trauma-(創(chuàng)傷)-PPT課件

1、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 greatlyCan you find out some typical examples of trauma?1. Primary survey1. Primary surveyThe advanced trauma life support(ATLS) can signif

2、icantly improve the outcome for the injured patient.ATLS emphasize “golden hours”.Assessment of “ABCs”:Airway with cervical spine protection;Breathing ;Circulation.Important because efforts to restore cardiovascular integrity be futile unless the oxygen content of the blood is adequate.Require cervi

3、cal spine immobilization until injury is excluded. Applying hard collar or placing sandbags on both sides of the head.Conscious ,without tachypnea, normal voice, unnecessary.Blood, vomit,the tongue, foreign bodies, and soft tissue swelling can cause airway obstruction.Suctioning affords immediate re

4、lief.Chin lift or jaw thrust effective.Establishing a definitive airway: endotracheal intubation is indicated in many conditions like apnea , coma, hematoma, aspiration.Altered mental status is the most common indications for intubation.Correct endotracheal placement is verified with direct laryngos

5、copy,capnography,audible bilateral breath sound,and finally a chest film.Once a secure airway is obtained ，adequate oxygenation and ventilation must be ensured.Inadequate ventilation conditions: tension pneumothorax,open pneumothorax,flail chest,massive air leak.Flail chest occurs when three or more

6、 contiguous ribs are fractured in at least two locations,Paradoxical movement of this free-floating segment of chest wall is evident .Resultant hypoventilation and hypoxemia require intubation and mechanical ventilation.Peripheral pulses palpation: SBP60-carotid pulse 70-femoral pules 80-radial puls

7、eHypotension:90BP and pulse measured every 5 minsRoutine blood cell countingArterial blood gas analysis typing and cross-matching (for transfusion)Coagulation panelThe internal carotid veinThe subclavicular veinvenous catheterpercutaneous punctureinternal carotid veinpercutaneous puncturesubclavicul

8、ar veinExternal control of any visible hemorrhage should be achieved promptly.Manual compression of open wounds with ongoing bleeding be done with a gauze and a gloved hand.Four life-threatening injuries must be identified promptly.massive hemothoraxcardiac tamponadeMassive hemoperitoneummechanicall

9、y unstable pelvic fractures with bleedingThree tools to differentiate: chest radiography, pelvis radiography, abdominal sonographyPericardiocentesis is indicated for patients with evidence of pericardial tamponade. A access to the pericardium is obtained through a subxiphoid approach ,needle angled

10、45degrees up from the chest wall and toward 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 th

11、e operating room for sternotomy.cardiac tamponadeHemorrhagic shockThorough history is obtained and the patient is systematically examined after life-threatening issues have been addressed.Ample history (allergies, medications, past illnessed , pregnancy, last meal events related to the injury)Head t

12、o toe physical examination.Digital rectal examinationVaginal examination in women with pelvic fractures.Vital signsCVP monitoringECG monitoringNastogastric tube placementFoley catheter placementRadiographsLab tests, Hemoglobin,urinalysis,base deficit,measurement,repeat FAST(focused assessment of son

13、ography for trauma) examination.HeadNeckChestAbdomenPelvisExtremitiesThe abdomen is a diagnostic black 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 pe

14、ritoneallavageexploratory laparotomyvascular injuryBloody vicious Bloody vicious circlecircleAndDamage controlDamage controlSurgerySurgeryThe lethal combination of coagulopathy, hypothermia, and metabolic acidosis.Once the cycle starts, each componenet magnifies the other,lead to a downward spiral a

15、nd ultimately a fatal arrhythmia.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.The

16、most common technique is to measure the patients bladder pressure. 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 management of seriously injured patients consists of performing the primary survey(ABCs);and to identify and treat life-threatening conditions. 3 patients with blunt injury should be assumed to have unstable cervical spine injuries until proven otherwise.4 patients with ongoing hemodynamic ins