特殊创伤的现场处理-On-site treatment o

特殊创伤的现场处理主讲人：刘丹阳On-sitetreatmentofspecialtraumaPresenter:LiuDanyang《应急救护技术》EmergencyrescuetechniquePart02骨盆骨折Pelvicfracture

陈某，男，半小时前，其在工地工作期间不慎从高处坠落，臀部先着地。现感臀部、腰骶部疼痛，双侧下肢感觉、运动尚存在。正巧其工友小王之前参加过急救培训，经过小王初步判断，考虑陈某为骨盆骨折，为防止李某出现继发性损伤，小王正确的现场救护是什么？情景导入ChenMou,male,halfanhourago,accidentallyfellfromaheightandlandedonhishipwhileworkingontheconstructionsite.NowIfeelthepaininhipandlumbosacralregion,andthesensationandmovementofbilaterallowerlimbsarestillexisting.IthappenedthathisworkmateWanghadtakenpartintheemergencytrainingbefore.AfterWang'sinitialjudgment,ChenMouwasconsideredtobeapelvicfracture.InordertopreventLiMoufromhavingsecondaryinjury,whatwasWang'scorrecton-siterescue?Importscene一、概述overview骨盆骨折是指由于骨盆处受到撞击所致的耻骨联合、骶骨等骨盆结构的连续性中断，临床常见。主要临床症状包括疼痛、活动困难、尿道周围淤青等。骨盆主要起保护内脏器官的作用，损伤可累及直肠、尿道等损伤，重症累及血管丛的患者可以出现失血性休克。根据损伤程度不同可以分为稳定性骨折、部分稳定性骨折、不稳定性骨折。Pelvicfracturereferstotheinterruptionofcontinuityofpelvicstructuressuchasthepubicsymphysisandsacrumduetotheimpactonthepelvis,whichiscommoninclinicalpractice.Themainclinicalsymptomsincludedpain,difficultyinmoving,andbruisearoundtheurethra.Thepelvisismainlyusedtoprotectinternalorgans.Thedamagemayinvolvetherectum,urethraandotherinjuries.Thepatientswithseverevascularplexusinvolvementmaysufferfromhemorrhagicshock.Accordingtothedegreeofinjury,itcanbedividedintostablefractures,partialstablefracturesandunstablefractures.二、急症的特点Characteristicsofemergencies不同类型的骨盆骨折可有不同的症状表现Differenttypesofpelvicfracturescanhavedifferentsymptoms:1.骨盆处疼痛感Pelvicpain患者主要在撞击、创伤后出现骨盆局部疼痛感，压痛明显，在坐位或活动双下肢时可出现疼痛加剧，部分患者疼痛难忍、可合并牵涉痛（当某些内脏器官发生病变时，常在身体表面一定区域产生感觉过敏或痛觉，这种现象叫做牵涉痛）。Patientsmainlysufferfromlocalpainandobvioustendernessinthepelvisafterimpactandtrauma.Thepainmayintensifyinthesittingpositionorinthemovingofbothlowerlimbs.Somepatientshaveunbearablepainandmaybecombinedwithreferredpain(whencertaininternalorgansbecomediseased,allergyorpainisoftengeneratedinacertainareaofthebodysurface;thisphenomenoniscalledreferredpain).2.活动困难Difficultiesinactivities患者可以出现活动障碍，主要表现为下肢旋转困难，可出现短缩畸形，患者同时可因疼痛难忍，无法活动等原因造成下肢活动障碍。Patientsmayhavedyskinesia,mainlymanifestedaslowerlimbrotationdifficulties,canappearshortshrinkdeformity,patientsatthesametimebecauseofthepainunbearable,unabletomoveandotherreasonscausedbylowerlimbdyskinesia.3.会阴部瘀斑、淤青Perinealecchymosisandbruise由于骨盆骨折后可以合并血管破裂出血，主要表现为会阴部的瘀斑、淤青。Becausepelvicfracturecanbecombinedwithbloodvesselruptureandbleeding,mainlymanifestedasperinealecchymosisandbruise.三、现场急救On-sitefirstaid现场救护员评估现场安全，做好自我防护检查伤情，根据伤情不同，为伤员选择合适体位迅速启动EMSS骨盆骨折三角巾或代用品固定骨盆膝下加软垫伤员双下肢屈曲，膝间加垫，固定膝关节观察生命征四、注意事项Precautions在现场环境安全，伤员生命体征平稳的情况下，迅速启动EMSS，采用上述方法进行处理，随时观察伤员生命体征。Undertheconditionthatthesiteenvironmentwassafeandthevitalsignsoftheinjuredwerestable,EMSSwasstartedquicklyandtheabovemethodswereadoptedforhan