医学ppt孕妇创伤急救

Chapter19TraumainPregnancy TraumainPregnancy孕妇创伤 Overview概要 Dualgoalsinmanagingpregnanttrauma需要处理两个或以上的病人Physiologicalchangesofpregnancy孕妇生理改变Responsetohypovolemia对血溶积减少的反应Typesofinjuriesmostcommonlyassociated常见伤势Initialassessmentandmanagement初步检查及处理Traumapreventioninpregnancy预防孕妇创伤 3 TraumainPregnancy TraumainPregnancy孕妇创伤 Uniquechallenges挑战Vulnerabilityofpregnanttraumapatient孕妇于创伤时之弱点Potentialinjuriestounbornchild对胎儿的伤害Dualroles双重角色Providecaretomother照顾母体Providecaretofetus照顾胎儿 4 TraumainPregnancy FetalDevelopment 7 TraumainPregnancy ViabilityAssessment 8 TraumainPregnancy 阴道出血 肚脐 耻骨联合 流产 可被见 宫高 PhysiologicChanges 9 TraumainPregnancy 肠蠕动 血色素 心输出量 血量 血压 心率 血含二氧化碳量 PhysiologicChanges孕妇生理的改变 Respiratorysystem呼吸系统Diaphragmelevatedduetouterinesize日渐长大的子宫令横隔膜上升Decreasedthoracicvolume肺容量下降Relativealkalosis血液相对为碱性Predisposedtohyperventilation较易出现呼吸过速 10 TraumainPregnancy VitalSignsinPregnancy孕妇生命表征的改变 Donotmistakenormalvitalsignsforsignsofshock 切勿把正常的生命表征当作休克Normalpulse 10 15beatsfaster正常脉搏 快10 15次Bloodpressure 10 15mmHglower血压 低10 15mmHg30 35 bloodlossbeforesignificantbloodpressurechange失血量达30 35 才出现休克Bealerttoallsignsofshock 注意出现休克征状FrequentITLSOngoingExams反复ITLS 复检 捡查 11 TraumainPregnancy ResponsetoHypovolemia血溶积减少的反应 Vasoconstrictionandtachycardia血管收缩及心跳过速Reductionofuterinebloodflowby20 30 子宫血流量减少20 30 Fetalheartrateandbloodflowdecreases胎儿心跳速率及血流量下降Fetusbecomeshypoxemic胎儿出现血氧过低High flowoxygenisessential 给予高浓度的氧气Maternalshockhas80 fetalmortalityrate孕妇出现休克 胎儿死亡率可达80 12 TraumainPregnancy TraumainPregnancy ITLSPrimaryandSecondarySurveys初步检查及进一步检查OptimizematernalandfetaloutcomeHigh flowoxygenrapidlyadministered尽快给予高浓度氧Fetalhypoxiaoccursbeforematernalhypoxia胎儿会比母体早缺氧Fluidadministrationmustbeprompt必需正确输液Fluidvolumeneededisgreater输液量较多FrequentOngoingExams反复ITLS 复检 捡查Mortalityoffetusrelatedtomaternaltreatment胎儿死亡率与母体处理有关 13 TraumainPregnancy SupineHypotension仰卧血压低 Venousreturndecreases30 insupinepositionwith20 weekorlargeruterus 下腔静脉于仰卧时受压引致心脏血液回流受阻 通常20周以后出现Acutehypotension急性血压低Syncope昏厥Fetalbradycardia胎儿心跳过慢 14 TraumainPregnancy SupineHypotension Transportposition运送时之卧式Tiltorrotatebackboard20 30otopatient sleft将脊板左倾20 30度Elevaterighthip4 6incheswithtowel于盆腔下垫上4 6吋毛巾Manuallydisplaceuterustoleft将子宫移向左侧 15 TraumainPregnancy SupineHypotension TransportpositionBetterstabilizedwithvacuumbackboardMorecomfortablethanstandardbackboard固定于真空脊板较比一般脊板舒适 16 TraumainPregnancy EvaluationofUterineSize 17 TraumainPregnancy 18 Relativelyminorabdominaltraumacancausefetaldeath Maternaldeathismostcommoncauseoffetaldeath 