创伤完整版本

.,TRAUMA,ProAhmat.YusufPh.D.1stHospitalOfXinjiangMedicalUniversity,.,.,Definition,Injuriesresultfromexposuretophysicalagentssuchasmechanicalenergy,heat,electricity,chemicals,andionizingradiationThedestroyofcontinuityandintegralityofbodysurface,tissuesandorgans,.,Outlineoftrauma,ClassificationPathologyRepairDiagnosisTreatment,.,Classification,CloseOrOpenPositionOrOrganCauseDegree,.,ClosedInjury,.,OpenInjury,.,PositionHeadandneck、chest、abdomenOrganLiver、spleen、softtissue,.,Cause,BayonetInjuryGunshotWoundBlastInjuryIncisedWoundCrushInjuryTrafficAccident,.,.,Triage,Critical-RequireimmediatesurgerySerious-RequiresurgerybutcanwaitMinorinjury,.,Physiologicresponese,ThephysiologiceffectofthestressresponseistomaintainperfusionandfunctionoftheheartandbrainAcutely,thisresultsinasurvivaladvantages,however,withprolongedactivationoftheinflammatoryresponse,deleteriouseffectscanbeseenincludingSIRS,MODS,andevendeath,.,LocalReaction,InflammationCellProliferation,.,小血管扩张,毛细血管壁通透性增加,炎性细胞,损伤,小血管收缩,吞噬细菌、组织碎片,释放细胞、生长因子,炎症反应细胞增殖,局部红、肿、热、痛功能障碍,.,Trauma,ACTH、TRH、GH、ADH,Renin-angiotensin-AldosteroneMechanism,Systemicchange,.,.,TypeOfWoundHealing,HealingbyfirstintentionPrimaryhealingHealingbysecondintentionSecondaryhealing,.,PrimaryHealing,Healingoccurswhentissueisclearlyincisedandreapproximatedwithrepairoccuringwithoutcomplication,.,PrimaryHealing,.,SecondaryHealing,Healingoccursinopenwoundsthroughformationofgranulationtissueandeventualcoverageofthedefectbyspontaneousmigrationofepithelialcells,.,SecondaryHealing,.,Procedureofhealing,InflammatoryPhaseProliferativePhaseRemodelingPhase,.,InflammatoryPhase,Inflammation,Hemostasis,.,Granulation,Scar,ProliferativePhase,.,RemodelingPhase,.,Factorsofhealing,InfectionCirculationDysfunctionNeutritionStausImmunologyImpressionDrugAndOtherPhysicalOrChemicalFact,.,Infection,.,CirculationDysfunction,.,NeutritionStaus,.,ImmunologyImpression,.,DrugAndOtherPhysicalOrChemicalFact,CortisonX-RayOthers,.,Diagnosisoftrauma,HistoryPhysicalExaminationLab-studies,.,Diagnosisoftrauma,Inmostcases,thepresentationmakesthediagnosisstraightforwardItmaybemissedbecauseofthesubtletyofthepresentationthepresenceofmultipleinjuries,.,History,TimeoftheaccidentNatureandspeedofimpactConsciouslevelofpatientwhendiscoveredandlaterchangesinconsciouslevelAnestimateofbloodlossDetailsofdrugs,fluidsandothertreatmentsadministeredPreviousstateofhealthincludingpastmedicalhistory,drughistoryanddrugallergiesDetailsofpriorfood,alcoholordrugintake,.,History,Cause、Mechaism、Location、Position,.,Physicalexamination,PrimarysurveySecondarysurvey,.,Primarysurvey,A.AirwayB.BreathingC.CirculationD.DisabilityE.ExposureF.Fracture,.,Primarysurvey,.,PhysicalExamination,PatientsgeneralconditionThelevelofconsciousnessBloodpressurePulserateorheartrateRespiratoryrhythmetcInsevereinjuriesthepatientshouldbecompletelyandcarefullyexamined,fromheadtotoes,.,SecondarySurvey-CRASHPLAN,C-CirculationR-RespirationA-AbdomenS-SpineH-HeadP-PelvisL-LiverA-ArteryN-Nervesystem,.,.,PhysicalExamination,InspectionPalpationMovementMeasure,.,PhysicalExamination,InspecttheinjurygivevitalcluesastothelikelydegreeofdamagePalpateforpulses,thepresenceofaDopplersignaldoesnotexcludeanarterialinjury,.,PhysicalExamination,Whengrossdeformityandcrepitationarepresent,furtherexaminationofthefractureisnotnecessaryNeurologicalcomplicationsmustbeconsideredinallseverelyinjuredorunconsciouspatients,.,Distal1/3rdfractureoffemur,M.becepsfemoris,M.gastrocnemii,A.popliteaandV.poplitea,.,Labstudies,ItisimportanttomakesureDonotdelaythetreatment,.,Imaging,X-rayCTMRI,.,ShouldensurethatstandardAPandlateralradiographsincludeboththejointaboveandthejointbelowthegivenfractureIfthereareperi-articularfractures,obliqueviewsoftheinternalandexternalconditionwouldgiveadditionaldetail,X-Ray,.,X-Ray,.,MonteggiaFracture,.,X-Ray,.,CT,ComputerTomographyScansareusefulinevaluatingtheextentofinjuries.mostparticularlyincomplexspinal,pelvicandcalcanealinjuries,.,CT,.,.,MRI,MRIMagneticResonanceImagingDiagnostictechniquewhichprovidescrosssectional;also3dimensionalimagesofinjuriesSofttissuedamageispickedupparticularlywell,.,MRI,.,AngiogramCut-offofanteriorbranchofInternalIliac,.,Treatmentoftrauma,PrehospitalcareHospitalcare,.,Prehospitalcare,SatisfactoryoutcomesforinjuredpatientsarestronglyinfluencedbytheinitialcaredeliveredParticularlyinthe“goldenhour”followingadmissiontothehospitalemergencydepartment,.,LifeThreateningSituations,Incasesoflife-threatening,thepatientmustfirstbestabilized-ABCprincipleLifebeforelimbmustalwaysbethefirstprincipleoftreatmentThoroughassessmentofthetraumaassoonasthepatientsconditionisstabilized,.,ATLS-AdvancedTraumaLifeSupport,DonofurtherharmtothepatientAssessandresuscitatethepatientsimultaneouslyDeveloparigidorderofprioritydealingfirstwiththegreatestthreatstolife(theprimarysurvey)Conductathoroughsearchforallotherinjuries(secondarysurvey)Stabilizethepatientbeforetransfertoadefinitivetraumacarefacility,.,Airway,.,Breathing,.,Breathing,.,Circulation,.,Circulation,.,Neurologysystem,.,Neurologysystem,.,RecommendationdoseofMethylprednisolene,IVbolus30mg/kgBW15min.FollowedbyIV5.4mg/kgBW/Hrfor23hoursStartwithin8hoursafterSCI,.,.,Thoracicinjuries,EnsurethepatientisbreathingwithunrestrictedsymmetricalchestmovementRememberthemostfrequentseriousmajorchestinjuriesareHaemothorax/haemopneumothoraxFlailchestTensionpneumothoraxCardiactamponadeAlthoughthediagnosiswillbeobviousonachestX-Ray,inacriticallyinjuredpatienttheremaynotbetimeandalifewillbesavedafterinsertionofachestdrainorpericardiocentesisafteranaccurateclinicaldiagnosisOccasionallyalifewillbesavedbyurgentthoracotomyintheemergencyroomtoarresthaemorrhagefromtheheartorlungroot,.,Abdominalinjuries,Majorintra-abdominalbloodlossusuallyfollowsinjurytotheliverorspleenorapenetratinginjurythatdamagesthegreatvesselsormesenteryinahaemodynamicallyunstablepatient.Ifdoubtexists,adiagnosticperitoneallavagewillusuallyidentifyanyintra-abdominalbleeding.InastablepatientaCTscanwillidentifyanyinjurytoliver,spleenorkidneyRuptureofahollowviscuscanbedifficulttodetectandmaybemissedonsimpleradiologicalstudies.Itshouldbesuspectedinapatientwhobecomessepticfornoapparentcauseorinanypatientwh