:

.
.

: ,

.
: . ,
. - " .
. ,
. , .
-" , , .
." ,
. -" ,
) (
-Xanthelasma . , ,
. , . -
. -
." , . , .
, ,
. ) -(ecchymosis ,
. ," " .
,
" . ,
. ,
.

-Pulse Pressure . ,
." , 30-40" .
. PP-
) , ( , )(
) , , ( PP .
) , , ,
( PP . 30-
-Orthostatic hypotention .

." .
,
.
10- .
" .
. "
. 1-3 " .
, .
: 5-20 ,
.
.
,
. .

rate - 50- . , 100

. . ,
.
Rhythm - .
. , rate"

 .
,pulse deficits .
- , , .
. -0 1+ ,
2+ , 3+ , 4+ ,
. , ,
. PP- . ,
.
: "collapsing"\ "water
."hammer
.
- rate - rhytm
"
. , .
: , , , , , ,
. ,
. 10% -
. ,
.

':

" ' ,CVP

.

." . "
30 .
45-90 ,
, .

 - , .
, -Erbs point . ,
. - ,4-5
. -
. - . xiphoid process
. ,
. . APEX
.PMI, ,"
5- .
.
. 5- ,
.
, . ,
, . thrill
.
.

" . 3-5
. ."
. , ,
.

S1 S2 - " . S1 S2
" S2 .S1 -
. ,

, .

.

 -S1 .
. s1
, .APEX -
"
S1 .

. s1 .
-S2 .
, "
S2.
, S2 .
.
. S2
s2 .
) -Gallop sounds (
) (
s1 - s2 . ,
.
. ,
. , .S3
, , ,
. ,
.S4" ,
. ,CAD
.
-
,
.
. " "

 S2 S2
.gallop" .
S1 " ".
) -(murmurs .
. ,
3 .4- ,
,
? s2 ? 1-6
1 . ,
, , .
, , .
-Friction rub , ,
. " .
, .
.
:
. ,

. ,S1 .S2
.
.
S3 S4 .
,
. .
: , )
( , ,1-6 ,
.

 .
, ."
3.
,
, , , , .
.
5
1+ .4+
Clubbing .
.
... ... ,
: . ,
" .
" .50
S4 .
90% - S2 ."
. 60% .

. ,

. , ,
. ,
, SA AND AV NODES

 . ,
. , ,
.

,
.

- .

- .

:
LDL<100 - Coronary Artery
Disease LDL<70. LDL<180 130
.
HDL>40>.150
- 130/80 .140/90
.

-Diabetes Mellitus > mg/dl 110.HBa1c<7% -

) Obesity ( BMI 18.5 - .kg/m2 24.9 -

40 35'.
- 30-60
.

 .
.CVD
.
.CVD -
base line .
.
.
) -Electrocardiography ,823 ,808-810 " (.

. ,
, .
. " :
, ) (digoxin, kinidin .
: .
, ) (SA 80, NA 40-60
, ,200 .
.
":

) (

) (

)(

)(

) (

 - .
.
") : (.
:
-V1 , -V2 .
-V4 . , ,
APEX" V3 .4-6 V2 -V4. V5
V4 -V6 .
.V4
.
" - V4
- V7. V8 .
-
.(r (V5r-
, , , . 15 ,12 12 .18
, , ,
, 15 .
3 18 .
.
- V1,V2, V3, V4, V5, V6 : ,
, . ".
: L1,L2, L3, AVR, :
.AVL,AVF RL- .
MV 0.2 , ." ,
25
P: 0.5-2.5 . 0 . . ,
.
:PR " . P
.AV NODE 0.2 -0.12 . .

 :Q . , .
. ,
, . , MI
. Q L3
. Q , .
Q .R 0.04.
:R .P Q , "
. 15 .L1
:S .R . .
:QRS " . 0.11 .
, .
.
:ST S ,T ) (TP
. , , ,
.
:QT .T
) ( . .
. .
: , )1500
"( ,R 300 . R R
.
ECG - . ,
.
.
-Hardwire cardiac monitoring . 3-5
, " ."bed side ,
.ST .
base line . ,
" .

