GeneralG01MxInjuryAssessment20JT20re20101710章节.ppt

* * Sterile dressings should be applied to control identifiable bleeding, while avoiding the blind use of clamps in the emergency setting. The use of a tourniquet is indicated in a traumatic amputation * In the severely injured patient time may not permit blood pressure measurements on the initial survey. This chart provides general guidelines to assess the BP by palpation of the peripheral pulses. Hypotension is suggested by a delayed capillary refill of more than 2 secs * The 70 Kg male holds approximately 5 liters of blood or equivalent of 25 units of PRBC. The above classification is based on the percent of blood loss and provides some parameters to estimate the amount of blood loss as a means of fluid replacement. Reference ATLS Manual, 7th addition, American College of Surgeons, Trauma Committee. * Initial management of the the trauma patient in shock is a 2L bolus of RL in the adult (30ml/kg in pediatric patient). The patient s response to this challenge will indicate the severity of the blood loss an if blood products should be obtained. Urinary output is the best indicator of volume status.(ant.) Hct/Hg are unreliable and inappropiate diagnostic tools. The Orthopaedic surgeon can provide valuable insight to the Trauma Team when dealing with severe pelvic ring injuries and/or long bone fractures and the potential for blood loss associated with each. * In the trauma patient shock is hemorrhagic until proven otherwise and treatment directed at restoring cellular and organ perfusion with adequate oxygen delivery to the tissues. Listed are the differential diagnosis of shock. Cardiogenic shock can occur secondary to myocardial dysfunction form tamponade, arrhythmias,or myocardial damage. Beck’s Triad-distended neck veins, muffled heart sounds, and hypotension may indicate the need for pericardiocentesis. Arrhythmias may be due to infarction or contusion and treated with appropriate antiarrhythmic medications. Neurogenic shock may present with hypo