创伤和战伤救治(Traumaandwarwound).ppt

13 瑞金医院外科教研室 陈拥军 Most Americans fail to identify injury as the leading cause of death for children under 10, youth 10-18, and young adults age. Young age deaths 50% people killed in traffic crashes are young adults aged 15 – 44years. 60% of all DALYs lost (Disability adjusted life years) due to RTA. In Asia, from 1975 to 1998 – RTA fatalities rose 44% , 243% in China. Make sure you have a strong stomach What is Blunt Trauma? 80% of Trauma Patients: #1 Motor Vehicle Motorcycle crashes #2 Pedestrians/bicyclists struck by cars #3 Falls #4 Assaults with blunt objects 主要脏器的功能变化 全身炎症反应综合症 Systemic inflammatory response syndrome, SIRS 发现以下情况，应考虑有腹内脏器损伤： 早期出现休克征象者； 腹部剧痛伴消化道症状； 有腹膜刺激征； 有便血、呕血、尿血。 根据致伤原因、伤口深度、伤道判断是否需剖腹探查； 如无法判断是否有内脏损伤，生命体征稳定时，先行影像学检查； 如生命体征不稳定，直接送手术室。 Why do Trauma Patients Die? Time! The sooner the trauma victim receives definitive care the greater the chances of survival. Definitive care is hemorrhage control and resuscitation Time varies with patient and injuries The “Golden Hour” is a typical goal. Decision Making 【Self-Study】 ——火器伤 ——战伤复合伤 ——放射复合伤 ——化学武器损伤 思考题 创伤的组织修复过程是怎样的？ 一般伤口如何处理(清创术)？ 创伤后机体会出现哪些反应？ 创伤的处理 Treatment 61% 18% 1% MOFS 0% 9% 55% Blood loss 39% 64% 40% Brain injury Late ( 7 d) Early (48 hr - 7d) Acute ( 48 hrs) Sauaia et al, J Trauma, 1995 急救： 急救医学 创伤急救系统 现场救治 有效的复苏措施 及时送到救治中心 治疗 Goals of Prehospital Trauma Care 治疗 Trauma-related incident Scene assessment Initial Survey Life threatening or multisystem injuries No Yes Initiate rapid transport Reassess Head-to-toe assessment Reassess Manage injuries as appropriate Initiate transport Head-to-toe assessment 治疗 创伤的现场急救： 快抢、快救、快送 现场急救基本措施：”ABC” Airway 气道 Birthing 呼吸 Circulation 循环 优先抢救： 心搏骤停、窒息、大出血、开放性气胸、 休克、腹部内脏脱出 治疗 通气术 心肺复苏 止血 包扎 骨折固定 搬运 检查并维持呼吸道通畅，检查胸部 有无创口，胸壁有无反常运动； 胸外心脏按压、人工呼吸； 压迫止血、加压包扎、止血带； 包扎外露伤口； 就地取材固定骨折； 妥善搬运 急救六大技术： 治疗 体位和制动 半卧位 抬高下肢 局部制动 判断伤情 －致命性创伤 －生命体征尚平稳 －潜在性创伤 治疗 进一步治疗