孕妇创伤急救课件

Chapter19TraumainPregnancyTraumainPregnancy

孕妇创伤

Overview概要Dualgoalsinmanagingpregnanttrauma需要处理两个或以上的病人Physiologicalchangesofpregnancy孕妇生理改变Responsetohypovolemia对血溶积减少的反应Typesofinjuriesmostcommonlyassociated常见伤势Initialassessmentandmanagement初步检查及处理Traumapreventioninpregnancy预防孕妇创伤2TraumainPregnancy-TraumainPregnancyLeadingcauseofmorbidityandmortality为孕妇发病率及死亡率的主要原因6–7%ofpregnanciesexperiencesometrauma6-7%孕妇曾遇上创创1in12injuredexperiencesignificanttrauma1-2%遭遇严重创伤Majorcauses主要原因Motor-vehiclecollisions交通意外Falls高处堕下Abuseanddomesticviolence虐待及家庭暴力Penetratinginjuries穿刺性创伤Burns烧伤4TraumainPregnancy-PregnantPatientIncreasedriskfortrauma创伤的风险增加Faintingspells,hyperventilation,excessfatiguecommonlyassociatedwithearlypregnancy

孕妇初期较易头晕,呼吸过速,易疲倦Balanceandcoordinationaffectedbychangesthroughoutpregnancy

怀孕过程可影响其平衡力及身体协调5TraumainPregnancy-FetalDevelopment6TraumainPregnancy-ViabilityAssessment7TraumainPregnancy-阴道出血肚脐耻骨联合流产可被见宫高PhysiologicChanges

孕妇生理的改变Respiratorysystem呼吸系统Diaphragmelevatedduetouterinesize 日渐长大的子宫令横隔膜上升Decreasedthoracicvolume肺容量下降Relativealkalosis血液相对为碱性

Predisposedtohyperventilation较易出现呼吸过速9TraumainPregnancy-ResponsetoHypovolemia

血溶积减少的反应Vasoconstrictionandtachycardia血管收缩及心跳过速

Reductionofuterinebloodflowby20–30%

子宫血流量减少20-30%

Fetalheartrateandbloodflowdecreases

胎儿心跳速率及血流量下降Fetusbecomeshypoxemic胎儿出现血氧过低High-flowoxygenisessential.给予高浓度的氧气Maternalshockhas80%fetalmortalityrate

孕妇出现休克,胎儿死亡率可达80%11TraumainPregnancy-SupineHypotension仰卧血压低Venousreturndecreases30%insupinepositionwith20-weekorlargeruterus.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Acutehypotension急性血压低Syncope昏厥Fetalbradycardia胎儿心跳过慢13TraumainPregnancy-SupineHypotensionTransportposition运送时之卧式Tiltorrotatebackboard20–30otopatient’sleft将脊板左倾20–30度Elevaterighthip4–6incheswithtowel于盆腔下垫上4-6吋毛巾Manuallydisplaceuterustoleft将子宫移向左侧

14TraumainPregnancy-SupineHypotensionTransportpositionBetterstabilized

withvacuumbackboardMorecomfortable

thanstandardbackboard固定于真空脊板较比一般脊板舒适15TraumainPregnancy-EvaluationofUterineSize16TraumainPregnancy-17Relativelyminorabdominaltrauma

cancausefetaldeath.Maternaldeathismostcommoncauseoffetaldeath.

胎儿死亡的原因最主要是母体死亡TraumainPregnancy-TypesofTrauma创伤种类Motor-vehiclecollisions交通意外Penetratinginjuries穿刺性创伤

Domesticviolence家庭暴力Falls高处堕下Burns烧伤19TraumainPregnancy-Motor-VehicleCollisions撞车65–75%ofpregnancy-relatedtrauma交通意外占孕妇创伤65-75%<1%injuredwhenminorvehicledamage如车辆轻微破烂,少于1%孕妇受伤Seatbeltssignificantlydecreasemortality安全带可减低死亡率

Hasnotshownanyincreaseinuterineinjury未证实会增加子宫受伤机会20TraumainPregnancy-AbdominalTrauma腹部创伤Physiologicchanges生理改变Decreasedsensitivity敏感度降低Gradualstretching续渐绷紧Hormonalchanges荷尔蒙改变Uterusveryvascular子宫大量有血液供应

Clinicalpresentation临床表现Guarding,rigidity,reboundresponseabsent可没有防卫性收缩,硬实,回缩痛等反应AbdominaltraumarequiresEDevaluation

所有腹部创伤都需要送院22TraumainPregnancy-PenetratingInjuries

穿透性创伤Gunshotwoundsandstabbings枪伤及刺伤Entrybelowfundus从子宫下穿入Uterusabsorbsforce,protectsmaternalorgans 子宫承受力量,保护母体内脏Highfetalmortalityrate胎儿死亡率:40–70%Lowermaternalmortalityrate减低母体死亡率:4–10%Entryabovefundus从子宫上穿入Bowelinjuryduetodisplacement肠脏受伤23TraumainPregnancy-Falls高处堕下Injuryfromfalls高处堕下受伤Increasewithprogressionofpregnancy受伤机会随着怀孕期增加Centerofgravityaltered中心改变Proportionatetoforceandbodypartimpacted与受力及身体撞击点有直接关系Pelvicinjuries盆骨受伤Placentalseparation胎盆分离Fetalfractures胎儿骨折25TraumainPregnancy-Burns烧伤FluidvolumeneededincreasesMortalityandmorbidity死亡率及发生率Maternalmortalitysameasnon-pregnant死亡率与非孕妇相同Fetalmortalityincreaseswith>20%BSA

烧伤面积>20%会増加胎儿死亡机会26TraumainPregnancy-TraumaPrevention预防Properseat-beltuse正确使用安全带Reportdomesticviolence举报家庭暴力Counselin