iom cartagena

8/9/2019 IOM Cartagena

1/77

Lo gmg`rofo hftmrismo,ofotigço, chshilieço y potilieço

Akrhsthof Jugifthmr, GJ, TkJ

EuojmliupmUhtk tkm kmlp ic Gora Qiu`myrofj ofj Qaitt Bizhf

Xiu aof smm oll prmsmftothifs if

www.jhuakhrurehmgohf.ire

http://www.diuchirurgiemain.org/


2/77

Ofotigy


3/77

Ofotigy

Hfsmrthif if `itk rojhus ofj ulfoif girm tkof ?4 ag

Zkhabfmss> 0,?; gg

Ht `mlifes ti tkm opifmuritha

systmg ic tkm cirmorg

Ht hs ifm port ic tkm cirmorg

aigportgmft


4/77

Aigpishthif

Trilifeothif ic tkm

pmrhistmug ic ulfo ofj

rojhus

Ailloemf (34-84%) ofj

mlosthf hf tkm prixhgol

ofj jhstol port

Amftrol `ofj>

Hftmrgmjhotm struaturm

`mtwmmf o cosaho ofj o

lheogmft


5/77

Zwi typms ic `mrs tkot cirgs o

arhssariss systmg

Ch`mrs eihfe crig tkm ulfo ti tkm

rojhus ofj crig prixhgol ti jhstol

Ch`mrs irhmftmj crig tkm ulfo ti tkmrojhus ofj crig jhstol ti prixhgol

wkhak orm tkm gist hgpirtoft

Ofotigy


6/77

Ch`mrs jhrmatmj jhstolly ofj rojholly

I`lhqum airj (Umht`rmakt‘s

lheogmft), tkhab struaturm (!

?-1 gg)

Trixhgol `ofj (hfaifstoft -

0,;5 +/- 4,5? gg tkhabfmss)


7/77

Ch`mrs jhrmatmj prixhgolly ofj

rojholly

Zkrmm ports> gmg`rofius - amftrol `ofj -

gmg`rofius

Amftrol `ofj> ?,1 gg tkhab / ? ag lorem

Aogoaki Eoraho CN mt ol. Jmsarhpahñf ofotñghao jm lo gmg`rofo hftmrñsmo jml oftm`rozi> mstujhi mfaojïvmrms. Pmv Ailig` Irtip Zrougotil. 04?1205(1)>?:4-?:1


8/77

?,? ti 0,3 ag

0,5-1,= ag

Oftmrhir vhmw

Tistmrhir vhmw

10%

0=´

=5%5,5 ag

?1,0 ag


9/77

Jhstol gmg`rofius pirthif

Trmsmfam ic o jhstol i`lhqum `ufjlm hf ?0/14

spmahgmfs

Jhstol `mrs `lmfj whtk tkm JP]N (mvmf ZCAA)

B. Fijo mt ol. NKQ 04482 1:O> :?=-:00


10/77

Tkyshiliey ofj

`higmakofhas ictkm hftmrissmius

gmg`rofm


11/77

“Hfjhrmat‗ pkyshiliehaol rilm

Lhghts ifm ic tkm `iorjmr ic tkm cirmorg aigportgmft


12/77

Ht hs tkm hfsmrthif shtm cir

tkm gusalms>

Oftmrhir aigportgmft>

CTL, CJT

Tistmrhir> MTL, OTL, MHT

“Hfjhrmat‗ pkyshiliehaol rilm

MHT

MTL

OTL


13/77

“Jhrmat‗ pkyshiliehaol rilm

Ht hs ifm ic tkm mlmgmfts ic

tkm cirmorg ofj porthahpotms

hf hts pkyshiliey

Zkm gmakofhaol hgplhaothifs

orm ifly bfiwf cir tkm

“amftrol `ofj‗

Zrofsghsshif ic oxhol ofj

trofsvmrsol liojs


14/77

Ofotighaol struaturms rmspifsh`lm ic tkm cirmorg sto`hlhty

Pojhol kmoj, offulorlheogmft, Zrofsvmrsm

(Jmfuaè) lheogmft

JP]N, ZCAA (+/-

JI@)

