腹部创伤的急诊(英文版)

ManagementofAcuteAbdominalTraumaOutlineIntroductionDiagnosisTreatmentConclusionIntroductionIncidenceincatsisunknownIntroductionManycausestoacuteabdominalinjurySomeareeasytodiagnoseandsomecanbeverychallengingPrincipalcausesBlunttrauma(automobileorfall),penetratinginjury(gunshotwoundorbitewound)aremostcommontypespresentedDiagnosisPhysicalexaminationfindingsDiagnosticstudiesExperiencewithtraumacasesTheseshelptodeterminewhichpatientcanbemanagedconservativelyandwhichmustberapidlytakentosurgicaltherapyDiagnosisBluntabdominaltraumacasesarechallengingdiagnosticproblemsbecausetheclinicalmanifestationsmaybedelayedforhoursorevendaysinsomecases.DiagnosisPhysicalexaminationisthemostinformativeIncreasingabdominalsizeisanimportantclueforintra-abdominalhemorrhagePalpatetheabdomenforrigidityandpainManybluntinjuriescancauseinternalbleedingandlacerationoftheliverandspleenExaminationSevereVentralBruisingExaminationPenetratingWoundExaminationPalemucousmembranesWeakpulseProfoundhypovolemicshockPatientTriageOftenmustbeginstabilizationtherapypriortocompletediagnosisorduringdiagnosticproceduresdependingonseverityoftheconditionIVFluidsOxygenBloodTransfusionDiagnostic4QuadrantAbdominocentesis Fluidobtainedistestedfor: HCT,Totalsolids,CytologyBloodUreaNitrogenLipase,Amylase,andBilirubinDiagnostic4QuadrantsHCTBloodUreaNitrogenRuptureoftheUrinarysystem Kidney,Ureter,BladderBilirubinFluidalmostblackincolorCytologyRadiologyRadiologyContrastmedialeakageRadiologyAbdominalfluid=lossofdetailUltrasoundFreefluideasytodetect.CreatesaspacebetweenorgansManagementAbdominalcompressionbandageTreatmentRapidvolumeexpansionIntravenousfluid(crystalloids)givenupto60-90ml/kginthefirsthourAbdominalcompressionBloodpressureevaluationFrequentgirthevaluationPCV/TPevaluatedevery15-30minutesTreatmentIfthehemorrhageisnotself-limitingtransfusionandexploratorysurgerymaybeindicated.Agoodruleofthumbifthepackedcellvolumedropsrapidlybelow25%=transfusionrequiredInaseverelyanemicanimalsbloodshouldbeadministeredasrapidlyaspossibleusingapressurebagoranin-linesyringeattachedtoathree-waystopcock.Auto-transfusionisarapidsourceofavailableblooduntiladonorcanbelocated

Surgery?Canitwait?UsuallyBettertostabilizethepatientratherthanrapidlyexploreifpossibleRarelymustbedoneimmediatelyUncontrollablehemorrhageprimaryneedAortacanbecompressedforupto20minutestodefinelocationSurgeryBluntTraumaonlyifindicatedPeritonitis(bile,urine,gallbladder,septic)OftenlacerationofliverandspleenhealwithsurgeryPenetratingwoundAlwaysConclusion1.Traumafrequentlyaffectsmultipleorgansystems.

2.Anorganized,systematicapproachshouldbeundertakenforeachpatient

3.Anaggressivediagnosticandtherapeuticapproachistakentowardseachoftheinvolvedsystems4.Overtrea