Riassunto
La centrale operativa avvisa il pronto soccorso dell’ arrivo imminente di un bambino traumatizzato, caduto dal terzo piano. Circa 15 minuti dopo, il personale dell ’ ambulanza entra nella sala traumi con un bambino di 15 mesi, di sesso maschile, immobilizzato sull ’ asse spinale, con ossigenoterapia in maschera. La squadra d ’ emergenza ({titrauma team}) che prende in carico il paziente è composta da tre medici specializzandi (medicina d ’ urgenza, chirurgia, neurochirurgia), un tecnico di radiologia e due infermieri. A causa di un ’ emergenza in reparto, l ’ anestesista non può raggiungere il gruppo. Come previsto dal protocollo ospedaliero per i politraumatizzati, il medico d ’ urgenza assume il ruolo di team leader. Purtroppo, sia lo specializzando in medicina d ’ urgenza, sia quello di chirurgia hanno poca esperienza con i pazienti pediatrici. Il primo esame rivela un paziente incosciente con grave trauma cranico e facciale. Il bambino è tachipnoico, con polsi centrali deboli e pupille scarsamente reagenti. I paramedici riferiscono che il piccolo è caduto da una finestra del terzo piano, dopo essere rimasto brevemente senza sorveglianza. Mentre lo specializzando in chirurgia assiste la ventilazione in maschera, un infermiere tenta di reperire un accesso venoso, senza successo. Nel frattempo, il monitoraggio ECG evidenzia due episodi di bradicardia. Lo specializzando in medicina d ’ urgenza considera un cambio di strategia soltanto dopo che il secondo infermiere suggerisce di ricorrere all ’ accesso intra-osseo. Nonostante non abbia esperienza con la tecnica, riesce a inserire un accesso intra-osseo al primo tentativo.
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St.Pierre, M., Hofinger, G., Buerschaper, C., Simon, R., Daroui, I. (2013). Stress. In: Gestione delle crisi in medicina d’urgenza e terapia intensiva. Springer, Milano. https://doi.org/10.1007/978-88-470-2799-2_9
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