 QRS .
.
-Telemetry ,
. :
, ,
.abenzoin
24-48 .
.
-Signal averged ECG ."

. 150-300 ,QRS
.
15.
-(Continous ambulatory monitoring (holter
. , . 10-24
. .
.
.
-Transtelephonic monitoring " .
" . .
.
- .
24 7 , .
," .
.
:Cardiac biomarker analysis :
.
,

 .

, .
,
.

) CK-MB ( - MI .

-Lictic dehydrogenase

2-3 .

- ,MI

. 1-3
.MI - 4-12 24 .
MI
.
.MI

-I\T

. .
3-4 4-24.
3.

-(Brain (b-type) natriuretic peptid (BNP

.
.
, .
, BNP>51.2 .
BNP>1000 , .

-(C-reactive protein (CRP .

. .
CRP .

 ) 3 (
.

-Homocysteine

.CVD ,CVD
.CVD
.
, B12, B6
. 12 . .5-15

, , .BUN

- .

. ,
. 2:
.extrinsic, intrinsic .
PTT APTT - intrinsic pathway
. PT extrinsic pathway
warfarin. INR PT
, PT .warfarin
2-3.5 .
:
,

.
. LDL :-
.HDL LDL HDH -
) LDL (HDL- HDL - .
24 ,
12 .

) - > (200

. .
) (
. .
, , , ,
, LDL .> 160
.
.
HDL .70- 35-70 35-75
.
HDL .LDL - ,
, .
.40

(100-200) -

.
. , .
LDL .HDL
:
" 4

,
. .
, , MI
, ,
. :
, , ,
, .

 ,
.

.

.

.
BRUCE ,
3 . 80- -
90% .
2- "
, , ,
, , , .

, , ,
" .
- 4 .
.
. ,
.
, .
. 10-15
. .

"
(dipyridamole (Persantine), adenosine (Adenocard :
IV "

 . dipyridamole 15-30
, , ,
. adenosine ,
) 10( .
Dobutamine .
((Dobutrex , ,
.
.theophylline
- 4 .
. aminophylline theophylline 24-48
. .dipyridamole
.
. .
1-3.
-Radionuclide imaging :

, .
thallium : .technetium -
. ,
" scintillation Planar .
imaging 3- spect - .

180-360 - . .

-Myocardial perfusion imaging

. .
" Thallium .
.MI ,
.
.

 . "
. 3 .
Fixed .
defect . ,
, .
PCI .
Tc (cardiolite
, .
.
-
) ( ) .(planar/spect

.X-ray ,spect
20-30
, .planar

-(Multiple gated acquisition scanning (MUGA

, scintillation
.
.
.
.
.

-(Computed tomography (CT X

.
EBCT . CT
.
,congenital heart lesions , , ,
.ejection fraction , MI, PCI
- EBCT

 .
MI . EBCT-

.
- .
.
. .
.

-(Positron emission tomography (PET

.
.
TEE . thalium
.
. .
" .
.
"
. ,
.
.
- 4 .
.

-(Magnetic resonance imaging (MRI

.

. , .
,
.

 - , ,
.
, .
.
, .
.
.
. .
:
- , ,
.
- , , , , ,
.

. : )
( ) ,ptca, pci ,( .
" ejection fraction .
.aorthograpthy , ,
.

- .

