兒童創(chuàng)傷急救

Chapter17TraumainChildrenTraumainChildrenTraumainChildren

兒童創(chuàng)傷OverviewEffectivetechniquestogainconfidence有效增加信心的技巧Injuriesbasedonmechanismsofinjury受傷機(jī)理ITLSPrimaryandSecondarySurveys初步及進(jìn)一步檢查Consentandtheneedforimmediatetransport家長(zhǎng)同意及需實(shí)時(shí)運(yùn)送Pediatricequipmentneeds適合兒童之器材VariousmethodsofSMRonchild兒童脊椎固定方法EMSinvolvementinpreventionprograms參與預(yù)防意外計(jì)劃2TraumainChildren-TraumainChildrenDifferentfromadults與成人不同Differentpatternsofinjuries不同傷勢(shì)模式Differentresponsestothoseinjuries不同反應(yīng)Specialequipmentrequired需要特別器材Assessmentequipmentandtreatmentequipment檢查及冶療用的器材Difficulttoassessandcommunicate

較難評(píng)估及溝通Comewithcaregiversandotherfamilymembers與家人或照顧者同行3TraumainChildren-Communicating溝通Family-centeredcareiscritical.以家庭為中心Caregivernotalwaysparent.照顧者未必是父母Involvecaregiversasmuchaspossibleincare.盡量讓照顧者參與Giveexplanationsandcarefulinstructions.必需詳加解釋及指示Inclusionandrespectwillimprovestabilization.包容及尊重可穩(wěn)定傷者Keepcaregiversinphysicalandverbalcontact.與照顧者保持接觸Demonstratecompetenceandcompassion.4TraumainChildren-AssessingMentalStatus

撿查精神狀態(tài)Consoledordistracted可按撫或轉(zhuǎn)注意力Mostsensitiveindicatorofadequateperfusion

能準(zhǔn)確反映組織灌注是否足夠Caregiversbestatdetectingsubtlechanges照顧者會(huì)較易分辯出傷者微小改變5TraumainChildren-AssessingMentalStatusInitiallevelofconsciousness最初清醒程度Preschoolchild:sleepingvs.unconscious幼兒:疲倦vs人事不醒Mostwillnotsleepthrougharrivalofambulance大部份沿途不會(huì)睡覺Askcaregiverstowakechild著照顧者弄醒傷者Suspecthypoxia,shock,headtrauma,seizure

懷疑缺氧、休克、頭部受傷、癲癇6TraumainChildren-CommunicatingInteractionstrategies使用適齡的語言Appropriatelanguagefordevelopmentallevel合適的語言Speaksimply,slowly,clearly說話要慢及簡(jiǎn)溸Begentleandfirm必需肯定Avoid“no”questions避免說”不”Getafavoritebelonging

利用其喜愛的玩具/隨身物品Getonchild’slevel降下身段至與傷者視線平衡ExplainSMRnecessity解釋脊椎固定之需要Allowcaregivertoaccompanychild讓照顧者與傷者同行7TraumainChildren-CaregiverConsent照顧者”同意”Criticalcareshouldnotbedelayed.切勿延醫(yī)冶理Emergencycareneeded如需進(jìn)行急救Consentnotavailable未能取得”同意”Transportbeforepermission,

documentwhy,notifymedicaldirection記錄,速送醫(yī)院,通知醫(yī)五Consentdenied不同意Trytopersuade,documentactions,obtainsignature嘗試說服、記錄、簽署Notifylawenforcementandappropriateauthorities行使有關(guān)法例Reportsuspectedabuse如懷疑兒童受虐待,通知警方8TraumainChildren-PediatricEquipment兒科器材Length-basedtape身長(zhǎng)尺Weightestimate大約體重Fluidandmedicationdosesprecalculated

輸液及藥物劑量Commonequipmentsizeestimates

常用器材尺碼9TraumainChildren-PhotocourtesyofKyeeHan,MDMechanismsofInjury受傷機(jī)理Falls高處下墮Usuallylandonhead通常頭先著地Seriousheadinjuryunusualfrom<27inches嚴(yán)重頭部受傷并不常見于身長(zhǎng)<27吋Protectivegear保護(hù)裝備MVCs交通意外Seat-beltsyndrome安全帶綜合癥Liver,spleen,intestines,lumbarspine