胎儿死亡的原因最主要是母体死亡 TraumainPregnancy PregnantTraumaArrest孕妇创伤性心跳停上 Treatedsameasforothervictims急救法与普通伤者相同Defibrillationsettingsaresame相同去颤法电量Drugdosagesaresame相同药物剂量Fluidvolumeneededincreases需要较大量静脉输液4litersnormalsalinerapidinfusionduringtransport送院时输液4公升Ifmotherunsalvageable 如孕妇不能挽救ContinueCPR继续CPRNotifyhospitalofpossiblecesareansection通知院方 准备接生 剖腹接生 19 TraumainPregnancy TypesofTrauma创伤种类 Motor vehiclecollisions交通意外Penetratinginjuries穿刺性创伤Domesticviolence家庭暴力Falls高处堕下Burns烧伤 20 TraumainPregnancy Motor VehicleCollisions撞车 65 75 ofpregnancy relatedtrauma交通意外占孕妇创伤65 75 1 injuredwhenminorvehicledamage如车辆轻微破烂 少于1 孕妇受伤Seatbeltssignificantlydecreasemortality安全带可减低死亡率Hasnotshownanyincreaseinuterineinjury未证实会增加子宫受伤机会 21 TraumainPregnancy Motor VehicleCollisions Maternaldeath母体死亡 HeadinjuryMostcommon头部受伤为最常见Uncontrolledhemorrhage不能制止的内出血Secondmostcommon第二常见Assesspelvis检查盆骨 Fetalinjury胎儿受伤 22 TraumainPregnancy Fetaldistress胎儿衰竭Fetaldeath胎儿死亡Placentalabruption胎盆剥落Uterinerupture子宫破裂Pretermlabor早产 AbdominalTrauma腹部创伤 Physiologicchanges生理改变Decreasedsensitivity敏感度降低Gradualstretching续渐绷紧Hormonalchanges荷尔蒙改变Uterusveryvascular子宫大量有血液供应Clinicalpresentation临床表现Guarding rigidity reboundresponseabsent可没有防卫性收缩 硬实 回缩痛等反应AbdominaltraumarequiresEDevaluation所有腹部创伤都需要送院 23 TraumainPregnancy PenetratingInjuries穿透性创伤 Gunshotwoundsandstabbings枪伤及刺伤Entrybelowfundus从子宫下穿入Uterusabsorbsforce protectsmaternalorgans子宫承受力量 保护母体内脏Highfetalmortalityrate胎儿死亡率 40 70 Lowermaternalmortalityrate减低母体死亡率 4 10 Entryabovefundus从子宫上穿入Bowelinjuryduetodisplacement肠脏受伤 24 TraumainPregnancy DomesticViolence家庭暴力 10 experienceabuseduringpregnancy10 孕妇曾于懐孕期受虐待Proximalandmidlineinjuries近端及中线部位受伤Faceandneckmostcommon面部及颈为最常见Lowbirthweight出生体重较轻Abusedbyspouseorboyfriend 70 85 U S被配偶或男友虐待 70 85 25 TraumainPregnancy Falls高处堕下 Injuryfromfalls高处堕下受伤Increasewithprogressionofpregnancy受伤机会随着怀孕期增加Centerofgravityaltered中心改变Proportionatetoforceandbodypartimpacted与受力及身体撞击点有直接关系Pelvicinjuries盆骨受伤Placentalseparation胎盆分离Fetalfractures胎儿骨折 26 TraumainPregnancy Burns烧伤 FluidvolumeneededincreasesMortalityandmorbidity死亡率及发生率Maternalmortalitysameasnon pregnant死亡率与非孕妇相同Fetalmortalityincreaseswith 20 BSA烧伤面积 20 会増加胎儿死亡机会 27 TraumainPregnancy TraumaPrevention预防 Properseat beltuse正确使用安全带Reportdomesticviolence举报家庭暴力Counselingfordomesticviolence辅导Patienteducation病人教育Multiplechangesassociatedwithpregnancy孕妇身体多方面改变Physiological anatomical emotional生理 解剖 情绪 28 TraumainPregnancy Summary总结 TraumainPregnancy孕妇创伤Knowledgeofphysiologicalchanges生理上的改变Hypotensionandhemorrhage