,
, "

,
- " .
: , "" , )( ,
, )" ( ,
,

 , , , ,
, .
: , .
- "
, . ,
3- IV . ,
, " . .
.
.
- siran .
. .
- ."
siran . ,
.siran
-
. .
,bun:,, , , ,
, , , , ,
, .
: -
: , ) .
.
( , ) ( , , :
. . , , , )
( , . -
, , , ,,
) ( ,
) 12 6 ,

 , 30
(.
: ,
, ) perclos
( , , )
( , 12 , .
:
, , ,
)(.
) -P.T.C.A( . , ,,
. . 30% .
. .
.
-STENT .
.PLAVIX , .
PLAVIX.
- , , )
, ,
( , .
:Electrophysiological study
, - ,
) ( AF VF
, - )
( , .
- , ,
, .
-" . .
" . , ,

 . " ) sinus
, node , ( .
2-6 , .
" " . , .
.
- , )"
( , , .
" - , , , ,
, " , 8,
," , ,
) , ,( , , .
- 24 . "
, , .
.
) , , , (.
:Echocardiography

- ,

. .
,
.
. "
. ) (echo
.
" ,M-mode . ,
,Cross sectional . ,
. color few-
.
.
, ,

 . ,
.
CAD . :
, .
.
' . ,
. 30-45 .
, .

-(Transesophageal echocardiography (TEE

.
.
dobutamine .
.CAD

. , ,
,
. TEE
.
: 6 ,
.
.
.
" ," , , .
.
."
. 24
. .
:

) :CVP- central vein pressure

( , .
, , , ,

.
: ' . .
. . phlebostatic
axis . : ,
. : , .

- :

, , .
: ' . , .
. WEDGE
.. . 25\8" .
. . . : ,
. : , , ,
, , .

. ,. . :,,
.
.
: , . "
. . : ,
, , , , , , .

,823 - . 830 .

-Sinus node dysrhytmias

. ),
,( , ) , , ,
( , ) , ,(amiodarone ,
) .(ICP,MI :
, , ,\ ,,
, , , , .
.60
.
, . ,
. ,
, , ,"
, " -
. 0.5 IV 3-5 3
. .
.

.) STRESS : ,,
, , , ,( , ,
) , ( ,
) , ,( ,
, ) , "( .
.80-100
Postural orthostatic tachycardia .
-(syndrome (POTS , "
5-10 .
. ,

 - )( "
. ,
. :
.
.
. POTS -
,
.

-Atrial dysrhytmias

-Premature arial complex "

. : , , , ,,
, , , .
." , ",
AF .
, " " ." : P
.P RR
.

-Atrial flutter ,

250-400 ." : P .
P F " " . AV -
, ,
. : , . :
, , . :
) ( ,
" , .
" , ,
- , .

-Atrial fibrillarion .

." 350-600 ,
) P ( , .
, ) (proxismal
. : , , ,CAD , ,
, , , .
: , .pulse deficit , .
: ) ( , ) -
( , , ,
.

-(Supra ventricular rythem (SVT

160-220 ." ,P RR
. :) WPW ,
() REENTERY , , ( . : ,
.IV

:Ventricular dysrhytmias

-Premature ventricular complex

. " ." ,P
, RR.
: , , , ,,
, , , , ),
( , , . ,
. ,MI, PVC .
. .
: , )(.

-Ventricular tachycardia

." : ,P .
. : . :

) amiodarone, procainamie, sotalol, lidocain (,

. .

-Ventricular fibrillation

." .
VT .VT "
, .
. CPR : , ,
.
.VF 32-34 - ,
, , ,
.

-Ventricular asystole .flatline "

QRS 2 P
. , .
. : CPR . :
, , , ,
, , , , .
,"
.

abnormalities

Conduction

AV AV node .
) , ,(,
, . ,
" . "
. ,
, , , .
. . :
, . : , .

-1 AV

node . RR : .

-2 .1-

.
. WENKEBACH. 2
.AV node PP ," QRS MOBITS 2

-3 .AVnode

, . "
QRS " .P :
. ,
. , ,
, .IV ,MI
. .

:
- ,
. ,
.
. ,
.
, ,,
, .
.
.

, .
,
.


.
.
, ".
. .
" . .
.
- ,
. - , ,
.
- ,
, .
-
: " , .
. ,
" .
, .
.
6
. , ,
.
: . ) (

.
. , ,
. .
, .

 : .
.
,
. , .
,
.

