Intubare o non intubare questo è il dilemma…..

6 Gen

amleto_laringo

Siete di turno in elisoccorso, sono le 3 di un pomeriggio invernale. Vi chiamano per trasferire una donna di 44 anni affetta da stroke ischemico con emiplegia dell’emisoma destro ed afasia. La paziente non collaborante è a tratti agitata. GCS E4 V1 M5. Respiro efficace ma sbuffante, emodinamica compensata.

In anamnesi sindrome depressiva trattata con Paroxetina ed Alprazolam. Nessuna altra malattia degna di nota.

I sintomi sono insorti alle 10 della mattina e la paziente è stata trasportata, dopo sedazione (Midazolam) al DEA con ambulanza medicalizzata. Giunta in DEA viene deciso che la paziente è elegibile per la trombolisi sitemica che viene effettuata, ma a 5 ore quasi dall’insorgenza dei sintomi non ha prodotto miglioramenti clinici apprezzabili.

Motivo del trasferimento è effettuare una procedura “rescue” in locoregionale. Il tempo di trasporto verso il presidio che ospita la radiologia inteventistica è di 20-25 minuti di volo (Elicottero modello EC 145).

L’anestesista di turno e la neurologa del presidio inviante non individuano criteri per l’intubazione orotracheale.

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