Hftmrissmius gmg`rofm ofj tkm gusalms

hfsmrthfe if `itk ulfo ofj rojhus


15/77


16/77

Lioj trofscmr vorhms oaairjhfe ti>

Criftol hfalhfothif ic tkm wrhst,

Urhst pishthifhfe hf ffmxhif ir mxtmfshif,

Cirmorg ritothif

Ml`iw hfalhfothif hf tkm criftol plofm

Lifehtujhfol sto`hlhty


17/77

Ukot skiulj wm rmgmg`mr 9

Oxhol liojs orm skormj`mtwmmf rojhus ofj

ulfo ofj ei crig tkm

jhstol port ic tkm rojhus

ti tkm ulfo


18/77

Pojhol kmoj rmsmathif

Olliws prixhgol gherothif

ic 5 gg, mvmf hc sict-

thssums orm hftoat


19/77

ZCAA ir HIG smathif


20/77

Aig`hfmj smathif + rojhol kmoj rmsmathif

Gonir jhsploamgmft


21/77

Ml`iw> ! Pojhus 6 offulor lheogmft +++

Cirmorg > ! Hftmrissmius gmg`rofm

Urhst > ! ZCAA

Mlmgmfts ic lifehtujhfol sto`hlhty


22/77

Zkm cirmorg os o cufathifol ufht

“Kmy! H‘g tryhfe ti poss tkm pitotims! ….Pmgmg`mr, gycirmorgs orm nust os usmlmss

os yiurs!‗


23/77

Trifisuphfothif

Iaaurs oriufj of oxhs nihfhfe tkm

rojhol kmoj ofj ulfor kmoj -Eihfe

olife tkm HIG

Firgol prifisuphfothif> Hftmerhty ic>

prixhgol, jhstol OFJ ghjjlm

rojhiulfor nihft


24/77

Zkm ghjjlm rojhiulfor nihft


25/77

Zkm tkrmm liabmrs aifampt

Mvmry cirmorg struaturm porthahpotms ti tkmprifisuphfothif ofj aifsthtutms o liabmr

Moak liabmr aof `m o`smft, ufsto`lm ir liabmj

Croeiforj> tkm liabmrTorhs, tkm Liuvrm


26/77

Trixhgol liabmr 7 TP]N

LiabhfeTrixhgol

rojhiulfor

s fistishs

O`smftPojhol kmoj

rmsmathif

]fsto`lmPojhol kmoj

jhsliaothif


27/77


28/77

Ghjjlm liabmr

Liabhfe Qyfistishs

O`smft

]fsto`lmHIG lmshif ir

jyopkysol

croaturm


29/77

Aifsmqumfams hf alhfhaol

proatham Liabhfe ic ofy ic tkm tkrmm liabmrs

liabmj oll tkm cirmorg

Qyfistishs

HIG rmtroathif hf

prifisuphfothif lhghtothif

Ibogiti mt ol. NKQ 044321?@>185-:44


30/77


31/77

Aifsmqumfams

O`smfam ic twi liabmrs aoffit `m aigpmfsotm `ytkm lost ifm

Pojhol kmoj rmsmathif + HIG Lmshif

ZCAA jhsrupthif + HIG lmshif


32/77

Totkiliey ic tkm cufathifol

cirmorg ufht


33/77

Hftmrissmius

gmg`rofm

trougothsg

Lifehtujhfol gmakofhsg

Lmshifs jmpmfj ic tkm cirmorg

ritothif


34/77

Tishthif Lmshif Mxogplm Mxpmrhgmftothif

Quphfothif;=´

Cirmorg`ifms croaturm

Quphfothif

:=´

Pojhol kmoj

croaturm

Quphfothif

?=´

Aigplmx

rojhol kmoj

croaturm

Fmutrol

Pitothif

Hftmrissmius

Gmg`rofm

jhsrupthif

GaEhflmy NA mt ol.Cirmorg ofj Ml`iw Hfnury>Zkm Hfclumfam icPitothifol Tishthif N@NQ

Og 04412 ;=> 0:41-0:48.


35/77

Ifm liabmr lmshif

?T> Pojhol kmoj croaturm, hsilotmj rojhol kmoj

rmsmathif

8/?: Gosif H rojhol kmoj croaturm koj jhstol HIG jhsrupthif.

Kousgoff. N. Zrougo 04482 33>:=5-:3?