) + (

:
. : ,
.
: ,Ventricular Fibrilation, Ventricular Tachicardia
.
, .

- : ,
, .
: V.F -
. 10 % -
: .
. .
:
: . ON/ OFF
:. )(V1,V5-V6
. .
. .
: .
vf.

 :
* .
* .
* .
* .
* .
*
:
. , .
* .
* .
*
) (

) , (.
* .
*
, , "
.
*
, ,

.
*
, .

 -CARDIOVERSION ,
. : , .
: , , : , , : INR , , 2.5
, , ,
, .
: , , "
, ,
.
.

:
.
:
.1
.2
.3
: / , ((pacing .( (sensing
Endocardial\ Epicardial , .
: ,
.
:

- , , .

,
. : ,

 , ,
" . " .

- , ,

.
.

) -(transcutaneos ,

,
.
.
:
, ,
, ,

, .
NASPE-BPEG :
: A,V,D :
: sens : A, V, D
: :sens , , ,)
( I,T,D,O
: )( R
: )(ICD
DDDR ... ,IMPLANTABLE ,
- CARDIOVERTER DEFIBRILLATOR .VT , VF
DOUEL CHAIMBER " .
:
, , , , ,
, , .

 :
, ,
/ . 24 - .
" ,
/ , .
: , , .
: , , . . :
, , , .MRI : ,
.

) (
: , ,
, ,

 , , :
, ,
.

-Tradotional Coronary Artery Bypass Graft

,888" .
.
) .(CPB )left/right internal
(marmmary artery, saphenous vein ,
.
, 10 ,
. ,CPB
. .
-Cardiopulmonary bypass
.
. vena ,
,cava .
) " dextrone 5% .( lactated vingers solution -
, , " .
,"
. .
. ,
protamine sulfate
. - " . 28 -30
.18
.4 7%
. .
. "

 . ,
, , . -
" .
:
.1

- .

.2

- .

:
ACT=Activating Clotting Time
(ACT>480sec). Ac 100-160 . -
, .25%-
. .
,off pump - .1990 -
. .
,
. .
.
.
,MI - .
.
-Valvuloplasty 920-925
. valvuloplasy
. .
" .missurotomy
.
. " "
) ( . .

 -Commissurutomy . .
.commissure
, . , ,
. .

-Closed .

.balloon valvuloplasty
,
.
. : ,
, , ,
.

.
. .
. ,
.
, "
. 10-30,
.
.
,
. , " ,
.
. : ,,
, , , ,
.
closed surgical valvuloplasty
.

 , . ,
.

-Open .

. .
. , ,
.
, .
-Annuloplasty . .
" .
.
, " " "
, .
. ,
.
, .
-Leaflet repair .
. )
( .
. .
-Chordoplasty ,chordae
. ,
.chordea tendinea , ,
. , , .
.

-Valve replacement
.1960 .
.

 ) .(thoractomy
. ,
.
'
. , ,
. 3 3 . ,

.
, .
.
" .TEE
,
. , .
,"
.
, .
.
: , , ," , " , ,
.
:

- .

.
, , ,
. .
.
.

- 3 .

.
-Xenografts . .


. ,70
.
. 7-10 -Homografts . .
.
. 10-15 .
-Autografts . .
.
. ) ( ,
20 . .
, .

) (.924

.
. 4 .
. , " 24-48
. .
5-15 2-4.
IV" , .
.
1-4 , .
.
.
.
warfarin .INRS 2-3.5
) 3( . .
.
. , 3-7 .
. " 3-7

 baseline .
" .

) (928

, .
,
Left .
.ventricular outflow tract, latissimus dursi muscle wrap
1967- .-
1983 cyclosporine
cyclosporine .

