创伤完整版本课件

TRAUMA,ProAhmat.YusufPh.D.1stHospitalOfXinjiangMedicalUniversity,1,学习交流PPT,2,学习交流PPT,Definition,Injuriesresultfromexposuretophysicalagentssuchasmechanicalenergy,heat,electricity,chemicals,andionizingradiationThedestroyofcontinuityandintegralityofbodysurface,tissuesandorgans,3,学习交流PPT,Outlineoftrauma,ClassificationPathologyRepairDiagnosisTreatment,4,学习交流PPT,Classification,CloseOrOpenPositionOrOrganCauseDegree,5,学习交流PPT,ClosedInjury,6,学习交流PPT,OpenInjury,7,学习交流PPT,PositionHeadandneck、chest、abdomenOrganLiver、spleen、softtissue,8,学习交流PPT,Cause,BayonetInjuryGunshotWoundBlastInjuryIncisedWoundCrushInjuryTrafficAccident,9,学习交流PPT,10,学习交流PPT,Triage,Critical-RequireimmediatesurgerySerious-RequiresurgerybutcanwaitMinorinjury,11,学习交流PPT,Physiologicresponese,ThephysiologiceffectofthestressresponseistomaintainperfusionandfunctionoftheheartandbrainAcutely,thisresultsinasurvivaladvantages,however,withprolongedactivationoftheinflammatoryresponse,deleteriouseffectscanbeseenincludingSIRS,MODS,andevendeath,12,学习交流PPT,LocalReaction,InflammationCellProliferation,13,学习交流PPT,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,14,学习交流PPT,Trauma,ACTH、TRH、GH、ADH,Renin-angiotensin-AldosteroneMechanism,Systemicchange,15,学习交流PPT,16,学习交流PPT,TypeOfWoundHealing,HealingbyfirstintentionPrimaryhealingHealingbysecondintentionSecondaryhealing,17,学习交流PPT,PrimaryHealing,Healingoccurswhentissueisclearlyincisedandreapproximatedwithrepairoccuringwithoutcomplication,18,学习交流PPT,PrimaryHealing,19,学习交流PPT,SecondaryHealing,Healingoccursinopenwoundsthroughformationofgranulationtissueandeventualcoverageofthedefectbyspontaneousmigrationofepithelialcells,20,学习交流PPT,SecondaryHealing,21,学习交流PPT,Procedureofhealing,InflammatoryPhaseProliferativePhaseRemodelingPhase,22,学习交流PPT,InflammatoryPhase,Inflammation,Hemostasis,23,学习交流PPT,Granulation,Scar,ProliferativePhase,24,学习交流PPT,RemodelingPhase,25,学习交流PPT,Factorsofhealing,InfectionCirculationDysfunctionNeutritionStausImmunologyImpressionDrugAndOtherPhysicalOrChemicalFact,26,学习交流PPT,Infection,27,学习交流PPT,CirculationDysfunction,28,学习交流PPT,NeutritionStaus,29,学习交流PPT,ImmunologyImpression,30,学习交流PPT,DrugAndOtherPhysicalOrChemicalFact,CortisonX-RayOthers,31,学习交流PPT,Diagnosisoftrauma,HistoryPhysicalExaminationLab-studies,32,学习交流PPT,Diagnosisoftrauma,Inmostcases,thepresentationmakesthediagnosisstraightforwardItmaybemissedbecauseofthesubtletyofthepresentationthepresenceofmultipleinjuries,33,学习交流PPT,History,TimeoftheaccidentNatureandspeedofimpactConsciouslevelofpatientwhendiscoveredandlaterchangesinconsciouslevelAnestimateofbloodlossDetailsofdrugs,fluidsandothertreatmentsadministeredPreviousstateofhealthincludingpastmedicalhistory,drughistoryanddrugallergiesDetailsofpriorfood,alcoholordrugintake,34,学习交流PPT,History,Cause、Mechaism、Location、Position,35,学习交流PPT,Physicalexamination,PrimarysurveySecondarysurvey,36,学习交流PPT,Primarysurvey,A.AirwayB.BreathingC.CirculationD.DisabilityE.ExposureF.Fracture,37,学习交流PPT,Primarysurvey,38,学习交流PPT,PhysicalExamination,PatientsgeneralconditionThelevelofconsciousnessBloodpressurePulserateorheartrateRespiratoryrhythmetcInsevereinjuriesthepatientshouldbecompletelyandcarefullyexamined,fromheadtotoes,39,学习交流PPT,SecondarySurvey-CRASHPLAN,C-CirculationR-RespirationA-AbdomenS-SpineH-HeadP-PelvisL-LiverA-ArteryN-Nervesystem,40,学习交流PPT,41,学习交流PPT,PhysicalExamination,InspectionPalpationMovementMeasure,42,学习交流PPT,PhysicalExamination,InspecttheinjurygivevitalcluesastothelikelydegreeofdamagePalpateforpulses,thepresenceofaDopplersignaldoesnotexcludeanarterialinjury,43,学习交流PPT,PhysicalExamination,Whengrossdeformityandcrepitationarepresent,furtherexaminationofthefractureisnotnecessaryNeurologicalcomplicationsmustbeconsideredinallseverelyinjuredorunconsciouspatients,44,学习交流PPT,Distal1/3rdfractureoffemur,M.becepsfemoris,M.gastrocnemii,A.popliteaandV.poplitea,45,学习交流PPT,Labstudies,ItisimportanttomakesureDonotdelaythetreatment,46,学习交流PPT,Imaging,X-rayCTMRI,47,学习交流PPT,ShouldensurethatstandardAPandlateralradiographsincludeboththejointaboveandthejointbelowthegivenfractureIfthereareperi-articularfractures,obliqueviewsoftheinternalandexternalconditionwouldgiveadditionaldetail,X-Ray,48,学习交流PPT,X-Ray,49,学习交流PPT,MonteggiaFracture,50,学习交流PPT,X-Ray,51,学习交流PPT,CT,ComputerTomographyScansareusefulinevaluatingtheextentofinjuries.mostparticularlyincomplexspinal,pelvicandcalcanealinjuries,52,学习交流PPT,CT,53,学习交流PPT,54,学习交流PPT,MRI,MRIMagneticResonanceImagingDiagnostictechniquewhichprovidescrosssectional;also3dimensionalimagesofinjuriesSofttissuedamageispickedupparticularlywell,55,学习交流PPT,MRI,56,学习交流PPT,AngiogramCut-offofanteriorbranchofInternalIliac,57,学习交流PPT,Treatmentoftrauma,PrehospitalcareHospitalcare,58,学习交流PPT,Prehospitalcare,SatisfactoryoutcomesforinjuredpatientsarestronglyinfluencedbytheinitialcaredeliveredParticularlyinthe“goldenhour”followingadmissiontothehospitalemergencydepartment,59,学习交流PPT,LifeThreateningSituations,Incasesoflife-threatening,thepatientmustfirstbestabilized-ABCprincipleLifebeforelimbmustalwaysbethefirstprincipleoftreatmentThoroughassessmentofthetraumaassoonasthepatientsconditionisstabilized,60,学习交流PPT,ATLS-AdvancedTraumaLifeSupport,DonofurtherharmtothepatientAssessandresuscitatethepatientsimultaneouslyDeveloparigidorderofprioritydealingfirstwiththegreatestthreatstolife(theprimarysurvey)Conductathoroughsearchforallotherinjuries(secondarysurvey)Stabilizethepatientbeforetransfertoadefinitivetraumacarefacility,61,学习交流PPT,Airway,62,学习交流PPT,Breathing,63,学习交流PPT,Breathing,64,学习交流PPT,Circulation,65,学习交流PPT,Circulation,66,学习交流PPT,Neurologysystem,67,学习交流PPT,Neurologysystem,68,学习交流PPT,RecommendationdoseofMethylprednisolene,IVbolus30mg/kgBW15min.FollowedbyIV5.4mg/kgBW/Hrfor23hoursStartwithin8hoursafterSCI,69,学习交流PPT,70,学习交流PPT,Thoracicinjuries,EnsurethepatientisbreathingwithunrestrictedsymmetricalchestmovementRememberthemostfrequentseriousmajorchestinjuriesareHaemothorax/haemopneumothoraxFlailchestTensionpneumothoraxCardiactamponadeAlthoughthediagnosiswillbeobviousonachestX-Ray,inacriticallyinjuredpatienttheremaynotbetimeandalifewillbesavedafterinsertionofachestdrainorpericardiocentesisafteranaccurateclinicaldiagnosisOccasionallyalifewillbesavedbyurgentthoracotomyintheemergencyroomtoarresthaemorrhagefromtheheartorlungroot,71,学习交流PPT,Abdominalinjuries,Majorintra-abdominalbloodlossusuallyfollowsinjurytotheliverorspleenorapenetratinginjurythatdamagesthegreatvesselsormesenteryinahaemodynamicallyunstablepatient.Ifdoubtexists,adiagnosticperitoneallavagewillusuallyidentifyanyintra-abdominalbleeding.InastablepatientaCTscanwillidentifyanyinjurytoliver,spleenorkidneyRuptureofahollowviscuscanbedifficulttodetectandmaybemissedonsimpleradiologicalstudies.Itshouldbesuspectedinapatientwhobecomessepticfornoapparentcauseorinanypatientwhodevelopsprogressiveabdominalsigns,72,学习交流PP