36/77

Ifm liabmr lmshif

?G> Jhopkysol croaturm ic `itk cirmorg `ifms


37/77

Ifm liabmr lmshif

?J> Jhstol rojhus croaturm, ulfor kmoj croaturm,

ZCAA jhsrupthif


38/77

Qhfelm liabmr hfsto`hlhty 9

O shfelm liabmr hfsto`hlhty hs pri`o`ly fit pissh`lm

]lfor kmoj jhsliaothif 7 ossiahotmj HIG lmshif (Kirhh,

Uotofo`m)

Ifm `ifm cirmorg croaturm orm rorm> Giftmeeho‘s,

Eolmozzh‘s croaturms hgply of ossiahotmj HIG lmshif


39/77

Zwi liabmrs lmshif

0 TG> Giftmeeho‘s croaturm


40/77

Zwi liabmrs lmshif

0 GJ> Eolmozzh‘s


41/77

Zwi liabmrs lmshif

0 GJ> “Hsilotmj‗ ulfor kmoj jhsliaothif


42/77

Zwi liabmrs lmshif

0 TJ> arhss-ariss hfnury

@hpilor jhsliaothif whtk of hftoat HIG

(Lmufe 044=)


43/77

Zkrmm liabmrs lmshif

Mssmx-Liprmsth syfjrigm (?8=?)

Olrmojy jmsarh`mj `y Aurr & Aim hf

?8:3

Lifehtujhfol (ofj trofsvmrsm)hfsto`hlhty


44/77

Uigof, ?8 yrs ilj

Shilmft coll ir kmr lmct cirmorg

Giftmeeho + ZCAA lmshif 7

Mssmx-Liprmsth


45/77

Foturol khstiry ic crmsk lmshifs 9

Aof rmamft HIG jhsrupthif kmol 9

Cohllo, hf crmsk hfnury, jmsarh`ms o whjmfhfe ic tkm mjems (lhbm

hf OAL lmshifs) ofj o gusaulor hftmrpishthif (lhbm hf Qtmfmr‘s

lmshif)


46/77

Foturol khstiry ic crmsk lmshifs 9

Qmaifjory oeerovothif (ir opporhthif) ic Mssmx-

Liprmsth lmshifs skiws>

Qigm lmshifs goy fit kmol

Qigm porthol lmshifs goy oeerovotm

Hs tkmrm o ghfhgol shzm ic lmshif tkot aoffit kmol whtk

priermsshvm oeerovothif ic sygptigs 9


47/77

Jhoefistha ic Mssmx-Liprmsth‘s lmshifs


48/77

Jhoefistha hf mgmremfay Smry jhcault, fi spmaha shefs

Zkhfb ic ht> O lmshif ic twi liabmrs skiulj gobm yiu

susphahius ic o pissh`lm hfnury ic tkm tkhrj liabmr

9


49/77

05 yrs ilj, coll

crig o lojjmr,ml`iw ofj wrhst

pohf

00 yrs ilj, coll

jurhfe spirt


50/77

Hggmjhotm rmpohr 9

Ifly sigm aosm rmpirtmj whtk jhsoppihfthfe rmsults

Ht smmgs tkot tkm HIG aoffit kmol ir whtkstofj tkm

gmakofhaol liojs


51/77

Tothmft prmsmfts whtk pohf ossiahotmj whtk

lhghtothif ic ritothif ofj shefs ic hfsto`hlhty

(priermsshvm JP]N jhsliaothif).

Cmw alhfhaol shefs

Ifm fmmjs hgoehfe tmakfhqums

0ory jhoefistha


52/77

Tlohf [-roys

Hfjhrmat shefs> Trixhgol gherothif ic tkm rojhus, JP]N

jhsliaothif

Qogm pothmft

: wmmbs

: giftks


53/77

Tlohf [-roys

Jhrmat shefs> Oxhol

aigprmsshif tmsts

Gmklkicc> strmss [-roys ufjmr ofmstkmsho

Pojhus Tull Zmst Qghtk, N@NQ 0440

O prixhgol gherothif ic tkm

rojhus 6 1 gg hs ossiahotmjwhtk HIG jhsrupthif


54/77

GPH

TTS > ?44% (ZT / ZT + CT)

FTS > ;8% (ZF / CF + ZF)

Qmfsh`hlhty> ;5,= % (ZT / ZT + CF)

Qpmahahty> ?44 % (CT / CT + ZF)

GPH hs aifshjmrmj os tkm eilj stofjorj


55/77

GPH

Kypishefol Z? & Z0 - Cot Qoturothif +++

Kiwmvmr> gofy orthcoats hf trougothzmj pothmfts,

mspmaholly hc plotms ofj sarmws kovm `mmf hfsmrtmj


56/77

Qifieropky

Qtotha> Qigm outkirs aifshjmr tkot smfsh`hlhty ofj

spmahahty hs olgist ?44% !

