戶外創(chuàng)傷現(xiàn)場(chǎng)急救操作規(guī)范【-】

戶外創(chuàng)傷

現(xiàn)場(chǎng)急救操作規(guī)范深圳市第二人民醫(yī)院骨科丁強(qiáng)傷情判斷整體認(rèn)識(shí)決定處理措施的施行順序首先解決危害生命的因素生命體征及神志判斷

拍打〔面部〕呼叫〔姓名及傷因〕瞳孔〔對(duì)等、光反響〕脈搏呼吸〔胸動(dòng)、聽〕血壓

休克：有效循環(huán)血量↓和組織灌注↓導(dǎo)致細(xì)胞缺氧、代謝紊亂、功能受損的綜合征正常值：120/80mmHg±收縮壓＜90mmHg或脈壓差＜20mmHg時(shí)視為休克脈搏

橈動(dòng)脈、耳前動(dòng)脈、頸動(dòng)脈微弱不清、無力，＞100次/分鐘呼吸

用觀察棉花飄動(dòng)頻率：＜15次/分鐘或＞25次/分鐘外部傷口判斷

按照頭、頸、胸、腹、脊柱、骨盆、四肢的順序檢查按照望、觸、扣、聽的步驟檢查位置、數(shù)量、長度、深度、血管傷情內(nèi)部傷情判斷

按照頭、頸、胸、腹、脊柱、骨盆、四肢的順序檢查按照望、觸、扣、聽的步驟檢查位置、肌肉損傷、骨折、內(nèi)臟損傷要點(diǎn)：面色、眼瞼、口唇、鼻翼煽動(dòng)或頸上凹，皮溫、濕度、肌張力。內(nèi)外傷情同時(shí)檢查判斷外傷處理重點(diǎn)

心肺復(fù)蘇〔CPR〕

下肢抬高、頭略低位A〔air-way〕——呼吸道通暢：仰頭，頸后墊高，口咽與氣管成直線，去除氣道阻塞物B〔breathing〕——人工呼吸：捏閉鼻孔，墊襯單層紗布口對(duì)口。吸飽滿、用力吹。按壓:呼吸約為5:1〔一人施救〕及3:1〔二人施救〕C〔circulation〕——人工血液循環(huán)：直臂、翹指、雙手掌重疊，胸骨中下1/3處，胸骨下陷深度5cm，兒童適減其它創(chuàng)傷

止血固定頸部無論有無體征，只要有病癥，就應(yīng)視為受傷首先頸托固定

胸部對(duì)于胸腔開放性損傷，立即封閉胸腔，視病情決定是否需要閉式引流

腹部開放性腹腔損傷，立即封閉腹腔，腹外腸管不予回納，扣碗狀蓋保護(hù)脊柱無論有無體征，只要有病癥，就要視為受傷搬動(dòng)時(shí)注意肩、臀同時(shí)滾動(dòng)方法，及三人托起方法，禁止二人脫抬四肢軟組織傷創(chuàng)面〔口〕消毒〔用碘伏、雙氧水、清水等〕一般性滲血或小出血加壓包扎即可，止血效果不好的活動(dòng)性較大出血需要上止血帶對(duì)于噴射樣出血或〔和〕涌泉樣出血，能簡(jiǎn)單結(jié)扎血管就絲線結(jié)扎，不能簡(jiǎn)單處理就大量紗布?jí)K充填“8〞字包扎法的使用傷口清洗后包扎，關(guān)節(jié)處或附近的傷口使用“8〞字包扎方法，防止神經(jīng)血管受壓止血帶使用方法上臂或大腿的中上1/3處，加用墊襯，禁止使用金屬絲或電線。有止血帶者一定在傷者局部明顯部位標(biāo)記止血初始時(shí)間，止血帶一次止血時(shí)間為≤1小時(shí)，需要超時(shí)止血者一定中間放松10分鐘，放松時(shí)可以臨時(shí)按壓傷口以減少出血骨折的處理一般作為最后處理步驟對(duì)有骨折或疑心骨折的肢體進(jìn)行固定，使用過關(guān)節(jié)的夾板或樹枝或其它替代物轉(zhuǎn)運(yùn)

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