ASTMUL BRONSIC (AB) - Caz clinic

Caz clinic

ASTMUL BRONSIC (AB)

O.L, femeie, 49 ani, Jud. Iasi

Antecedente heredo-colaterale:

Ø   &n 20220y2424u bsp;  mama:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; AB,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; HTA.

Ø   &n 20220y2424u bsp;  tata: sanatos.

Antecedente personale:

Ø   &n 20220y2424u bsp;  nu prezinta nici o boala.

CVM:

Ø   &n 20220y2424u bsp;  casnica,

Ø   &n 20220y2424u bsp;  nefumatoare,

Ø   &n 20220y2424u bsp;  nu consuma alcool.

Motivele internarii:

Ø   &n 20220y2424u bsp;  dispnee, insotita de wheezing

Ø   &n 20220y2424u bsp;  cianoza moderata,

Ø   &n 20220y2424u bsp;  tahicardie, cresterea TA,

Ø   &n 20220y2424u bsp;  tuse cu expectoratie vascoasa.

Examenul clinic:

Ø   &n 20220y2424u bsp;  toracele cu diametru antero-posterior marit, cu hipersonoritate

Ø   &n 20220y2424u bsp;  raluri sibilante si ronflante pe ambele arii pulmonare,

Ø   &n 20220y2424u bsp;  expir prelungit

Examen paraclinic:

Ø   &n 20220y2424u bsp;  ex. sputei:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; euzinofile,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; mulaje bronsice.

Ø   &n 20220y2424u bsp;  ex. radiologic:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; nefolositor

Ø   &n 20220y2424u bsp;  explorarea functiei ventilatorii:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; VEMS - scazut,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; CV - scazut,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; PEF - 12%.

Ø   &n 20220y2424u bsp;  parametrii ASTRUP:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; PaO₂ - 30 mmHg,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; PaCO₂ - 65 mmHg,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; pH - 6,5.

Ø   &n 20220y2424u bsp;  EKG:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; tahicardie sinusala - 160/min,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; tahiaritmie supraventriculara, derivatie axiala dreapta a complexului QRS.

Ø   &n 20220y2424u bsp;  ex. hematologie:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; Hb,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; Ht,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; trombocite,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; glicemie.

Ø   &n 20220y2424u bsp;  ex. biochimie:

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; creatinina,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; RA,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; Na⁺,

§   &n 20220y2424u bsp;   &n 20220y2424u bsp; K⁺.

Diagnostic pozitiv:

Ø   &n 20220y2424u bsp;  anamneza,

Ø   &n 20220y2424u bsp;  teste de provocare bronsica.

Tratament:

A. Etiologic:

a. Prevenirea expunerii la alergenul causal:

Ø   &n 20220y2424u bsp;  evitarea contactului cu alergeni casnici,

Ø   &n 20220y2424u bsp;  evitarea expunerii la factorii ce cresc ventilatia bronsica,

B. Tratamentul protector:

Ø   &n 20220y2424u bsp;  CROMOGLICATUL DISODIC (Intal): 1 cp de 20 mg pulverizata cu 30 de minute inaintea expunerii la alergeni sau la effort,

Ø   &n 20220y2424u bsp;  NEDOCROMIL SODIC (Tilade)

Ø   &n 20220y2424u bsp;  KETOTIFENUL: 1 tb = 1 mg * 2/zi

C. Tratamentul simptomatic = bronhodilatatoare:

Ø   &n 20220y2424u bsp;  SALBUTAMOL: 100 μg/doza

Ø   &n 20220y2424u bsp;  SALMETEROL: 50 μg * 2 ori/zi

D. Tratamentul patogenic: