《儿童创伤急救》ppt课件.ppt

1、Chapter 17 Trauma in Children,Trauma in Children,Trauma in Children儿童创伤,Overview,Effective 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 equipment needs适合儿童

2、之器材 Various methods of SMR on child儿童脊椎固定方法 EMS involvement in prevention programs参与预防意外计划,2,Trauma in Children,Trauma in Children,Different from adults与成人不同 Different patterns of injuries不同伤势模式 Different responses to those injuries不同反应 Special equipment required需要特别器材 Assessment equipment and treat

3、ment 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,3,Trauma in Children,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 care.尽量让照顾者参与 Give e

4、xplanations 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,4,Trauma in Children,Assessing Mental Status捡查精神状态,Consoled or distracted可按抚或转注意力 Most sensitive in

5、dicator 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,5,Trauma in Children,Assessing Mental Status,Initial 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 arrival of ambulance大部份沿途不会睡觉 A

6、sk caregivers to wake child着照顾者弄醒伤者 Suspect hypoxia, shock, head trauma, seizure 怀疑缺氧、休克、头部受伤、癫痫,6,Trauma in Children,Communicating,Interaction strategies使用适龄的语言 Appropriate language for developmental level合适的语言 Speak simply, slowly, clearly说话要慢及简溸 Be gentle and firm必需肯定 Avoid “no” questions避免说”不” G

7、et 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,7,Trauma in Children,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 available未能取得”同意” Transpor

8、t 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 如怀疑儿童受虐待,通知警方,8,Trauma in Children,Pediatric Equipment儿科器材,Length-

9、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,9,Trauma in Children,Photo courtesy of Kyee Han, MD,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 27 inches严重头部受伤并不常见于身长27吋 Prote

10、ctive gear保护装备 MVCs交通意外 Seat-belt syndrome安全带综合症 Liver, spleen, intestines, lumbar spine 肝、脾、小肠、腰椎 Auto-pedestrian crashes路人被撞,10,Trauma in Children,Mechanisms of Injury,Burns烧伤 Airway obstruction气道受阻 Foreign body异物 Child abuse虐待儿童 Suspect if history does not match injury 受伤经过与伤势不吻合 Story keeps chan

11、ging经常改变说法,11,Trauma in Children,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,12,Trauma in Children,Courtesy of Bob Page, NREMT-P,Airway in Children,Opening airway张开气道 Tongue is

12、 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,13,Trauma in Children,Breathing in Children儿童呼吸,Work of breathing呼吸方法 Retractions, flari

13、ng, 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,14,Trauma in Children,20, 15, 10,Ventilation Rate换气次数,15,Trauma in Children,10 per minute fo

14、r adolescent 如为中童, 10次/分钟,20 per minue for 1 year 如 1岁, 20次/分钟,15 per minute for 1 year 如 1岁, 15次/分钟,Breathing Management呼吸处理,16,Effective BVM ventilation 有效BVM换气 intubation is elective.可考虑插喉,Trauma in Children,Endotracheal Intubation 气管内导管,Oral endotracheal intubation从口腔插入 No blind nasotracheal int

15、ubation for 8 years 少于8岁不可施行鼻入插喉法 Uncuffed tube无气袋式喉管 Length-based tape system身长尺 Same diameter as tip of childs little finger与小童尾指头直径相同 Frequently reassess placement需经常捡查喉管位置,17,Trauma in Children,Circulation in Children儿童血循环,18,Persistent tachycardia is most reliable indicator of shock. 最有效显示伤者休克的

16、征状为持续的脉搏过快,Trauma in Children,Circulation in Children,Early shock more difficult to determine. 较难于休克初期预测 Persistent tachycardia持续的脉搏过快 Rate 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 Circulatio

17、n 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 80 mmHg in child; 70 mmHg in young infant,19,Trauma in Children,Shock in Children,Strong 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 deterio

18、rate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/kg Consider intraosseous infusion骨髓输液法 Frequent Ongoing Exams持续检查,20,Trauma in Children,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 Sho

19、ck休克 Altered mental status意识紊乱 Dilated pupil曈孔扩大 Glasgow Coma Scale score 13 Pediatric Trauma Score 8,21,Trauma in Children,Pediatric Trauma Center,Mechanism that predicts severe injury预期严重伤势 Fall from height 10 feet高处堕下 Motor-vehicle collision MVC with fatalities车祸中有人死亡 Ejection from an automobile

20、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多过一个器官受伤,22,Trauma in Children,Pediatric Trauma Center,Recommended建议送院 Burns烧伤 Near-dro

21、wning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,23,Trauma in Children,Life-Threatening Injuries 危害生命伤势,Head injury头部受伤 Most common cause of death最常见死亡原因 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,

22、24,Trauma in Children,Life-Threatening Injuries,High-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基本收缩压 Preschool child: 80 mmHg; older child: 90 mmHg 幼儿: 80 mmHg,小童: 90 mmHg Be prepared to prevent aspira

23、tion 预防气道吸入异物,25,Trauma in Children,Life-Threatening Injuries,Chest 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 thoracostomy 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 che

24、st, aortic rupture, pericardial tamponade 肋骨折、槤架胸、主动脉撕裂、心胞膜填塞,26,Trauma in Children,Life-Threatening Injuries,Abdominal injury腹部创创 Liver and/or spleen rupture肝、脾撕裂 Second leading cause of traumatic 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 injur

25、y with minimal signs 严重伤势可只有轻微征状 Suspect with any abnormal abdominal assessment 若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,27,Trauma in Children,Life-Threatening Injuries,Spinal 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,28,Trauma in Children,Life-Threatening Injuries,SMR脊椎固定 Pad unde