trauma创伤VIP免费

TRAUMAThegeneralhospitalofNingXiamedicaluniversityDr.LeiPengDEFINEDascellulardisruptioncausedbyandexchangewithenvironmentalenergy.Itremainsthemaincauseofdeathforallindividuals.Traumacanchangepeople’sgreatly一、INTRODUCTIONCanyoufindoutsometypicalexamplesoftrauma?QUESTION1.PrimarysurveyTheadvancedtraumalifesupport(ATLS)cansignificantlyimprovetheoutcomefortheinjuredpatient.ATLSemphasize“goldenhours”.Assessmentof“ABCs”:Airwaywithcervicalspineprotection;Breathing;Circulation.二、INITIALEVALUATIONANDRESUSCITATIONImportantbecauseeffortstorestorecardiovascularintegritybefutileunlesstheoxygencontentofthebloodisadequate.Requirecervicalspineimmobilizationuntilinjuryisexcluded.Applyinghardcollarorplacingsandbagsonbothsidesofthehead.Conscious,withouttachypnea,normalvoice,unnecessary.AirwaywithcervicalspineprotectionBlood,vomit,thetongue,foreignbodies,andsofttissueswellingcancauseairwayobstruction.Suctioningaffordsimmediaterelief.Chinliftorjawthrusteffective.Establishingadefinitiveairway:endotrachealintubationisindicatedinmanyconditionslikeapnea,coma,hematoma,aspiration.Alteredmentalstatusisthemostcommonindicationsforintubation.Correctendotrachealplacementisverifiedwithdirectlaryngoscopy,capnography,audiblebilateralbreathsound,andfinallyachestfilm.Onceasecureairwayisobtained，adequateoxygenationandventilationmustbeensured.Inadequateventilationconditions:tensionpneumothorax,openpneumothorax,flailchest,massiveairleak.BreathingandventilationFlailchestoccurswhenthreeormorecontiguousribsarefracturedinatleasttwolocations,Paradoxicalmovementofthisfree-floatingsegmentofchestwallisevident.Resultanthypoventilationandhypoxemiarequireintubationandmechanicalventilation.Peripheralpulsespalpation:SBP>60-carotidpulse>70-femoralpules>80-radialpulseHypotension:<90BPandpulsemeasuredevery5minsCirculationandhemorrhagecontrolRoutinebloodcellcountingArterialbloodgasanalysistypingandcross-matching(fortransfusion)CoagulationpanellaboratorytestCirculationandhemorrhagecontrolsaphenousveincutdowntoestablisheffectiveandreliablevenouschannelisveryimportantCirculationandhemorrhagecontrolTheinternalcarotidveinThesubclavicularveinvenouscatheterpercutaneouspunctureinternalcarotidveinpercutaneouspuncturesubclavicularveinExternalcontrolofanyvisiblehemorrhageshouldbeachievedpromptly.Manualcompressionofopenwoundswithongoingbleedingbedonewithagauzeandaglovedhand.CirculationandhemorrhagecontrolFourlife-threateninginjuriesmustbeidentifiedpromptly.massivehemothoraxcardiactamponadeMassivehemoperitoneummechanicallyunstablepelvicfractureswithbleedingThreetoolstodifferentiate:chestradiography,pelvisradiography,abdominalsonographyPericardiocentesisisindicatedforpatientswithevidenceofpericardialtamponade.Aaccesstothepericardiumisobtainedthroughasubxiphoidapproach,needleangled45degreesupfromthechestwallandtowardtheleftshoulder.Bseldingertechniqueisusedtoplaceapigtailcatheter.bloodaspiratedwithasyringeortubingbygravitydrain.Evacuationofunclottedpericardialbloodpreventssubendocardialischemiaandstabilizethepatientfortransporttotheoperatingroomforsternotomy.cardiactamponadeDisabilityandexposureShockclassificationandinitialfluidresuscitationHemorrhagicshockThoroughhistoryisobtainedandthepatientissystematicallyexaminedafterlife-threateningissueshavebeenaddresse...