2022医学课件儿童创伤急救

1、Chapter 17Trauma in Children第一页，共三十五页。Trauma in ChildrenTrauma in Children儿童创伤第二页，共三十五页。OverviewEffective techniques to gain confidence有效增加信心的技巧Injuries based on mechanisms of injury受伤机理ITLS Primary and Secondary Surveys初步及进一步检查 Consent and the need for immediate transport家长同意及需实时运送Pediatric equipme

2、nt needs适合儿童之器材Various methods of SMR on child儿童脊椎固定方法EMS involvement in prevention programs参与预防意外方案3Trauma in Children -第三页，共三十五页。Trauma in ChildrenDifferent from adults与成人不同Different patterns of injuries不同伤势模式Different responses to those injuries不同反响Special equipment required需要特别器材 Assessment equi

3、pment and treatment equipment检查及冶疗用的器材Difficult to assess and communicate 较难评估及沟通Come with caregivers and other family members与家人或照顾者同行4Trauma in Children -第四页，共三十五页。Communicating沟通Family-centered care is critical.以家庭为中心Caregiver not always parent.照顾者未必是父母Involve caregivers as much as possible in ca

4、re.尽量让照顾者参与Give explanations and careful instructions.必需详加解释及指示Inclusion and respect will improve stabilization.包容及尊重可稳定伤者Keep caregivers in physical and verbal contact.与照顾者保持接触Demonstrate competence and compassion.5Trauma in Children -第五页，共三十五页。Assessing Mental Status捡查精神状态Consoled or distracted可按抚

5、或转注意力Most sensitive indicator of adequate perfusion 能准确反映组织灌注是否足够Caregivers best at detecting subtle changes 照顾者会较易分辩出伤者微小改变6Trauma in Children -第六页，共三十五页。Assessing Mental StatusInitial level of consciousness最初清醒程度Preschool child : sleeping vs. unconscious 幼儿:疲倦vs人事不醒Most will not sleep through arri

6、val of ambulance大部份沿途不会睡觉Ask caregivers to wake child着照顾者弄醒伤者Suspect hypoxia, shock, head trauma, seizure 疑心缺氧、休克、头部受伤、癫痫7Trauma in Children -第七页，共三十五页。CommunicatingInteraction strategies使用适龄的语言Appropriate language for developmental level适宜的语言Speak simply, slowly, clearly说话要慢及简溸Be gentle and firm必需肯

7、定Avoid “no questions防止说不Get a favorite belonging 利用其喜爱的玩具/随身物品Get on childs level 降下身段至与伤者视线平衡Explain SMR necessity 解释脊椎固定之需要Allow caregiver to accompany child 让照顾者与伤者同行8Trauma in Children -第八页，共三十五页。Caregiver Consent照顾者同意Critical care shouldnotbe delayed.切勿延医冶理Emergency care needed如需进行急救Consent not

8、 available未能取得同意Transport before permission, document why, notify medical direction记录,速送医院,通知医五Consent denied不同意Try to persuade, document actions, obtain signature 尝试说服、记录、签署Notify law enforcement and appropriate authorities 行使有关法例Report suspected abuse 如疑心儿童受虐待,通知警方9Trauma in Children -第九页，共三十五页。Pe

9、diatric Equipment儿科器材Length-based tape身长尺Weight estimate大约体重Fluid and medication doses precalculated 输液及药物剂量Common equipment size estimates 常用器材尺码10Trauma in Children -Photo courtesy of Kyee Han, MD第十页，共三十五页。Mechanisms of Injury受伤机理Falls高处下堕Usually land on head通常头先着地Serious head injury unusual from

10、27 inches严重头部受伤并不常见于身长27吋Protective gear保护装备MVCs交通意外Seat-belt syndrome平安带综合症Liver, spleen, intestines, lumbar spine 肝、脾、小肠、腰椎Auto-pedestrian crashes路人被撞11Trauma in Children -第十一页，共三十五页。Mechanisms of InjuryBurns烧伤Airway obstruction气道受阻Foreign body异物Child abuse虐待儿童Suspect if history does not match inj

11、ury 受伤经过与伤势不吻合Story keeps changing经常改变说法12Trauma in Children -第十二页，共三十五页。Airway in Children儿童气道Signs of obstruction呼吸受阻征状Apnea无呼吸Stridor吸气时有喘鸣声“Gurgling respiration有杂声的呼吸Contribute to obstruction诱因Hyperextension过度舒张Hyperflexion过度屈曲13Trauma in Children -Courtesy of Bob Page, NREMT-P第十三页，共三十五页。Airway

12、in ChildrenOpening airway张开气道Tongue is large; tissue soft舌大,组织软Jaw-thrust下颔上提法Oropharyngeal airway口咽气道Nasopharyngeal airways鼻咽气道Too small to work predictably 因鼻孔太少未必有效Neonate obligate nose breather 新生婴儿用鼻孔呼吸Clear nose with bulb syringe用球状泵吸走分泌14Trauma in Children -第十四页，共三十五页。Breathing in Children儿童呼