肝、脾、小腸、腰椎A(chǔ)uto-pedestriancrashes路人被撞10TraumainChildren-MechanismsofInjuryBurns燒傷Airwayobstruction氣道受阻Foreignbody異物Childabuse虐待兒童Suspectifhistorydoesnotmatchinjury

受傷經(jīng)過與傷勢(shì)不吻合Storykeepschanging經(jīng)常改變說法11TraumainChildren-AirwayinChildren兒童氣道Signsofobstruction呼吸受阻征狀A(yù)pnea無呼吸Stridor吸氣時(shí)有喘鳴聲“Gurgling”respiration有雜聲的呼吸Contributetoobstruction誘因Hyperextension過度舒張Hyperflexion過度屈曲12TraumainChildren-CourtesyofBobPage,NREMT-PAirwayinChildrenOpeningairway張開氣道Tongueislarge;tissuesoft舌大,組織軟Jaw-thrust下頷上提法Oropharyngealairway口咽氣道Nasopharyngealairways鼻咽氣道Toosmalltoworkpredictably

因鼻孔太少未必有效Neonateobligatenosebreather

新生嬰兒用鼻孔呼吸Clearnosewithbulbsyringe用球狀泵吸走分泌13TraumainChildren-BreathinginChildren兒童呼吸Workofbreathing呼吸方法Retractions,flaring,grunting

肋間收縮、鼻翼擴(kuò)張、咕嚕聲

Persistentgruntingrequiresventilation持續(xù)咕嚕聲需要施行助呼吸Respiratoryrate呼吸次數(shù)Fast,thenperiodsofapneaorveryslow

先后短暫停止或轉(zhuǎn)慢Minorbluntnecktraumacanbecritical.輕微頭部挫傷可引起嚴(yán)重傷勢(shì)14TraumainChildren-20,15,10VentilationRate換氣次數(shù)15TraumainChildren-10perminuteforadolescent如為中童,10次/分鐘

20perminuefor<1year如<1歲,20次/分鐘15perminutefor>1year如>1歲,15次/分鐘BreathingManagement呼吸處理16EffectiveBVMventilation—有效BVM換氣

intubationiselective.可考慮插喉TraumainChildren-EndotrachealIntubation

氣管內(nèi)導(dǎo)管Oralendotrachealintubation從口腔插入Noblindnasotrachealintubationfor<8years

少于8歲不可施行鼻入插喉法Uncuffedtube無氣袋式喉管Length-basedtapesystem身長(zhǎng)尺Samediameterastipofchild’slittlefinger與小童尾指頭直徑相同F(xiàn)requentlyreassessplacement需經(jīng)常撿查喉管位置17TraumainChildren-4+ageinyears=sizeoftube(mm)4CirculationinChildren兒童血循環(huán)18Persistenttachycardiaismostreliableindicatorofshock.最有效顯示傷者休克的征狀為持續(xù)的脈搏過快TraumainChildren-CirculationinChildrenEarlyshockmoredifficulttodetermine.較難于休克初期預(yù)測(cè)Persistenttachycardia持續(xù)的脈搏過快Rate>130usuallyshockinallagesexceptneonates脈搏>130多為休克,新生嬰兒除外Prolongedcapillaryrefillandcoolextremities微血管回流時(shí)閉遲及肢體冰冷Levelofconsciousness清醒程度Circulationcanbepoorevenifchildisawake

血循環(huán)衰竭的兒童仍可完全清醒Lowbloodpressureissignoflateshock.血壓低是休克的后期征狀BP<80mmHginchild;<70mmHginyounginfant19TraumainChildren-ShockinChildrenStrongcompensatorymechanisms生理的補(bǔ)嘗機(jī)制較強(qiáng)Appearsurprisinglygoodinearlyshock

早期休克可有效發(fā)揮“Crash”whendeteriorate但情況會(huì)急轉(zhuǎn)直下Beprepared必需有心理準(zhǔn)備Fluidadministration20mL/kgineachbolus輸液補(bǔ)充每次20mL/kgConsiderintraosseousinfusion骨髓輸液法FrequentOngoingExams持續(xù)檢查

20TraumainChildren-PediatricTraumaCenter

兒童創(chuàng)傷中心Criteria條件Obstructedairway氣道阻塞Needforairwayintervention處理氣道Respiratorydistress呼吸困難Shock休克Alteredmentalstatus意識(shí)紊亂Dilatedpupil曈孔擴(kuò)大GlasgowComaScalescore<13PediatricTraumaScore<821