创伤和战伤 中山大学 外科学精选.ppt

Resuscitation-CHemorrhage Control Pneumatic splint Pneumatic antishock garment (PASG) Surgical intervention Thoracotomy Celiotomy (laparotomy) Surgical pelvic fixation Sure the scalp * Resuscitation-CFluid Replacement Vascular access lines Intraosseous needle insertion to the proximal tibia ( 6y) Initial fluid resuscitation Warmed balanced salt solution 1 to 2 boluses (2 L to the adult, 20 ml/kg to the child) Blood replacement Fully crossmatched blood Type-specific blood Type O packed cells Autotransfusion * Resuscitation- D E Disability (neurologic status) ABC: adequate perfusion and oxygen supply to the brain Spine protection Environment control: keep warm! Warm rooms Warm blankets Warm resuscitation fluids Warm inspired air * In-hospital care Primary survey Resuscitation Secondary survey Monitoring and investigation Definitive care * Secondary Survey Timing Primary survey is completed Resuscitation efforts are well established Patient with normal vital functions Complete history Head-to-toe evaluation Reassessment of all vital signs Complete physical examination * Secondary Survey AMPLE history Allergies Avoid allergic reactions Medications currently used Chronic conditions Physiological responses to the shock Past illness and operation/Pregnancy Last meal Potential for vomiting and aspriation Patient with diabetes Events/Environment related to the injury * Secondary Survey AMPLE history Blunt trauma Penetrating trauma Burns and cold Hazardous materials Chemicals Toxins Radiation Biological agents Events: mechanism of injury (MOI) * Secondary SurveyHead-to-toe examination Head Face Neck Thorax Abdomen Perineum/Rectum/Vagina Spine extremity Neurological assessment * In-hospital care Primary survey Resuscitation Secondary survey Monitoring and investigation Definitive care * Monitoring Investigation Monitoring Vital signs: HR, RR, T, BP Oxygenation and ventilation Circulation Investigation X-ray: chest, pelvis, spine, extremity CT: head, chest, abdome