Lifehtujhfol vhmw


57/77

Zrofsvmrsm vhmw, tirf

gmg`rofm

Zrofsvmrsm vhmw, hftoat

gmg`rofm


58/77

Jyfogha sifieropky

Tripismj `y Qiu`myrofj

Zkm HIG hs jhvhjmj hf tkrmm ports

Zkm pri`m hs ploamj if tkm

pistmrhir shjm

Ifm puskms if tkm oftmrhirgusalms ic tkm cirmorg


59/77

• O slhekt `ulehfe ic tkmHIG hs vhsh`lm hf firgol

su`nmats

• Tritrushif ic tkm oftmrhirgusalm hs jhoefistha ic HIGjhvhshif

• Qmfsh`hlhty/spmahahty wos?44% hf prixhgol ofj

ghjjlm zifm

Hftoat gmg` ofm


60/77

Hftoat gmg`rofm

Pupturm whtk tkm

kmrfho shef


61/77


62/77

Zrmotgmft ic akrifha lmshifs

T h l P]N


63/77

Trixhgol P]N

Pojhol kmoj

rmaifstruathif whtk

ollieroct (= aosms, skirt

C])

Tristkmtha rmploamgmft

(fit whtk shlostha)


64/77

Jhstol P]N ZCAA rmaifstruathif/rmpohr +++

]lfo skirtmfhfe +/- ulfor kmoj rmsmathif (whtk

rmsmathif jhstol ti tkm ulfor hfsmrthif ic tkm amftrol

`ofj ic tkm HIG

Z motgmft jh matmj ti ci mo g `ifm

s


65/77

Zrmotgmft jhrmatmj ti cirmorg `ifms

Airrmathif ic golufhif (ulfo +++)

Ifm-`ifm cirmorg

Hftmrissmius gmg`rofm rmpohr 9


66/77

Hftmrissmius gmg`rofm rmpohr 9

Gofy trhols, piirly aifalushvm

Gist trofsplofts try ti rmprijuam tkm

amftrol òfj (ìfm-potmllor lheogmft-

ìfm, tmfjif eroct ifm ir twi cosahalms,lheogmftiplosthms)

Akliris mt ol. NKQ

044;211O>?0:-?14


67/77


68/77

Zkm tmakfhqum wm jmsarh`mj

Life trofsploft (smgh-tmfjhfisus)

Olife tkm gmakofhaol oxhs ic tkm cirmorg

?


69/77

?

0


70/77

0

1


71/77

1

:


72/77

:


73/77

Gohf pri`lmg> JP]N

Gist pothmfts orm sthll ufsto`lm ot

tkm JP]N

Qmaifjory priamjurms

?


74/77

Aifalushif

Totkiliey ic tkm hftmrissmius gmg`rofm aoffit `m

jhssiahotm crig potkiliey ic tkm cirmorg

Zkm wkilm cirmorg hs o cufathifol ufht

Zkm tkrmm liabmrs aifampt kmlps ti `mttmrufjmrstofj tkm lmshifs

?

0


75/77

Aifalushif

Hftmrissmius gmg`rofm lmshifs orm olwoys

ufjmrmsthgotmj

Zkhfb ic ht hf rmamft trougo hc itkmr liabmrs orm

jogoemj +++

Jyfogha sifieropky wiulj pri`o`ly `m kmlpcul

Zkm hjmol trmotgmft hf crift ic crmsk lmshif hs sthll

ufbfiwf

0

1


76/77

Aifalushif

Hf akrifha lmshifs, surehaol trmotgmfts orm sthll

jhsoppihfthfe

Zrmot rst tkm `ify lmshifs ofj tkm prixhgol ofj

jhstol liabmrs

Um pripism o irhehfol lheogmftiplosty wkhak tobmhfti oaaiuft tkm gmakofhaol oxhs ic tkm cirmorg

1

::


77/77

Aifalushif

Zkmrm orm pri`o`ly itkmr ufbfiwf lmshifs ic tkm

HIG> Zrofsvmrsm hfsto`hlhty, porthol rupturm, liaolhzmj

sthccfmss,...

Zkot yiu goy jhsaivmr ofj mxplirm

::

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