上海交大外科学腹损pbl课件

腹部损伤

AbdominalTrauma

AboutmyselfName:费健Email:Mobile:137-0176-9798开始了大家要专心啊A22yearoldmanwasdrivingdrunkandwithouthisseatbeltfastenedwhenhewasinvolvedinasingle-vehicleautomobileaccident.WhenattendedbyEMT（abbr.emergencymedicaltechnician急诊医士）personnel,noinformationwasavailableaboutthetimeoftheaccident.Hewasfoundagitatedandcomplainingofabdominalpain.

StudyQuestions1:

What’syourfirstimpressionofthiscase?

OpenorClosedInjuries?HolloworSolidOrgans?SingleorMultiple?病史询问

A:Allergy过敏史

M:Medication用药史

P:Pasthistory过去病史

L:Lastmeal最后一次进食喝水时间及

LMP(女性)

E:Event外伤发生之经过史StudyQuestions2:

What’sthekeypointsofphysicalexam?

Hisairwaywaspatent.Atthescene,hewasbreathingat20perminutewithabloodpressureof90/60andapulseof130.Hewasplacedinahardcervicalcollarandonabackboardandtransportedtoyouremergencyroom.Uponarrivalhisvitalsignsarethesame,withatemperatureof36oC.

理学检查

病患是否有休克症状

(tachycardia﹑tachypnea﹑coldswealing)

胸腹部是否有开放性伤口

胸腹部是否有挫伤﹑瘀血肿等

女性病患应注意是否怀孕StudyQuestions3:

Whatwillyoudonext?

-Anasogastrictuberevealsgreenliquid.

-Aurinarycatheterrevealsdarkyellowurine.

-Hishemoglobinis7.

-Hisabdominallavage（灌洗）revealsgrossblood.

StudyQuestions4:

What’sthefinaldiagnosis?

影像学检查：

X线平片、CT、

B超、DSA

目的要求：了解：腹部损伤的分类、病因和病理；掌握：腹部损伤的临床表现；熟练掌握：腹部闭合性损伤引起的脏器破裂、出血、穿孔的诊断及治疗原则。NewEngJMedVolume356:1353-1360March29,2007Number13NextCase10-2007—A55-Year-OldManImpaledinaRowingAccident腹部闭合性损伤，以下都是不能早期确诊的原因除了（）。A．实质脏器损伤但其被膜未破B．同时合并其他部位的严重损伤C．空腔脏器穿孔不大D．腹腔穿刺抽出不凝固血液E．后腹膜脏器的损伤A．腹膜炎出现早B．腹膜炎严重，呈板状腹C．腹膜炎出现较晚，但较重D．腹膜炎出现较晚且