13、吸Work of breathing呼吸方法Retractions, flaring, grunting 肋间收缩、鼻翼扩张、咕噜声 Persistent grunting requires ventilatio n持续咕噜声需要施行助呼吸Respiratory rate呼吸次数Fast, then periods of apnea or very slow 先后短暂停止或转慢Minor blunt neck trauma can be critical.轻微头部挫伤可引起严重伤势15Trauma in Children -第十五页，共三十五页。20, 15, 10Ventilation Ra

14、te换气次数16Trauma in Children -10 per minute for adolescent如为中童, 10次/分钟 20 per minue for 1 year如1 year如 1岁, 15次/分钟第十六页，共三十五页。Breathing Management呼吸处理17Effective BVM ventilation有效BVM换气intubation is elective.可考虑插喉Trauma in Children -第十七页，共三十五页。Endotracheal Intubation 气管内导管Oral endotracheal intubation从口腔插

15、入No blind nasotracheal intubation for 130 usually shock in all ages except neonates脉搏130多为休克,新生婴儿除外Prolonged capillary refill and cool extremities微血管回流时闭迟及肢体冰冷Level of consciousness清醒程度Circulation can be poor even if child is awake 血循环衰竭的儿童仍可完全清醒Low blood pressure is sign of late shock.血压低是休克的后期征状BP

16、 80 mmHg in child; 70 mmHg in young infant20Trauma in Children -第二十页，共三十五页。Shock in ChildrenStrong compensatory mechanisms生理的补尝机制较强Appear surprisingly good in early shock 早期休克可有效发挥“Crash when deteriorate但情况会急转直下Be prepared必需有心理准备Fluid administration 20 mL/kg in each bolus输液补充每次20 mL/kgConsider intra

17、osseous infusion骨髓输液法Frequent Ongoing Exams持续检查 21Trauma in Children -第二十一页，共三十五页。Pediatric Trauma Center 儿童创伤中心Criteria条件Obstructed airway气道阻塞Need for airway intervention处理气道Respiratory distress呼吸困难Shock休克Altered mental status意识紊乱Dilated pupil曈孔扩大Glasgow Coma Scale score 13Pediatric Trauma Score 10

18、 feet高处堕下Motor-vehicle collisionMVC with fatalities车祸中有人死亡Ejection from an automobile in a MVC 车祸中弹离车厢In MVC, significant intrusion into compartment 车祸中受困于车厢中Hit by a car as a pedestrian or bicyclist行人被撞Fractures in more than one extremity多边一条肢体骨抑Significant injury to more than one organ system多过一个器

19、官受伤23Trauma in Children -第二十三页，共三十五页。Pediatric Trauma CenterRecommended建议送院Burns烧伤Near-drowning遇溺Head injuries with loss of consciousness 人事不醒的头部受伤Notify hospital as early as possible.尽早知会医院24Trauma in Children -第二十四页，共三十五页。Life-Threatening Injuries 危害生命伤势Head injury头部受伤Most common cause of death最常见

20、死亡原因Level of consciousness change best indicator 清醒程度之改变为最有效的征状Pupil assessment important检查瞳孔25Trauma in Children -第二十五页，共三十五页。Life-Threatening InjuriesHigh-flow oxygen高浓度氧气Hyperventilate only with cerebral herniation syndrome 加快换气只适用于出现脑疝征状Fluid administration titrated to systolic BP 控制输液速度至可维持根本收缩

21、压Preschool child: 80 mmHg; older child: 90 mmHg幼儿: 80 mmHg,小童: 90 mmHgBe prepared to prevent aspiration 预防气道吸入异物26Trauma in Children -第二十六页，共三十五页。Life-Threatening InjuriesChest injury胸部创伤Respiratory distress common最常见的征状为呼吸困难Pneumothorax or tension pneumothorax气胸或张力性气胸Difficult to assess较难分别Needle t

22、horacostomy can be life-saving剌胸膜腔穿刺Pulmonary contusion胸部挫伤Rare injuries较少发生伤势Rib fractures, flail chest, aortic rupture, pericardial tamponade 肋骨折、槤架胸、主动脉撕裂、心胞膜填塞27Trauma in Children -第二十七页，共三十五页。Life-Threatening InjuriesAbdominal injury腹部创创Liver and/or spleen rupture肝、脾撕裂Second leading cause of tr

23、aumatic death 伤第二致死伤势Bleeding often contained within organ 出血通常局限于器官之内Difficult to diagnose难以诊断Severe injury with minimal signs 严重伤势可只有轻微征状Suspect with any abnormal abdominal assessment 假设有任何异常腹部征状当作严重伤势处理Be prepared to prevent aspiration. 预防气道吸入异物28Trauma in Children -第二十八页，共三十五页。Life-Threatening I

24、njuriesSpinal injury脊椎创伤Uncommon before adolescence青少年以下较少发生9 years usually lower cervical-spine injuries头椎下受伤Higher incidence of SCIWORAspinal-cord injury without radiographic abnormality 可无X-光片异常29Trauma in Children -第二十九页，共三十五页。Life-Threatening InjuriesSMR脊椎固定Pad under torsofor neutral position 于天然屈曲位下放置较垫May have to secure without cervical collar 可不使用颈圈固定颈椎Do not restrict chest movement 切勿紧束胸部30Trauma in Children -第三十页，共三十五页。Child Restraint Seats儿童汽车平