trauma-(創(chuàng)傷)-PPT課件(PPT 48頁)

1、TRAUMA第1頁，共48頁。DEFINED as cellular disruption caused by and exchange with environmental energy.It remains the main cause of death for all individuals.Trauma can change peoples greatly一、INTRODUCTION第2頁，共48頁。Can you find out some typical examples of trauma?QUESTION第3頁，共48頁。1. Primary surveyThe advance

2、d trauma life support(ATLS) can significantly improve the outcome for the injured patient.ATLS emphasize “golden hours”.Assessment of “ABCs”:Airway with cervical spine protection;Breathing ;Circulation.二、INITIAL EVALUATION AND RESUSCITATION第4頁，共48頁。Important because efforts to restore cardiovascular

3、 integrity be futile unless the oxygen content of the blood is adequate.Require cervical spine immobilization until injury is excluded. Applying hard collar or placing sandbags on both sides of the head.Conscious ,without tachypnea, normal voice, unnecessary.Airway with cervical spine protection第5頁，

4、共48頁。第6頁，共48頁。Blood, vomit,the tongue, foreign bodies, and soft tissue swelling can cause airway obstruction.Suctioning affords immediate relief.Chin lift or jaw thrust effective.Establishing a definitive airway: endotracheal intubation is indicated in many conditions like apnea , coma, hematoma, as

5、piration.Altered mental status is the most common indications for intubation.第7頁，共48頁。Correct endotracheal placement is verified with direct laryngoscopy,capnography,audible bilateral breath sound,and finally a chest film.第8頁，共48頁。第9頁，共48頁。第10頁，共48頁。Once a secure airway is obtained ，adequate oxygena

6、tion and ventilation must be ensured.Inadequate ventilation conditions: tension pneumothorax,open pneumothorax,flail chest,massive air leak.Breathing and ventilation第11頁，共48頁。第12頁，共48頁。第13頁，共48頁。Flail chest occurs when three or more contiguous ribs are fractured in at least two locations,Paradoxical

7、 movement of this free-floating segment of chest wall is evident .Resultant hypoventilation and hypoxemia require intubation and mechanical ventilation.第14頁，共48頁。第15頁，共48頁。第16頁，共48頁。Peripheral pulses palpation: SBP60-carotid pulse 70-femoral pules 80-radial pulseHypotension:90BP and pulse measured e

8、very 5 minsCirculation and hemorrhage control第17頁，共48頁。Routine blood cell countingArterial blood gas analysis typing and cross-matching (for transfusion)Coagulation panellaboratory testCirculation and hemorrhage control第18頁，共48頁。saphenous vein cutdowntoestablisheffectiveand reliablevenouschannel is

9、very importantCirculation and hemorrhage control第19頁，共48頁。The internal carotid veinThe subclavicular veinvenous catheterpercutaneous punctureinternal carotid veinpercutaneous puncturesubclavicular vein第20頁，共48頁。External control of any visible hemorrhage should be achieved promptly.Manual compression

10、 of open wounds with ongoing bleeding be done with a gauze and a gloved hand.Circulation and hemorrhage control第21頁，共48頁。Four life-threatening injuries must be identified promptly.massive hemothoraxcardiac tamponadeMassive hemoperitoneummechanically unstable pelvic fractures with bleedingThree tools

11、 to differentiate: chest radiography, pelvis radiography, abdominal sonography第22頁，共48頁。Pericardiocentesis is indicated for patients with evidence of pericardial tamponade. A access to the pericardium is obtained through a subxiphoid approach ,needle angled 45degrees up from the chest wall and towar

12、d the left shoulder. B seldinger technique is used to place a pigtail catheter.blood aspirated with a syringe or tubing by gravity drain. Evacuation of unclotted pericardial blood prevents subendocardial ischemia and stabilize the patient for transport to the operating room for sternotomy.cardiac ta

13、mponade第23頁，共48頁。Disability and exposure第24頁，共48頁。第25頁，共48頁。Shock classification and initial fluid resuscitation第26頁，共48頁。Hemorrhagic shock第27頁，共48頁。第28頁，共48頁。Thorough history is obtained and the patient is systematically examined after life-threatening issues have been addressed.Ample history (alle

14、rgies, medications, past illnessed , pregnancy, last meal events related to the injury)Head to toe physical examination.Digital rectal examinationVaginal examination in women with pelvic fractures.三 Second survey第29頁，共48頁。Vital signsCVP monitoringECG monitoringNastogastric tube placementFoley cathet

15、er placementRadiographsLab tests, Hemoglobin,urinalysis,base deficit,measurement,repeat FAST(focused assessment of sonography for trauma) examination.Adjuncts to PE第30頁，共48頁。HeadNeckChestAbdomenPelvisExtremitiesRegional assessment and special diagnostic tests第31頁，共48頁。The abdomen is a diagnostic bla

16、ck box.Abdominal rigidity and hemodynamic compromise are undisputed indications for prompt surgical exploration.(exploratory laparotomy)Triple-contrast CT can delineate the trajectory of the bullet Abdomen第32頁，共48頁。第33頁，共48頁。第34頁，共48頁。peritoneallavage第35頁，共48頁。exploratory laparotomy第36頁，共48頁。第37頁，共4

17、8頁。vascular injury第38頁，共48頁。Bloody vicious circleAndDamage controlSurgery第39頁，共48頁。The lethal combination of coagulopathy, hypothermia, and metabolic acidosis.Once the cycle starts, each componenet magnifies the other,lead to a downward spiral and ultimately a fatal arrhythmia.Bloody vicious cycle第4

18、0頁，共48頁。Purpose: to limit operative time so that the patient can be returned to the SICU for physiologic restoration and the cycle thereby broken.Indicaitons: refractory hypothermia, profound acidosis, refractory coagulopathy.Goal: control bleeding and limit GI spillage.Damage control surgery第41頁，共48頁。第42頁，共48頁。Abdominal compartment syndromeThe most common technique is to measure the patients bladder pressure.第43頁，共48頁。第44頁，共48頁。 trauma remains the most common cause of individuals between the ages of 1 and 44 years and is the third most common cause of death regardless of age. the initial m