. : , , ,
.
,
12 .
. , , , ,
, , , -
. ,
,
) -
6(.
-Orthotopic transplantation .
vena cava - .
)
.(vena cava "
" , . "

 .
.
-
. , , ,
, ) ( .
cyclosporine, tacrolimus (prograf), azothioprine (imuran), mycophenolate
(mofetil (cellcept ) (ieprednisone .
.
70-90
.
20-30 . . ,
.
.
.cyclosporine/ tacrolimus "
.
,
. , , , ,
,
. .
80-90 5- 60-70.
,
,
.

) (

-
.
."

 .
.baseline ,
. , .

," , , , .
.
, , .
- . ," ,
, , " . baseline,
.
. -
.
. -
, , ,
, , , , ' ,
. - ,
, , ,
, .
.

.
- ,
. - , ,
.
- ,
.
-
, , ,
.

. ,
.
.

. " .

. ,
, .

.

. " ," .
.IV
.
.(lorazepam (ativan), diazepam (valium

. , , ,
) ( .
,
.
. .

. , .
, ,
.
- ,
.

 -
- .
.baseline-
- , , , , ,
.
- , , ," ,CVP ,"
, , , .
- , , ,
, CO2 , tidel
,volume .
- , , , , ,
" .
- ,urine specific gravity ,.
,output, intake -
.
- , , , .
: , , ,CO2
,SPO2 , , , ...
,
.
. : , ,
. , .
- .
, .
" ,
, ,MI , .
- intake ,output -,
, , , , ,


, , . .
- -
24 .
.
2-4
.
: , , ,
. , .
.spo2, co2 , ,
.
- .
. ,
, , , .
, , ,
, , ,, .
- , .
.
.
, , ,
.
.
, , ,
, .
.
.
- " ,MI , , , .
, ,, ,

 . - , ,
, , .
- , ,
, , , ,
, .
-

, " , ,CVP ,
. .
. 30 -
.
. -
.
. ,
. -
.
.
. , ,
, , . .
,AF , ,
. .
, , , ,,
.

." 100%
.
.baseline , .
, 1-2 .
.

 , ."
24 ,
,
,
.
.

- intake-

,output .

.
.

.
, ." , ,
. 2-5
.
. ,
.
, . .

-"

.
" . .
. , )
( . ) PCA
( .
. ,
.
," , .
.(naloxone (narcan

, . .
.
, , , , , .
, , ,
, [ .
.
, ,
.
. .
.
. ,
.
. IV .
,
. .

. ' ." "

, ,
, . , ,
.
' . "
) pleural effusion : , () pyrexia ,
,() pericardial effusion ,
( .leuritis, pericarditis , ,
. ,
, ,
.

 ,
.
-
: , .
, -
. 6 -.
.1

:
* - , .
* .
* .
* / ) (.
* .
* .
* , .

.2

:
/
* ) (
* .
*
* 38 .
" .
* .

.3

:
)(
.
* 3.
.

* )( 10
.
* .
* .
.4

) : (.

-
"" ) (.
* ) 2-3 - (.
* .
* 6 " .
- : .

.5

:
:
*
*
* 3".
* .
* ,
.
:

.6

.1

!!

.2

) , (.

:
.
: . - .

 . .
,
) (.
110 60 - ,
.
* .
* - 2" 5"
.
.7

:
.
2-3
.
* : , ,
) 4 - (.
* .

.8

:
.
. .

.9

:
/ .
/ , 10 - .
.

.10

:
, .

 PT
.
" T. COUMADIN PT -) INR -
( " .
.
.
, ,,

. .

.COMMADIN - ,
.

-
-Angiography 814-815 " .
.
.
-Aorthgraphy .

 -Coronary arteriography ,
. ,
, .
8-12 . ,
" . ,
, .
" .
,

.
. .
.
, ,
, , , , , .
. ,
. ,
).(CVA, stroke
-Doppler " ,
. , ,
. " )
( " . .
CW ,
.
" " ) ( .
, 5-10 . .
- 20-30 .
, . '
)" '
( . 40-60

 . .
.
,
.
. .
-ABI " .
, ,
.
5 . " .
" . ,
. "
)
- 20
( . . -ABI
.
ABI=1. ABI 0.5-
0.95 ) ( ,
ABI ,0.5 ABI .0.25
:ABI 40%
80% . .
, . , ,40
. ABI - 1.3
.300

-
) :" , " (983
)\ ( .
. : , ,

 , MI
. .
, .
. . ,
, Pain, pallor, pulse, paresthesy, .
.paralgsy - :
.
)(
. , .
.
, . - .
) ( ,
, .
, . 6 ,
6 . ,
. , 3-4
.
: ,
. , ,
. . 20-30.

.
. 15% .
30 .
- ,
, .
) (
, . ,
, .

 ,
. .
.
, .'
.
:

- ,

. ,
, ,' ,
. 8-
24 .

. ABI 8 24
. .
.
.

- ,

,CVP .
)
( . . .
,
.
.
, "
".

.
.

 , , .
,
. .
) :" , " (992
, , .
. -
.
.
, . ,
-
.
. ,
. .
. , , .
.
. , ,
" " .intermittent claudication
) ( .
. :
, ,
. : " ,
. ,
.
.
.
. . ,
, .
, .


. .
. ,
. - , ) (
" . , -.
- ) ( , ,

.
:
- , . -
, . ,
. : " 4
) ( .
, . " 120 ,160 ,
.120
ABI . ABI 0.5 .1-
. :
. .
: , ".
, 4\3 .
,"
.
.
." ,
- ,
. .
, - ,
. , ) ,
( . .

) :Aneurysm" , " (997

, .
Saccular aneurysm .
Fasiform aneurysm . Mycotic .
aneurysm .
.

- .

.40-70 , .
. :
, ,
, , , .

. ,
. : " ,
, ,
.
. " TEE ,.CT-
: . "
. " ,
" sodium nitroprussid IV
. , .
" .
"
. gore tex\ PTEE " .
.

- , .

. 4 ,
. . :

 .
, .
, " . : .

. ,
. :
. .
, .
CT , .
, 6
, .
. : .60-90
, 6-" .
, 5.5".
: .
" . , " ,
,ACE 2 .
. 8" ,
50% . 2.5 3- .
. 5-6"
, .
0.55" .
, .4%
.
, , ,
.
: , ,
, , , .
" . "

 . .
" .
-
.
, . ) (
.
. .
" " .
, .
."
)
( , .
, . ,
"
. "
, . " ,

" .
-vena cava
. vena cava
. : 50-75%
" 45-95% .
)" , " .(2215
.
. :
) ( , ) ( ,
- , . :
. .85% -

 , . -
, . .
)( . 4 2 , 2- .
)( ,
) ( . . CCA ,
:2- . ,
. )(
. ,
)( . , .
. .
, .
. 20%- . ,
" " " . 15%- ,
, .
- .
. , .
, .
. . :

. hemiplegia

Pharezis . .
anestezia parestezia.
Monoplegia .

. - .
-.

- .

, .Amaurosis fugax .
. ,
. , .,

 ,
.

, .

.
.
-
.
,
. .
- .
.
, .
. .
. 70%
, 45% 5-
. ,70%
11% 5- , .
:Carotid endarterectomy ,
.
.70%
,60% . : 70%
70%.
:
- 5.5% . .
" , .
. ,
.
-
. .

 . 48-
. "
baseline - .
- 5% . phenylephrine
." 24-48 . "
MI .
- .
.
, .
" .
- .
. ," , ,
.
.
- . .50%
.

-
) -Deep vein thrombosis (1005-1014

: saphineous ,,

'
. .
.
.
. ,
.
-

 . 3 "
)virchow triad " '(
, , .

2 3

.
, .
, , ) .(+65
. ,
. ,
, , .
.
, , ,PO C ,S-
, ,5 ,
, , .
) .(thrombophlebitis
,
.phlebothrombosis
.
.
,
" ."
.
. ,
, DVT "
.
: .

. .
.

