内容课件教案trauma

1、Trauma in AdultsQinShaoqiangAffiliated Hospital of HaiNan Medical UniversityQuestion?At accident sceneAt ED ContentsIntroduction of Trauma System;Introduction of Triage and Trauma System Entry Criteria .To know well Primary Survey.Introduction of Radiographic Imaging and Laboratory Analysis.Introduc

2、tion 1Injury is the fourth leading killer of Americans and the single greatest cause of death before the age of 45 years internationally.Introduction 2The major causes of death following trauma are head injury, chest injury, and major vascular injury.Introduction 3Trauma care should be organized acc

3、ording to the concepts of rapid assessment, triage, resuscitation, diagnosis, and therapeutic intervention.Trauma Systems 1A systems approach is required to reduce morbidity and mortality that occur after traumatic injury.Trauma Systems 2In a well-run trauma center, the critically injured patient un

4、dergoes a multidisciplinary evaluation, and diagnostic and therapeutic interventions are performed with smooth transitions between the ED, radiography or CT suite, operating room, and postoperative intensive care setting.23. Chin Med J 2010;(10):1251-1254 4. Chin Med J 2010;(10):1251-1254 Trauma Sys

5、tems 3 Essential Characteristics of Level 1 Trauma Centers 24-h availability of surgeons in all subspecialties (including cardiac surgery/bypass capability) 24-h availability of neuroradiology and hemodialysis Program that establishes and monitors effect of injury prevention and education efforts Or

6、ganized trauma research programTriage and Trauma System Entry Criteria 1Physiologic abnormalities Systolic blood pressure 90 mm Hg Glasgow Coma Scale score 12 in. MVC with major vehicular deformity 20 in. Ejection from vehicle MVC with entrapment or prolonged extrication of 20 min Fall of 20 ft MVC

7、with fatality in same passenger compartment Auto-pedestrian or auto-bicycle collision at 5 mph Vehicular rolloverPrimary Survey 1Pre-hospital mechanism of trauma, suspected injuries, vital sign values, clinical symptoms, examination findings, and treatments providedPrimary Survey 2ED ED staff assign

8、 tasks to team members, Prepare resuscitation and procedural equipment, Ensure the presence of surgical consultants and other care team members. A focused history obtained. Primary Survey 3 ED care A . Airway and cervical spine; B . Breathing; C . Circulation;D . Disability; E . Exposure. Primary Su

9、rvey (Rapid identification and management of immediately life-threatening injuries) 1A. Airway and cervical spine 1. Assess, clear, and protect airway: jaw thrust/chin lift, suctioning. 2.Perform endotracheal intubation with in-line stabilization for patient with depressed level of consciousness or

10、inability to protect airway. 3.Create surgical airway if there is significant bleeding or obstruction, or laryngoscopy cannot be performed.Primary Survey (Rapid identification and management of immediately life-threatening injuries)2B. Breathing 1. Ventilate with 100% oxygen, monitor oxygen saturati

11、on. Auscultate for breath sounds. 2.Inspect thorax and neck for deviated trachea, open chest wounds, abnormal chest wall motion, crepitus at neck or chest. 3. Consider immediate needle thoracostomy for suspected tension pneumothorax. 4.Consider tube thoracostomy for suspected hemopneumothorax.Primar

12、y Survey (Rapid identification and management of immediately life-threatening injuries)3C. Circulation 1.Assess for blood volume status: skin color, capillary refill, radial/femoral/carotid pulse, blood pressure. 2.Place two large-bore peripheral IV catheters. 3.Begin rapid infusion of warm crystall

13、oid solution, if indicated. 4.Apply direct pressure to sites of brisk external bleeding. 5.Consider central venous access if peripheral sites are unavailable. 6.Consider pericardiocentesis for suspected pericardial tamponade. 7.Consider left lateral decubitus position in late-trimester pregnancy.Pri

14、mary Survey (Rapid identification and management of immediately life-threatening injuries)4D. Disability 1.Perform screening neurologic and mental status examination, assessing: 2.Pupil size and reactivity. 3.Limb strength and movement, grip strength. 4.Orientation, Glasgow Coma Scale score. 5.Consi

15、der measurement of capillary blood glucose level in patients with altered mental status.Primary Survey (Rapid identification and management of immediately life-threatening injuries)5E. Exposure Completely disrobe the patient, inspect for burns, toxic exposures. Log-roll patient, maintaining neutral

16、position and in-line neck stabilization, to inspect and palpate thoracic spine, flank, back, and buttocksSpecific Injuries of Importance 1Severe Head and Spinal Trauma coma (GCS score of 3 to 8);1. head CT ;2. In patients requiring intubation;3. chest radiograph .Specific Injuries of Importance 2Ten

17、sion Pneumothorax, Open Pneumothorax, and Massive Hemothorax A tube thoracostomy (chest tube insertion) should be performedSpecific Injuries of Importance 3Penetrating Abdominal Trauma Indication of emergency surgery Abdominal tenderness or distention on palpation, coupled with hypotension, indicate

18、 the emergent need for surgery in a patient who has sustained a penetrating abdominal injury and should prompt immediate transport to the operating room. Specific Injuries of Importance 4Impaled Objects Objects deeply impaled in the chest and abdomen should be left in place .Specific Injuries of Importance 5Traumatic Arrest cardiopulmonary resuscitation A.Prehospital; B.ED.Secondary SurveyWhile res