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Faire bilan entrée/sortie mesurables. Règle générale : apports de base jusqu'à 3 ml/kg/h de cristalloïde (Ringer Lactate) ,
, Compenser les pertes sanguines par des macromolécules : Gélofusine* sans limite
, Voluven* maxi 50 ml / Kg soit : ????ml
, Hb : 7 g/dl. Patient ASA 1-2. Pas de tares. Hb : 8 g/dl. Patient âgé, polypathologique. Hb : 9 g/dl
, Réalimentation Par la SNG selon protocole nutritionniste
, Antioedémateux Solumédrol : 1,5mg/kg/j en IVL pendant 48 heures soit? mg
, Anti agrégant plaquettaire : KARDEGIC 160 mg par jour pendant 15 jours
Soins : Position 1/2 assise, tête regardant en face ,
, canule : premier change à J3 ? canule acrylique sans ballonnet, pansement à refaire tous les jours, selon consignes. Soins de bouche : Aspiration douce et répétée de la stase salivaire et sanguine Soin doux au coton monté et bétadine* bain de bouche Si péroné : Appui autorisé avec béquilles dès J3
, Si chinois : Immobilisation du membre supérieur pendant 10 J
, Kinésithérapie mobilisatrice et respiratoire Bilan biologique : Ionogramme sanguin, NFS -plaquettes, TCA : Deux fois par semaine
, Antibiothérapie jusque cicatrisation pour ostéoradionécrose
, Si apparition de fièvre ? prélèvement bactériologiques locaux et hémocultures puis ROCEPHINE* : 2 g/ jour en IVL associé à FLAGYL* 1500 mg en une prise orale
, Paracétamol 4g par jour, TRAMADOL 50 mg × 4/j associé à Oxynorm* 5 mg sublingual QS