{"id":29750,"date":"2019-09-19T15:35:37","date_gmt":"2019-09-19T14:35:37","guid":{"rendered":"https:\/\/cram.org\/?page_id=29750"},"modified":"2019-09-19T15:35:39","modified_gmt":"2019-09-19T14:35:39","slug":"fractura-de-closca-i-paraplegia","status":"publish","type":"page","link":"https:\/\/cram.org\/ca\/clinica-i-rescat\/medicina-i-cirurgia\/fractura-de-closca-i-paraplegia\/","title":{"rendered":"Fractura de closca i Paraplegia"},"content":{"rendered":"

FRACTURA DE CLOSCA I PARAPLEGIA<\/strong><\/h1>\n<\/div>
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DADES<\/strong><\/h2>\n<\/div>
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    Esp\u00e8cie: Caretta Caretta<\/span><\/div><\/li>
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    Nom: Super L\u00f3pez<\/span><\/div><\/li>
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    Pes: 23 kg<\/span><\/div><\/li>
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    Lloc de recollida: Blanes<\/span><\/div><\/li>
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    Data: 17\/06\/2004<\/span><\/div><\/li><\/ul>
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    HIST\u00d2RIA<\/strong><\/h2>\n<\/div>

    S\u00faper va quedar atrapada en una xarxa de tresmall a 12 metres de fons. Els pescadors la van pujar a bord i van telefonar al 112, qui va alertar a l’equip de rescat del CRAM. Presentava dues fractures considerables de closca, produ\u00efdes probablement per una h\u00e8lix, i estava en estat de xoc. El reflex palpebral era m\u00ednim.<\/p>\n<\/div><\/div><\/div>

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    EXAMEN F\u00cdSIC<\/strong><\/h2>\n<\/div>

    En arribar al centre de recuperaci\u00f3, l’animal no presentava cap mena de reflex a l’exploraci\u00f3 neurol\u00f2gica. No reaccionava a cap mena d’est\u00edmul ni respirava. Van comen\u00e7ar llavors les maniobres de reanimaci\u00f3. Es tracta d’un massatge card\u00edac realitzat mitjan\u00e7ant moviment d’extensi\u00f3 i flexi\u00f3 de les aletes davanteres. Per a aquesta operaci\u00f3 ha de ser col\u00b7locat en dec\u00fabit esternal en un pla de 45\u00ba orientat cap avall. Al no obtenir resposta, es va procedir a la seva intubaci\u00f3 endotraqueal i ventilaci\u00f3 positiva. despr\u00e9s d’uns minuts, l’animal va reaccionar i va comen\u00e7ar a respirar per si mateix. Se li va administrar la medicaci\u00f3 inicial i va ser col\u00b7locada en el tanc de vigil\u00e0ncia intensiva, davant el seu precari estat cl\u00ednic. Presentava dues fractures de closca obertes, profundes i conminuta en el ter\u00e7 cabal.<\/p>\n<\/div>

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    DIAGN\u00d2STIC<\/strong><\/h2>\n<\/div>

    Se li van realitzar en un primer moment, anal\u00edtica sangu\u00ednia completa i radiografies anteroposteriors i dorsoventrals. Presentava deshidrataci\u00f3 i hiperfosfatemia lleugera, que es van corregir despr\u00e9s de la fluidoterapia, a m\u00e9s de linfocitosis, que va perdurar en el temps fins a la seva recuperaci\u00f3 completa. A nivell radiol\u00f2gic es van identificar dues fractures que afectaven a D8 i D9. Mitjan\u00e7ant TAC es va identificar la secci\u00f3 completa de la medul\u00b7la espinal a nivell de les v\u00e8rtebres esmentades, lesi\u00f3 que es va confirmar posteriorment mitjan\u00e7ant resson\u00e0ncia magn\u00e8tica nuclear. Tant la porci\u00f3 cabal de la D8 com la cranial de la D9 estaven destru\u00efdes per complet. Els ex\u00e0mens neurol\u00f2gics peri\u00f2dics van determinar que l’animal patia una par\u00e0lisi esp\u00e0stica de les extremitats posteriors. Aparentment semblava moure les aletes posteriors, per\u00f2 segons una especialista en neurologia aquest moviment era una conseq\u00fc\u00e8ncia t\u00edpica d’aquesta lesi\u00f3 denominada \u00abmarxa espinal\u00bb, segons la qual, despr\u00e9s d’una lesi\u00f3 medul\u00b7lar greu, es poden produir moviments involuntaris de les extremitats, per\u00f2 tan sols de forma reflexa. Despr\u00e9s de confirmar aquest diagn\u00f2stic, es va decidir deixar en el centre de recuperaci\u00f3 sense possibilitats de ser alliberada a causa de la incapacitat de moviment de dues aletes del mateix costat i, per tant, d’estar en inferioritat de condicions en el mitj\u00e0 salvatge davant possibles perills.<\/span><\/p>\n<\/div>

