trauma-(创伤)-PPT课件(PPT 48页)

1、TRAUMA第1页，共48页。DEFINED as cellular disruption caused by and exchange with environmental energy.It remains the main cause of death for all individuals.Trauma can change peoples greatly一、INTRODUCTION第2页，共48页。Can you find out some typical examples of trauma?QUESTION第3页，共48页。1. Primary surveyThe advance

2、d trauma life support(ATLS) can significantly improve the outcome for the injured patient.ATLS emphasize “golden hours”.Assessment of “ABCs”:Airway with cervical spine protection;Breathing ;Circulation.二、INITIAL EVALUATION AND RESUSCITATION第4页，共48页。Important because efforts to restore cardiovascular

3、 integrity be futile unless the oxygen content of the blood is adequate.Require cervical spine immobilization until injury is excluded. Applying hard collar or placing sandbags on both sides of the head.Conscious ,without tachypnea, normal voice, unnecessary.Airway with cervical spine protection第5页，

4、共48页。第6页，共48页。Blood, vomit,the tongue, foreign bodies, and soft tissue swelling can cause airway obstruction.Suctioning affords immediate relief.Chin lift or jaw thrust effective.Establishing a definitive airway: endotracheal intubation is indicated in many conditions like apnea , coma, hematoma, as

5、piration.Altered mental status is the most common indications for intubation.第7页，共48页。Correct endotracheal placement is verified with direct laryngoscopy,capnography,audible bilateral breath sound,and finally a chest film.第8页，共48页。第9页，共48页。第10页，共48页。Once a secure airway is obtained ，adequate oxygena

6、tion and ventilation must be ensured.Inadequate ventilation conditions: tension pneumothorax,open pneumothorax,flail chest,massive air leak.Breathing and ventilation第11页，共48页。第12页，共48页。第13页，共48页。Flail chest occurs when three or more contiguous ribs are fractured in at least two locations,Paradoxical

7、 movement of this free-floating segment of chest wall is evident .Resultant hypoventilation and hypoxemia require intubation and mechanical ventilation.第14页，共48页。第15页，共48页。第16页，共48页。Peripheral pulses palpation: SBP60-carotid pulse 70-femoral pules 80-radial pulseHypotension:90BP and pulse measured e

8、very 5 minsCirculation and hemorrhage control第17页，共48页。Routine blood cell countingArterial blood gas analysis typing and cross-matching (for transfusion)Coagulation panellaboratory testCirculation and hemorrhage control第18页，共48页。saphenous vein cutdowntoestablisheffectiveand reliablevenouschannel is

9、very importantCirculation and hemorrhage control第19页，共48页。The internal carotid veinThe subclavicular veinvenous catheterpercutaneous punctureinternal carotid veinpercutaneous puncturesubclavicular vein第20页，共48页。External control of any visible hemorrhage should be achieved promptly.Manual compression

10、 of open wounds with ongoing bleeding be done with a gauze and a gloved hand.Circulation and hemorrhage control第21页，共48页。Four life-threatening injuries must be identified promptly.massive hemothoraxcardiac tamponadeMassive hemoperitoneummechanically unstable pelvic fractures with bleedingThree tools

11、 to differentiate: chest radiography, pelvis radiography, abdominal sonography第22页，共48页。Pericardiocentesis is indicated for patients with evidence of pericardial tamponade. A access to the pericardium is obtained through a subxiphoid approach ,needle angled 45degrees up from the chest wall and towar

12、d the left shoulder. B seldinger technique is used to place a pigtail catheter.blood aspirated with a syringe or tubing by gravity drain. Evacuation of unclotted pericardial blood prevents subendocardial ischemia and stabilize the patient for transport to the operating room for sternotomy.cardiac ta

13、mponade第23页，共48页。Disability and exposure第24页，共48页。第25页，共48页。Shock classification and initial fluid resuscitation第26页，共48页。Hemorrhagic shock第27页，共48页。第28页，共48页。Thorough history is obtained and the patient is systematically examined after life-threatening issues have been addressed.Ample history (alle

14、rgies, medications, past illnessed , pregnancy, last meal events related to the injury)Head to toe physical examination.Digital rectal examinationVaginal examination in women with pelvic fractures.三 Second survey第29页，共48页。Vital signsCVP monitoringECG monitoringNastogastric tube placementFoley cathet

15、er placementRadiographsLab tests, Hemoglobin,urinalysis,base deficit,measurement,repeat FAST(focused assessment of sonography for trauma) examination.Adjuncts to PE第30页，共48页。HeadNeckChestAbdomenPelvisExtremitiesRegional assessment and special diagnostic tests第31页，共48页。The abdomen is a diagnostic bla

16、ck box.Abdominal rigidity and hemodynamic compromise are undisputed indications for prompt surgical exploration.(exploratory laparotomy)Triple-contrast CT can delineate the trajectory of the bullet Abdomen第32页，共48页。第33页，共48页。第34页，共48页。peritoneallavage第35页，共48页。exploratory laparotomy第36页，共48页。第37页，共4

17、8页。vascular injury第38页，共48页。Bloody vicious circleAndDamage controlSurgery第39页，共48页。The lethal combination of coagulopathy, hypothermia, and metabolic acidosis.Once the cycle starts, each componenet magnifies the other,lead to a downward spiral and ultimately a fatal arrhythmia.Bloody vicious cycle第4

18、0页，共48页。Purpose: to limit operative time so that the patient can be returned to the SICU for physiologic restoration and the cycle thereby broken.Indicaitons: refractory hypothermia, profound acidosis, refractory coagulopathy.Goal: control bleeding and limit GI spillage.Damage control surgery第41页，共48页。第42页，共48页。Abdominal compartment syndromeThe most common technique is to measure the patients bladder pressure.第43页，共48页。第44页，共48页。 trauma remains the most common cause of individuals between the ages of 1 and 44 years and is the third most common cause of death regardless of age. the initial m