孕婦創(chuàng)傷急救課件

1、孕婦創(chuàng)傷急救Trauma in Pregnancy孕婦創(chuàng)傷Overview概要Dual goals in managing pregnant trauma需要處理兩個(gè)或以上的病人Physiological changes of pregnancy孕婦生理改變Response to hypovolemia對(duì)血溶積減少的反應(yīng)Types of injuries most commonly associated常見傷勢(shì)Initial assessment and management初步檢查及處理Trauma prevention in pregnancy預(yù)防孕婦創(chuàng)傷3Trauma in Pregna

2、ncy -Trauma in Pregnancy孕婦創(chuàng)傷Unique challenges挑戰(zhàn)Vulnerability of pregnant trauma patient孕婦于創(chuàng)傷時(shí)之弱點(diǎn)Potential injuries to unborn child對(duì)胎兒的傷害Dual roles雙重角色Provide care to mother照顧母體Provide care to fetus照顧胎兒4Trauma in Pregnancy -Trauma in PregnancyLeading cause of morbidity and mortality為孕婦發(fā)病率及死亡率的主要原因67%

3、 of pregnancies experience some trauma 6-7%孕婦曾遇上創(chuàng)創(chuàng)1 in 12 injured experience significant trauma 1-2%遭遇嚴(yán)重創(chuàng)傷Major causes主要原因Motor-vehicle collisions交通意外Falls高處墮下Abuse and domestic violence虐待及家庭暴力Penetrating injuries穿刺性創(chuàng)傷Burns燒傷5Trauma in Pregnancy -Pregnant PatientIncreased risk for trauma創(chuàng)傷的風(fēng)險(xiǎn)增加Faint

4、ing spells, hyperventilation, excess fatigue commonly associated with early pregnancy孕婦初期較易頭暈,呼吸過速,易疲倦Balance and coordination affected by changes throughout pregnancy懷孕過程可影響其平衡力及身體協(xié)調(diào)6Trauma in Pregnancy -Fetal Development7Trauma in Pregnancy -Viability Assessment8Trauma in Pregnancy -陰道出血肚臍恥骨聯(lián)合流產(chǎn)可被

5、見宮高Physiologic Changes9Trauma in Pregnancy -腸蠕動(dòng)血色素心輸出量血量血壓心率血含二氧化碳量Physiologic Changes孕婦生理的改變Respiratory system呼吸系統(tǒng)Diaphragm elevated due to uterine size日漸長大的子宮令橫隔膜上升Decreased thoracic volume肺容量下降Relative alkalosis血液相對(duì)為堿性 Predisposed to hyperventilation較易出現(xiàn)呼吸過速10Trauma in Pregnancy -Vital Signs in P

6、regnancy孕婦生命表征的改變Do not mistake normal vital signs for signs of shock.切勿把正常的生命表征當(dāng)作休克Normal pulse: 1015 beats faster 正常脈搏:快10-15次Blood pressure: 1015 mmHg lower 血壓:低10=15 mmHg3035% blood loss before significant blood pressure change失血量達(dá)30-35%才出現(xiàn)休克Be alert to all signs of shock.注意出現(xiàn)休克征狀Frequent ITLS O

7、ngoing Exams反復(fù)ITLS”復(fù)檢”撿查11Trauma in Pregnancy -Response to Hypovolemia血溶積減少的反應(yīng)Vasoconstriction and tachycardia血管收縮及心跳過速 Reduction of uterine blood flow by 2030% 子宮血流量減少20-30% Fetal heart rate and blood flow decreases 胎兒心跳速率及血流量下降 Fetus becomes hypoxemic 胎兒出現(xiàn)血氧過低High-flow oxygen is essential.給予高濃度的氧氣

8、 Maternal shock has 80% fetal mortality rate 孕婦出現(xiàn)休克,胎兒死亡率可達(dá)80%12Trauma in Pregnancy -Trauma in PregnancyITLS Primary and Secondary Surveys初步檢查及進(jìn)一步檢查Optimize maternal and fetal outcomeHigh-flow oxygen rapidly administered盡快給予高濃度氧Fetal hypoxia occurs before maternal hypoxia胎兒會(huì)比母體早缺氧Fluid administratio

9、n must be prompt必需正確輸液Fluid volume needed is greater輸液量較多Frequent Ongoing Exams反復(fù)ITLS”復(fù)檢”撿查Mortality of fetus related to maternal treatment 胎兒死亡率與母體處理有關(guān)13Trauma in Pregnancy -Supine Hypotension仰臥血壓低Venous return decreases 30% in supine position with 20-week or larger uterus.下腔靜脈于仰臥時(shí)受壓 引致心臟血液回流受阻,通常2

10、0周以后出現(xiàn)Acute hypotension 急性血壓低Syncope昏厥Fetal bradycardia 胎兒心跳過慢14Trauma in Pregnancy -Supine HypotensionTransport position運(yùn)送時(shí)之臥式Tilt or rotate backboard 2030o to patients left 將脊板左傾20 30度Elevate right hip 46 inches with towel于盆腔下墊上4-6吋毛巾Manually displace uterus to left 將子宮移向左側(cè) 15Trauma in Pregnancy -

11、Supine HypotensionTransport positionBetter stabilized with vacuum backboardMore comfortable than standard backboard 固定于真空脊板較比一般脊板舒適16Trauma in Pregnancy -Evaluation of Uterine Size17Trauma in Pregnancy -18Relatively minor abdominal traumacan cause fetal death.Maternal death is most common cause of f

12、etal death.胎兒死亡的原因最主要是母體死亡Trauma in Pregnancy -Pregnant Trauma Arrest 孕婦創(chuàng)傷性心跳停上Treated same as for other victims急救法與普通傷者相同Defibrillation settings are same相同去顫法電量Drug dosages are same相同藥物劑量Fluid volume needed increases需要較大量靜脈輸液4 liters normal saline rapid infusion during transport 送院時(shí)輸液4公升If mother u

13、nsalvageable:如孕婦不能挽救Continue CPR繼續(xù) CPRNotify hospital of possible cesarean section通知院方:準(zhǔn)備接生/剖腹接生19Trauma in Pregnancy -Types of Trauma創(chuàng)傷種類Motor-vehicle collisions交通意外Penetrating injuries穿刺性創(chuàng)傷Domestic violence家庭暴力Falls高處墮下Burns燒傷20Trauma in Pregnancy -Motor-Vehicle Collisions撞車6575% of pregnancy-rela

14、ted trauma交通意外占孕婦創(chuàng)傷65-75%20% BSA 燒傷面積 20%會(huì)増加胎兒死亡機(jī)會(huì)27Trauma in Pregnancy -Trauma Prevention預(yù)防Proper seat-belt use正確使用安全帶Report domestic violence舉報(bào)家庭暴力Counseling for domestic violence輔導(dǎo)Patient education病人教育Multiple changes associated with pregnancy 孕婦身體多方面改變Physiological, anatomical, emotional 生理,解剖,情緒28Trauma in Pregnancy -Summary總結(jié)Trauma in Pregnancy孕婦創(chuàng)傷Knowledge of physiological changes生理上的改變Hypotension and hemorrhage easily overlooked 血壓低及出血容易被忽視Rapid evaluation and interve