美国重症医学(FCCM)基础教程创伤和烧伤处理.pptVIP

Trauma and Burn Management Objectives Review initial assessment of the trauma patient Outline treatment of life-threatening injury Discuss use of radiography to identify injury Outline response to changes in patient’s status Discuss early burn management Trauma Care Principles Simultaneous assessment and treatment through a standardized approach If no improvement or decline in status, start over at primary assessment Early surgical involvement Primary Assessment – Airway / Breathing Assume cervical spine injury Airway assessment and management Effects of facial/mandibular fracture Laryngeal/tracheal injury – ecchymosis,hoarseness, edema, subcutaneous air Flail chest from rib fractures Pneumo- / hemothoraces Primary Assessment – Circulation Hemorrhage is most common cause of shock Establish large-bore venous access Initiate fluid resuscitation with lactated Ringer’s solution Follow with packed red blood cells after 2–3 L of crystalloid Control external hemorrhage by compression Monitoring – data flow sheet, vital signs, ECG, pulse oximetry, CVP, arterial line Hemorrhage Classification Hemorrhagic Shock Chest – hemothorax; drain and monitor Abdominal Intraperitoneal (lavage or sonography) Retroperitoneal (CT scan) Operative intervention Pelvis – usually venous; consider embolization, external stabilization Nonhemorrhagic Shock Tension pneumothorax Tube thoracostomy Cardiac tamponade Consider mechanism of injury Venous hypertension with shock Pericardial window preferredover needle pericardiocentesis Nonhemorrhagic Shock Blunt cardiac injury Consider mechanism of injury ECG nonspecific Cardiac enzymes rarely helpful Monitor at least 4 hours Neurogenic shock Cervical/thoracic spinal cord injury Associated bradycardia Secondary Assessment Identify potentially life-threatening injuries History of event, medical history, drugs,allergies, tetanus immunization Head to toe examination Fully expose patient Correct and prevent hypo