 " .
.DVT

, ,

.
. - ,
.
: , ,
, , , ,
, , .
: ,varicose veins ,
, , , ,
, . .
: DVT .
, , .
.
:
.
:

S.C - DVT

5-7 .
warfarin . aPTT, INR
.

(dalteparin (fragmin), enoxaparin (lovenox

S.C
. . .
. .

- .

t-pa (alteplaase, activase), retaplase (retavase), tenecteplase

.(TNKase), staphylokinase, urokinase, streptokinase 3

 . 5 .
.
.
-XA ,S.C 3 17
. .
.warfarin -
. .
: .
. " "
.
.
: ,aPTT, PT, INR, ACT ,
, .
,
.
, , IV
" . .
. .aPTT= 1.5
PT .INT
: .
. .
IV .
, , .30%
.
. ,
. ,
. ,

. lepirudin

 ((refludan .argatroban - -
.
.warfarin
, , .
. 5-7 .
.
. .
.
.

.
. .
: ,
,
.

.
=Unna boot , ' .
. .
=Cir caid , .
- . 35-
55 . .
.
, .
. , .
.
2 . 10 .
:
, ,

 . .

.
) :Chronic venous insufficiency" , ( 1013 -1010
. , ,
80% . , ,
, . ,
.
.
.DVT
, .
.

. , , .
- . ,
90%- . .
.
)( .
. .
: .
.
- . . -
,
. .varicus veins
) .(+30
. .
: .
, . SFI
.

 . ,
, , )( . .
.
: .
,
. .

.
: , ) ( .stripping ,
,
. .
. - .
, .
: )( .
. , .
"
".
, .
. , .
- . , .
,DVT , .
" ,
. .
, )( .
DVT .
.
,
.
,"

 .50-60 : ,
, ,
. ,
) ( .
.
.
) :Leg ulcers (1011-1013
75% ,
, , ...
:
. , .
, .
: .
. . .
- , , .
halox 5- .
" .
."
. .
.
,
. ,
.
- .
malleolus , , . "
extravasation .
-Rubor , .

 : .
. .
.
:
- , .
- . .
-Debridament . .
normal saline .saf- clens
, .debridement .
. :
, " , "
. ,
, .
.
.
7 .
. '
. .
.
.
- .
. .
.
.
,
, .
.
-(Hyperberic oxigenation (HBO
30 .

 100% .
.
,
. .
:
- .
' . .
, ,
, .
- .
. , ,
. .
- , ,
-
.
. , " .
.
.
.

.
.
"
. ,
.
, . ,
" , . .
, A ,C- .
.

 . "
, .
.
.
- , .

) (

-- , .

.
"
-----

" .
.

:
: .PAD
: , ,
.
: . ,
,
.
: , ,
, , , .
:

 -
. 15 -" ,
.
.
,
.
.
.
. baseline
. : , ,
. ,
.
-
.PAD , ,
. ,
. :

. , .
) (
. )(raynaud's disease

. . ' ,
.
.
. ,
.
.
. "
.


. , , '
.
.

.
- , ,
. , ,
.
,
. oxycodone plus acetylsalicylic acid (percodan), :
(oxycodone plus acetaminophen (percocet

.
- .
, .
, ,
. .
. .
.
. ,
.
. " .
, .

.
.
. C . A

 . ) (ZINC .
) (.
- .
,
.
, .
, .
. ,
.

... , " ...

-1
penetrating .
: ) ( .
) ( . ,mismatching
. ," .
.
-Ducts arteriolns )( .
.
: , .
.Rib fracture and plail chest . , .
. )( 3 -
. . . 2 ,1

 . - ,
. - " . .
-Plail chest . .
. . ) .
.
-Pneumothorax
. , .pleural space
. " . , simple
.pneumotorax
-Open pneumotorax . ,
. 4\3
.
-Teusio pneumothorax . , .

. . \vena cava inferior
superior .
) . , ,
(.
simple- . tension .simple
. tension , , .
-Haemothorax .
CC 300-400 . CC 100 .
CC 1000 .
open pneu
.tension