昏迷抢救课件_1.ppt

昏 迷coma 沈燕 2006－4－20 昏迷抢救18.rmvb 用棉芯轻触一下病人的角膜，正常人或轻症病人都会出现眨眼动作，而昏迷特别是深昏迷病人毫无反应。当确定病人昏迷时，应尽快送病人到医院抢救。 教学目标 了解： 昏迷量表的使用； 昏迷与晕厥、癔症性昏睡、木僵状态、闭锁综合征的鉴别诊断 熟悉： 昏迷的常见病因； 昏迷病人瞳孔的观察 掌握： 昏迷的定义； 昏迷的临床分级； 昏迷的急救护理 Definition 意识－－机体对自身及外界环境感知并能作出正确反应的状态。 意识障碍－－机体对外界环境的刺激缺乏反应的一种病理状态。 昏迷－－是严重的意识障碍，其主要特征为随意运动丧失，对外界刺激失去正常反应并出现病理反射活动。 判断意识障碍程度disturbance of consciousness 区分嗜睡、意识模糊、昏睡、昏迷 嗜睡somnolence ：病人呈持续睡眠状态，但可被轻度刺激唤醒，醒后能正确简单回答问题，但反应迟钝。 意识模糊confusion ：病人对时间、地点、人物的定向能力发生障碍，思维混乱，可有错觉、幻觉、精神错乱、谵妄等表现。 昏睡stupor ：病人处于沉睡状态，仅能被压眼眶、用力摇动身体等较强刺激唤醒。 昏迷coma：是最严重的意识障碍。 Summary： Disturbance of consciousness is impediment(障碍) of having an awareness of one’s environment and one’s own existence,sensations and thoughts. According to the degree of disturbance of consciousness, it can be divided: somnolence, confusion, stupor,coma. What is Coma and Persistent Vegetative State? A coma is a profound or deep state of unconsciousness. An individual in a state of coma is alive but unable to move or respond to his environment. Coma may occur as a complication of an underlying illness, or as a result of injuries, such as head trauma. A persistent vegetative state ( “brain-death”) sometimes follows a coma. Individuals in such a state have lost their thinking abilities and awareness of their surroundings, but retain non-cognitive function and normal sleep patterns. Even though those in a persistent vegetative state lose their higher brain functions, other key functions such as breathing and circulation remain relatively intact. Spontaneous movements may occur, and the eyes may open in response to external stimuli. They may even occasionally grimace(痛苦的表情), cry, or laugh. Etiology 1.颅内病变 cerebral disease （1）颅内感染：如脑膜炎 (meningitis) 等 （2）颅脑疾患：脑脓肿；脑血管疾病；颅脑外伤；脑寄生虫病；癫痫、癫痫发作后昏迷。 2.全身性疾病 general disease （1）急性感染性疾病 （2）内分泌与代谢障碍 （3）水电解质平衡紊乱 （4）外因性中毒 （5）物理性损害 Assessment History collection The degree of disturbance of consciousness Vital signs L