµµ???a) ?
  s?st?µat???? s???pe?e? (µ????e?d?? t?? ????a?a,
  ?d????????).

47
S???pe?e? t?? e?sp?e?st???? e??a?µat??

• ??d?µa a??te??? ae?a?????
• ??t??? f?e?µ??? t?? t?a?e??ß???????? d??d???
• ARDS
• ?? e?sp?e?st??? ???a?µa ?a? ? e?sp??? ?ap???
  d?µ???????? ?da???? ?daf?? ??? eµf???s? se
  de?te?? ????? a?ap?e?st???? ???µ??e??.

48
??sp?e?st??? ???a?µa ?a? ae?a?????

• ? ?e?µ???? ? ??µ???? pa?????ta? µp??e? ?a
  p???a??se? ß??ß? t?? ß?e???????? t?? a??te???
  ae?a????? ?a? t?? t?a?e??ß???????? d??d???
• S????µ??, µ??s????, ß?????????a.
• ?a s?µpt?µata ap? t??? ae?a?????? µp??e? ?a e??a?
  s?et??? ?p?a t?? p??te? ??e? ap? t? ???a?µa.
• St?? s????e?a ? ep?tas? t?? ??d?µat?? µp??e? ?a
  ??e? ?? ap?t??esµa d?aµat??? ep?de???s? µ?sa se
  ???e? ??e?.
• ? s?ßa??te?? ape??? se t?t??e? pe??pt?se?? e??a?
  ? ap?f?a?? t?? a??te??? ae?a?????

49
??de??e?? ß?????s??p?s?? / ?a?????s??p?s?? se
e??a?µa / e?sp??? ?ap???

• ?aµ??e? t???e? st??? ?????e?
• e??a?µata st? p??s?p?, ???? ap? t?? µ?t?, ?e???,
  st?µa, ????f?????a.
• ?e?a?? a???a????a pt?e?a.
• S?µe??????a st???s?? t?? a??te??? ae?a?????
• ??sp??? atµ??
• ??????s??p?s? se s?µa?t??? s?µµet??? t??
  ß?e???????? t?? a??te??? a?ap?e?st????,
  p????pt??? d?as?????s?. Se s?µa?t??? ??d?µa ?
  ß??ß? t?? ß?e???????? t?? t?a?e?a? ? t??
  ???tt?da?, p??t?µ?ta? d?as?????s? µ?s? t??
  ß?????s??p???.
• S???? t? p??t? 24??? µ??? ?pe?a?µ?a, e?????t?ta,
  s?µat?d?a a??????. ???a?????e?ta? epa?????? t??
  ß?????s??p?s?? se ep?de???s? t?? as?e???? ? µet?
  ap? 24 ??e?, ??? t???? ??d?µa

50
??as?????s? st? e?sp?e?st??? ???a?µa

• ??at???s? ßat?t?ta? ae?a????? (se pe??pt?s?
  aµf?ß???a? ?at? t?? a????? e?t?µ?s? e??a?
  asfa??ste?? ?a d?as??????eta? ? as?e???)
• ???a?µata ?????? p????? µ?t?? ?a? ?e?????,
  st?µat??.
• ???a?µata ?????? p????? t?a?????.
• ???stas?a ap??a?t? se e?s??f?s?
• ???a??ta ß??????
• ???a???? ?p?st????? t?? a?ap????
• Se ßa?e?? ß??ß?, ?d??? a? s???p?????? s?ßa??
  e??a?µata, s???te?ta? ? p???µ? t?a?e??st?µ?a

51
????t???as? ap? CO

• ?st????? ap??e?a s??e?d?s??, pa???s?a
  ?e???????at????? d?ata?a???, ??e?t???a?d????af???
  e???µata, ?????? p??? p??a?? t?? d???t???as? ap?
  CO.
• ?a???s?a a?e????t?? µetaß?????? ????s??
  ?p?d????e? d???t???as? ap? CO ? HCN.
• Se ????? t??? as?e?e?? µe ?p???a e?sp???? ?ap???
  ep???µ?t? ? µ?t??s? t?? ?a?ß???a?µ?sfa??????.
• ?p? a???µ???? ep?p?d?? ?????e?ta? 100 ??????? ?
  ?pe?ßa???? ????????e?ape?a.

52
??????s?

• St???e?a ap? National Burn Repository (NBR) pts
  admitted to 52 burn centers in USA. Used to
  develop a model for predicting burn mortality.
  51235 survivors, 2984 non-survivors.
• Non-survivors were
• Older
• More females
• More flame, less scalding
• More TBSA (45,9 28 vs 12,2 13,2)
• Inhalation injury
• Coexisting trauma
• More than one medical condition
• Pneumonia
• The optimal model for predicting mortality
  contained age, TBSA, inhalation injury,
  coexistent trauma and pneumonia

53
???a??st?

• ????? ??????