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    TRACTAMENT<\/strong><\/h2>\n<\/div>

    El tractament inicial fins a restablir vol\u00e8mia i superar el xoc va consistir en rehidrataci\u00f3 intravenosa amb s\u00e8rum fisiol\u00f2gic barrejat amb glucosalino, corticoides d’acci\u00f3 r\u00e0pida, inici d’antibioterapia i desbridament i neteja de les ferides. Als 5 dies de la seva estada en el centre de recuperaci\u00f3, va comen\u00e7ar a menjar per si mateixa i es va suprimir l’alimentaci\u00f3 parenteral, encara que, davant la gravetat de les lesions i la possibilitat de desenvolupar osteomielitis a partir de les fractures, es va mantenir l’antibioterapia durant mesos. Es va establir un protocol de cures cada tres dies. En casos de fractures obertes de closca amb exposici\u00f3 parcial de celoma \u00e9s important mantenir una bona neteja de les ferides. Per a aix\u00f2, es netegen les mateixes acuradament, desinfectant i retirant el teixit mort i es cobreix la ferida amb lanolina anhidra, una subst\u00e0ncia grassa que s’extreu de la pell de xai, que no reacciona amb els teixits vius i repel\u00b7leix l’aigua, servint a manera d’embenatge per a animals que estan en medi aqu\u00e0tic. D’aquesta forma es mant\u00e9 la ferida neta despr\u00e9s del capell\u00e0 durant diversos dies, sense que l’aigua del tanc pugui penetrar en el mateixa. Es van realitzar cures peri\u00f2diques augmentant el temps entre elles a mesura que la ferida anava tancant.<\/p>\n<\/div>

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    INFORMACI\u00d3 COMPLEMENT\u00c0RIA<\/strong><\/h2>\n<\/div>
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    \n

    L’animal presentava dues fractures profundes en el ter\u00e7 distal de la closca.<\/p>\n<\/div><\/div><\/div>

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    Una vegada estabilitzat l’animal, es realitzaven cures peri\u00f2diques.<\/p>\n<\/div><\/div><\/div>

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    Recreaci\u00f3 en 3D de la fractura.<\/p>\n<\/div><\/div><\/div>

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    Imatges de la resson\u00e0ncia magn\u00e8tica nuclear a la qual es va sotmetre a l’animal per a valorar l’abast de la lesi\u00f3.<\/p>\n<\/div><\/div><\/div>

    \"\"<\/div><\/div>
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    \n

    Estudi radiogr\u00e0fic de les lesions.<\/p>\n<\/div><\/div><\/div>

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    \"\"<\/div><\/div>
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    \n

    Super L\u00f3pez nedant.<\/p>\n<\/div><\/div><\/div>

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    <\/div><\/div><\/div><\/div><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":5110,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"100-width.php","meta":{"footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-29750","page","type-page","status-publish","hentry"],"yoast_head":"\nFractura de closca i Paraplegia - CRAM<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cram.org\/ca\/clinica-i-rescat\/medicina-i-cirurgia\/fractura-de-closca-i-paraplegia\/\" \/>\n<meta property=\"og:locale\" content=\"ca_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fractura de closca i Paraplegia - CRAM\" \/>\n<meta property=\"og:url\" content=\"https:\/\/cram.org\/ca\/clinica-i-rescat\/medicina-i-cirurgia\/fractura-de-closca-i-paraplegia\/\" \/>\n<meta property=\"og:site_name\" content=\"CRAM\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/fundacioncram\" \/>\n<meta property=\"article:modified_time\" content=\"2019-09-19T14:35:39+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/cram.org\/wp-content\/uploads\/2013\/12\/logo-CRAM.png\" \/>\n\t<meta property=\"og:image:width\" content=\"420\" \/>\n\t<meta property=\"og:image:height\" content=\"79\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:site\" content=\"@crampress\" \/>\n<meta name=\"twitter:label1\" content=\"Temps estimat de lectura\" \/>\n\t<meta name=\"twitter:data1\" content=\"18 minuts\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/cram.org\\\/ca\\\/clinica-i-rescat\\\/medicina-i-cirurgia\\\/fractura-de-closca-i-paraplegia\\\/\",\"url\":\"https:\\\/\\\/cram.org\\\/ca\\\/clinica-i-rescat\\\/medicina-i-cirurgia\\\/fractura-de-closca-i-paraplegia\\\/\",\"name\":\"Fractura de closca i Paraplegia - 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