孕妇创伤急救

,Chapter 19Trauma in Pregnancy,Trauma in Pregnancy孕妇创伤,Overview概要,Dual goals in managing pregnant trauma需要处理两个或以上的病人Physiological changes of pregnancy孕妇生理改变Response to hypovolemia对血溶积减少的反应Types of injuries most commonly associated常见伤势Initial assessment and management初步检查及处理Trauma prevention in pregnancy预防孕妇创伤,3,Trauma in Pregnancy -,Trauma in Pregnancy孕妇创伤,Unique challenges挑战Vulnerability of pregnant trauma patient孕妇于创伤时之弱点Potential injuries to unborn child对胎儿的伤害Dual roles双重角色Provide care to mother照顾母体Provide care to fetus照顾胎儿,4,Trauma in Pregnancy -,Trauma in Pregnancy,Leading cause of morbidity and mortality为孕妇发病率及死亡率的主要原因67% of pregnancies experience some trauma 6-7%孕妇曾遇上创创1 in 12 injured experience significant trauma 1-2%遭遇严重创伤Major causes主要原因Motor-vehicle collisions交通意外Falls高处堕下Abuse and domestic violence虐待及家庭暴力Penetrating injuries穿刺性创伤Burns烧伤,5,Trauma in Pregnancy -,Pregnant Patient,Increased risk for trauma创伤的风险增加Fainting spells, hyperventilation, excess fatigue commonly associated with early pregnancy孕妇初期较易头晕,呼吸过速,易疲倦Balance and coordination affected by changes throughout pregnancy怀孕过程可影响其平衡力及身体协调,6,Trauma in Pregnancy -,Fetal Development,7,Trauma in Pregnancy -,Viability Assessment,8,Trauma in Pregnancy -,阴道出血,肚脐,耻骨联合,流产,可被见,宫高,Physiologic Changes,9,Trauma in Pregnancy -,肠蠕动,血色素,心输出量,血量,血压,心率,血含二氧化碳量,Physiologic Changes孕妇生理的改变,Respiratory system呼吸系统Diaphragm elevated due to uterine size日渐长大的子宫令横隔膜上升Decreased thoracic volume肺容量下降Relative alkalosis血液相对为碱性 Predisposed to hyperventilation较易出现呼吸过速,10,Trauma in Pregnancy -,Vital Signs in Pregnancy孕妇生命表征的改变,Do not mistake normal vital signs for signs of shock.切勿把正常的生命表征当作休克Normal pulse: 1015 beats faster 正常脉搏:快10-15次Blood pressure: 1015 mmHg lower 血压:低10=15 mmHg3035% blood loss before significant blood pressure change失血量达30-35%才出现休克Be alert to all signs of shock.注意出现休克征状Frequent ITLS Ongoing Exams反复ITLS”复检”捡查,11,Trauma in Pregnancy -,Response to Hypovolemia血溶积减少的反应,Vasoconstriction and tachycardia血管收缩及心跳过速 Reduction of uterine blood flow by 2030% 子宫血流量减少20-30% Fetal heart rate and blood flow decreases 胎儿心跳速率及血流量下降 Fetus becomes hypoxemic 胎儿出现血氧过低High-flow oxygen is essential.给予高浓度的氧气 Maternal shock has 80% fetal mortality rate 孕妇出现休克,胎儿死亡率可达80%,12,Trauma in Pregnancy -,Trauma in Pregnancy,ITLS Primary and Secondary Surveys初步检查及进一步检查Optimize maternal and fetal outcomeHigh-flow oxygen rapidly administered尽快给予高浓度氧Fetal hypoxia occurs before maternal hypoxia胎儿会比母体早缺氧Fluid administration must be prompt必需正确输液Fluid volume needed is greater输液量较多Frequent Ongoing Exams反复ITLS”复检”捡查Mortality of fetus related to maternal treatment 胎儿死亡率与母体处理有关,13,Trauma in Pregnancy -,Supine Hypotension仰卧血压低,Venous return decreases 30% in supine position with 20-week or larger uterus.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Acute hypotension 急性血压低Syncope昏厥Fetal bradycardia 胎儿心跳过慢,14,Trauma in Pregnancy -,Supine Hypotension,Transport position运送时之卧式Tilt or rotate backboard 2030o to patients left 将脊板左倾20 30度Elevate right hip 46 inches with towel于盆腔下垫上4-6吋毛巾Manually displace uterus to left 将子宫移向左侧,15,Trauma in Pregnancy -,Supine Hypotension,Transport positionBetter stabilized with vacuum backboardMore comfortable than standard backboard 固定于真空脊板较比一般脊板舒适,16,Trauma in Pregnancy -,Evaluation of Uterine Size,17,Trauma in Pregnancy -,18,Relatively minor abdominal traumacan cause fetal death.,Maternal death is most common cause of fetal death.胎儿死亡的原因最主要是母体死亡,Trauma in Pregnancy -,Pregnant Trauma Arrest 孕妇创伤性心跳停上,Treated same as for other victims急救法与普通伤者相同Defibrillation settings are same相同去颤法电量Drug dosages are same相同药物剂量Fluid volume needed increases需要较大量静脉输液4 liters normal saline rapid infusion during transport 送院时输液4公升If mother unsalvageable:如孕妇不能挽救Continue CPR继续 CPRNotify hospital of possible cesarean section通知院方:准备接生/剖腹接生,19,Trauma in Pregnancy -,Types of Trauma创伤种类,Motor-vehicle collisions交通意外Penetrating injuries穿刺性创伤Domestic violence家庭暴力Falls高处堕下Burns烧伤,20,Trauma in Pregnancy -,Motor-Vehicle Collisions撞车,6575% of pregnancy-related trauma交通意外占孕妇创伤65-75%20% BSA 烧伤面积 20%会増加胎儿死亡机会,27,Trauma in Pregnancy -,Trauma Prevention预防,Proper seat-belt use正确使用安全带Report domestic violence举报家庭暴力Counseling for domestic violence辅导Patient education病人教育Multiple changes associated with pregnancy 孕妇身体多方面改变Physiological, anatomical, emotional 生理,解剖,情绪,28,Trauma in Pregnancy -,Summary总结,Trauma in Pregnancy孕妇创伤Knowledge of physiological changes生理上的改变Hypotension and hemorrhage easily overlooked 血压低及出血容易被忽视Rapid evaluation and interve