創(chuàng)傷完整版本

1、整理課件整理課件整理課件Definition Injuries result from exposure to physical agents such as mechanical energy ,heat ,electricity,chemicals, and ionizing radiation The destroy of continuity and integrality of body surface ,tissues and organs 整理課件Outline of trauma Classification Pathology Repair Diagnosis Treatme

2、nt整理課件Classification Close Or OpenPosition Or OrganCauseDegree 整理課件Closed Injury整理課件Open Injury 整理課件 Position Head and neck、chest 、abdomen Organ Liver 、spleen 、 soft tissue 整理課件Bayonet InjuryGunshot WoundBlast InjuryIncised WoundCrush InjuryTraffic Accident整理課件整理課件TriageCritical-Require immediate su

3、rgerySerious-Require surgery but can wait Minor injury 整理課件 Physiologic responese The physiologic effect of the stress response is to maintain perfusion and function of the heart and brain Acutely, this results in a survival advantages, however ,with prolonged activation of the inflammatory response

4、,deleterious effects can be seen including SIRS,MODS,and even death 整理課件Local Reaction Inflammation Cell Proliferation 整理課件小血管擴(kuò)張小血管擴(kuò)張毛細(xì)血管壁毛細(xì)血管壁通透性增加通透性增加炎性細(xì)胞炎性細(xì)胞損傷損傷小血管收縮小血管收縮吞噬細(xì)菌、組織碎片吞噬細(xì)菌、組織碎片釋放細(xì)胞、生長(zhǎng)因子釋放細(xì)胞、生長(zhǎng)因子炎癥反應(yīng)炎癥反應(yīng)細(xì)胞增殖細(xì)胞增殖局部紅、腫、熱、痛功能障礙局部紅、腫、熱、痛功能障礙 整理課件TraumaACTH、 TRH、 GH、 ADHRenin-angiotensin-

5、AldosteroneMechanism整理課件整理課件Type Of Wound Healing Healing by first intention Primary healing Healing by second intention Secondary healing 整理課件Primary Healing Healing occurs when tissue is clearly incised and reapproximated with repair occuring without complication 整理課件Primary Healing整理課件 Secondary

6、Healing Healing occurs in open wounds through formation of granulation tissue and eventual coverage of the defect by spontaneous migration of epithelial cells整理課件Secondary Healing整理課件Procedure of healing Inflammatory Phase Proliferative Phase Remodeling Phase整理課件 Inflammatory Phase InflammationHemos

7、tasis整理課件GranulationScarProliferative Phase 整理課件 Remodeling Phase整理課件 Factors of healing Infection Circulation Dysfunction Neutrition Staus Immunology Impression Drug And Other Physical Or Chemical Fact整理課件Infection整理課件Circulation Dysfunction整理課件Neutrition Staus整理課件Immunology Impression 整理課件Drug And

8、 Other Physical Or Chemical FactCortisonX-RayOthers整理課件Diagnosis of traumaHistoryPhysical ExaminationL a b - s t u d i e s 整理課件Diagnosis of trauma In most cases, the presentation makes the diagnosis straightforward It may be missed because of the subtlety of the presentation the presence of multiple

9、 injuries整理課件History Time of the accident Nature and speed of impact Conscious level of patient when discovered and later changes in conscious level An estimate of blood loss Details of drugs, fluids and other treatments administered Previous state of health including past medical history,drug histo

10、ry and drug allergies Details of prior food,alcohol or drug intake整理課件History Cause、Mechaism、Location、Position 整理課件Physical examination Primary survey Secondary survey整理課件 A. Airway B. Breathing C. Circulation D. Disability E. Exposure F. Fracture整理課件整理課件 Physical Examination Patients general condit

11、ion The level of consciousness Blood pressure Pulse rate or heart rate Respiratory rhythm etc In severe injuries the patient should be completely and carefully examined, from head to toes 整理課件Secondary Survey - CRASHPLAN C-Circulation R-Respiration A-Abdomen S-Spine H-Head P-Pelvis L-Liver A-Artery

12、N-Nerve system整理課件整理課件Physical ExaminationInspection Palpation MovementMeasure整理課件Physical Examination Inspect the injury give vital clues as to the likely degree of damage Palpate for pulses, the presence of a Doppler signal does not exclude an arterial injury整理課件Physical Examination When gross def

13、ormity and crepitation are present, further examination of the fracture is not necessary Neurological complications must be considered in all severely injured or unconscious patients整理課件 Distal 1/3 rd fracture of femurM.beceps femorisM.gastrocnemiiA.poplitea and V.poplitea整理課件Lab studies It is impor

14、tant to make sureDo not delay the treatment 整理課件Imaging X-ray CT MRI整理課件 Should ensure that standard AP and lateral radiographs include both the joint above and the joint below the given fracture If there are peri-articular fractures, oblique views of the internal and external condition would give a

15、dditional detailX-Ray整理課件X-Ray整理課件Monteggia Fracture整理課件X-Ray整理課件CT Computer Tomography Scans are useful in evaluating the extent of injuries.most particularly in complex spinal, pelvic and calcaneal injuries整理課件CT整理課件整理課件MRI MRI Magnetic Resonance Imaging Diagnostic technique which provides cross s

16、ectional; also 3 dimensional images of injuries Soft tissue damage is picked up particularly well整理課件MRI整理課件AngiogramCut-off of anterior branch of Internal Iliac 整理課件Treatment of trauma Prehospital care Hospital care整理課件Prehospital care Satisfactory outcomes for injured patients are strongly influen

17、ced by the initial care delivered Particularly in the “golden hour” following admission to the hospital emergency department整理課件 Life Threatening Situations In cases of life-threatening , the patient must first be stabilized-ABC principle Life before limb must always be the first principle of treatm

18、ent Thorough assessment of the trauma as soon as the patients condition is stabilized整理課件ATLS-Advanced Trauma Life Support Do no further harm to the patient Assess and resuscitate the patient simultaneously Develop a rigid order of priority dealing first with the greatest threats to life(the primary

19、 survey) Conduct a thorough search for all other injuries(secondary survey) Stabilize the patient before transfer to a definitive trauma care facility整理課件Airway整理課件 Breathing整理課件 Breathing整理課件Circulation整理課件Circulation整理課件整理課件整理課件Recommendation dose of Methylprednisolene IV bolus 30mg/kg BW 15 min.

20、Followed by IV 5.4mg/kg BW/Hr for 23 hours Start within 8 hours after SCI整理課件整理課件 Thoracic injuries Ensure the patient is breathing with unrestricted symmetrical chest movement Remember the most frequent serious major chest injuries are Haemothorax/ haemopneumothorax Flail chest Tension pneumothorax

21、 Cardiac tamponade Although the diagnosis will be obvious on a chest X-Ray ,in a critically injured patient there may not be time and a life will be saved after insertion of a chest drain or pericardiocentesis after an accurate clinical diagnosis Occasionally a life will be saved by urgent thoracoto

22、my in the emergency room to arrest haemorrhage from the heart or lung root 整理課件Abdominal injuries Major intra-abdominal blood loss usually follows injury to the liver or spleen or a penetrating injury that damages the great vessels or mesentery in a haemodynamically unstable patient. If doubt exists

23、,a diagnostic peritoneal lavage will usually identify any intra-abdominal bleeding. In a stable patient a CT scan will identify any injury to liver, spleen or kidney Rupture of a hollow viscus can be difficult to detect and may be missed on simple radiological studies. It should be suspected in a patient who becomes septic for no apparent cause or in any patient who develops progressive abdominal signs