医学-孕妇创伤急救

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对血溶积减少的反响Typesofinjuriesmostcommonlyassociated常见伤势Initialassessmentandmanagement初步检查及处理Traumapreventioninpregnancy预防孕妇创伤3TraumainPregnancy-TraumainPregnancy孕妇创伤Uniquechallenges挑战Vulnerabilityofpregnanttraumapatient 孕妇于创伤时之弱点Potentialinjuriestounbornchild

对胎儿的伤害Dualroles双重角色Providecaretomother照顾母体Providecaretofetus 照顾胎儿4TraumainPregnancy-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5TraumainPregnancy-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6TraumainPregnancy-FetalDevelopment7TraumainPregnancy-ViabilityAssessment8TraumainPregnancy-阴道出血肚脐耻骨联合流产可被见PhysiologicChanges9TraumainPregnancy-肠蠕动血色素心输出量血量血压心率血含二氧化碳量PhysiologicChanges

孕妇生理的改变10TraumainPregnancy-VitalSignsinPregnancy

孕妇生命表征的改变Donotmistakenormalvitalsignsforsignsofshock.切勿把正常的生命表征当作休克Normalpulse:10–15beatsfaster正常脉搏:快10-15次Bloodpressure:10–15mmHglower血压:低10=15mmHg30–35%bloodlossbeforesignificantbloodpressurechange失血量达30-35%才出现休克Bealerttoallsignsofshock.注意出现休克征状FrequentITLSOngoingExams反复ITLS〞复检〞捡查11TraumainPregnancy-ResponsetoHypovolemia

血溶积减少的反响12TraumainPregnancy-TraumainPregnancyITLSPrimaryandSecondarySurveys初步检查及进一步检查OptimizematernalandfetaloutcomeHigh-flowoxygenrapidlyadministered尽快给予高浓度氧Fetalhypoxiaoccursbeforematernalhypoxia胎儿会比母体早缺氧Fluidadministrationmustbeprompt必需正确输液Fluidvolumeneededisgreater输液量较多FrequentOngoingExams反复ITLS〞复检〞捡查Mortalityoffetusrelatedtomaternaltreatment胎儿死亡率与母体处理有关13TraumainPregnancy-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14TraumainPregnancy-SupineHypotension15TraumainPregnancy-SupineHypotensionTransportpositionBetterstabilized

withvacuumbackboardMorecomfortable

thanstandardbackboard固定于真空脊板较比一般脊板舒适16TraumainPregnancy-EvaluationofUterineSize17TraumainPregnancy-18Relativelyminorabdominaltrauma

cancausefetaldeath.Maternaldeathismostcommoncauseoffetaldeath.

胎儿死亡的原因最主要是母体死亡TraumainPregnancy-PregnantTraumaArrest

孕妇创伤性心跳停上Treatedsameasforothervictims急救法与普通伤者相同Defibrillationsettingsaresame相同去颤法电量Drugdosagesaresame相同药物剂量Fluidvolumeneededincreases需要较大量静脉输液4litersnormalsalinerapidinfusionduringtransport

送院时输液4公升Ifmotherunsalvageable:如孕妇不能挽救ContinueCPR继续

CPRNotifyhospitalofpossiblecesareansection

通知院方:准备接生/剖腹接生19TraumainPregnancy-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20TraumainPregnancy-Motor-VehicleCollisions撞车21TraumainPregnancy-Motor-VehicleCollisionsMaternaldeath母体死亡HeadinjuryMostcommon头部受伤为最常见Uncontrolledhemorrhage不能制止的内出血Secondmostcommon

第二常见Assesspelvis检查盆骨

Fetalinjury胎儿受伤22TraumainPregnancy-AbdominalTrauma腹部创伤23TraumainPregnancy-PenetratingInjuries

穿透性创伤24TraumainPregnancy-DomesticViolence

家庭暴力10%experienceabuseduringpregnancy10%孕妇曾于懐孕期受虐待Proximalandmidlineinjuries近端及中线部位受伤Faceandneckmostcommon

面部及颈为最常见

Lowbirthweight出生体重较轻Abusedbyspouseorboyfriend:70–85%(U.S被配偶或男友虐待:70-85%25TraumainPregnancy-Falls高处堕下Injuryfromfalls高处堕下受伤Increasewithprogressionofpregnancy受伤时机随着怀孕期增加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胎盆别离Fetalfractures胎儿骨折26TraumainPregnancy-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%会増加胎儿死亡时机27TraumainPregnancy-TraumaPrevention预防28TraumainPregnancy-Summary总结TraumainPregnancy孕妇创伤Knowledgeofphysiologicalchanges生理上的改变Hypotensionandhemorrhageeasilyoverlooked血压低及出血容易被无视Rapidevaluationan