创伤与战伤 中山大学 外科学-PPT文档.ppt
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1、,Aims of this lecture,Know the physiological responses of our bodies following trauma Know the features of different types of trauma Learn how to care an acutely injured patient based on the priority Know some general knowledge about weapon injury,Outline,Part I: Basic scientific knowledge about tra
2、uma Pathophysiology of trauma Wound healing Part II: Trauma Epidemiology & injury prevention Classification & triage Initial assessment & care Part III: Weapon Injury Blast injury Nuclear weapon injury Chemical weapon injury Combined injury,Part I: Basic scientific knowledge about trauma,Pathophysio
3、logy of trauma Immune response to trauma Changes in organ function following trauma Wound healing,Immune Response to Trauma,Dynamic stages in the immune response to trauma,Changes in organ function,Cardiovascular system Blood loss, hypovolemia, shock, hear failure Lung Hypercapnia Hypoxia Adult Resp
4、iratory Distress Syndrome (ARDS) Acute Lung Injury (ALI) Kidney Hypovolemia, renal hypoperfusion, Toxin-mediated (radiocontrast, antimicrobials) renal parenchymal injury Rhabdomyolysis Liver Gastrointestinal tract: bleeding Brain,Wound Healing,A: inflammatory phase B. proliferation phase C. Remodeli
5、ng phase,Primary healing,Secondary healing,Part II: Trauma,Epidemiology & injury prevention Classification & trauma triage Initial assessment and care of the injured patient Prehospital phase In-hospital phase,The Facts about Trauma,Leading cause of death Over all ages: Rank 4 Aged 1 to 44: Rank 1 A
6、ged 1-34: more than to all other causes of death combined Nonfatal Injuries (USA, 2003) 8% of all hospital discharges 37% of all emergency department visits The highest rate of injury In developing areas/countries Rapid economic change and urbanization Road traffic incidence caused Global: 1.18 mill
7、ion deaths; 30 million injuries USA: 45,000 deaths; 357,000 hospitalization China: 120,000 deaths; 550,000 injures,Lifetime Cost of Injury $406 Billion (USA, 2000),Is Trauma Preventable?,Trauma Occurs randomly, unpredictably? Does not occur by accident! Primary prevention Prevent the occurrence of t
8、he trauma itself Secondary prevention Limit energy transfer to the individual Minimize the severity of trauma Tertiary prevention Institute optimal care for the injured patient Improve outcome following trauma,Part II: Trauma,Epidemiology & injury prevention Classification & trauma triage Initial as
9、sessment and care of the injured patient Prehospital phase In-hospital phase,Classification,Base on the integrity of skin Closed injury Open injury Base on the injury site Base on the mechanism of injury (MOI) Base on the severity Related to the features, treatment options, and prognosis of trauma,C
10、losed Injury,Open Injury,Classification based on the injury site,Classification based on MOI,Mechanical injury Blunt injury: motor vehicle accident (MVA), fall, crush Penetrating injury: stab, impale, firearm Blast injury Temperature-associated injury Burns, cold injury Firearm-associated injury Spe
11、cial injury Chemical, biological, radiation injury Combined injury,Classification based on the severity Disaster Triage,Parameters Ability to ambulate Respiratory function Systemic perfusion Level of consciousness,Green Walking wounded Red: immediate transport RR30 RR2 RR30,CR2, unconscious Yellow:
12、delayed transport Black: unsalvageable,Simple Triage And Rapid Transport (START),Part II: Trauma,Epidemiology & injury prevention Classification & trauma triage Initial assessment and care of the injured patient Prehospital phase In-hospital phase,Algorithm for prehospital care,Scene Assessment,Safe
13、ty Dangerous environments Standard precautions Blood and body fluid may contain pathogens Situation Number of patients and their ages Need for additional assistances Kinematics - MOI MVA Falls Occupational/recreational injury Penetrating injury,Initial Assessment,Primary survey Airway Breathing Circ
14、ulation Disability (neurologic evaluation) Expose/environment control Secondary survey,Immediate Measures at the Scene (Basic Life Support, BLS),Basic airway management Supplemental oxygen Rescue breathing Cardiopulmonary resuscitation (CPR) Control of external hemorrhage Fluid therapy Spinal immobi
15、lization C-collar Long backboard,Golden Principles of Prehospital Trauma Care,Ensure the safety of the prehospital care providers and the patient Assess the scene situation to determine the need for additional resources Recognize the kinematics that produced the injuries Use the primary survey appro
16、ach to identify life-threatening conditions Provide appropriate airway management while maintaining cervical spine stabilization Support ventilation and deliver oxygen to maintain an SpO2 95% Control any significant external hemorrhage Provide basic shock therapy, including restoring and maintaining
17、 normal body temperature and appropriately splinting musculoskeletal injuries,Golden Principles of Prehospital Trauma Care,Consider the use of the pneumatic antishock garment for patients with decompensated shock (SBP 90 mm Hg). Maintain manual spine stabilization until the patient is immobilized on
18、 a long backboard For critically injured trauma patients, initiate transport to the closest appropriate facility within 10 min of arrival on scene Initiate warmed, intravenous fluid replacement en route to the receiving facility Ascertain the patients medical history and perform a secondary survey w
19、hen life-threatening conditions have been satisfactorily managed or have been rule out Above all, do no further harm,Part II: Trauma,Epidemiology & injury prevention Classification & trauma triage Initial assessment and care of the injured patient Prehospital phase In-hospital phase,In-hospital Phas
20、e,Primary survey Resuscitation Secondary survey Monitoring and investigation Definitive care,Primary Survey,Airway maintenance with cervical spine protection Breathing and ventilation Circulation with hemorrhage control Disability, neurologic status Expose/environment control completely undress prev
21、ent hypothermia,Primary survey and resuscitation are all taking place simultaneously,Primary Survey- Airway,Inspection Foreign body Facial, mandibular, tracheal/laryngeal Fx Asking a simple question normal voice Signs of possible airway compromise weak voice breathlessness, noisy breathing, labor br
22、eathing hoarseness absent response agitation combativeness cyanosis,Primary Survey- Airway,Common causes of airway obstruction Tongue Edematous soft tissues Blood Foreign bodies Teeth Vomitus,Primary Survey- Breathing & Ventilation,Expose the neck & chest Physical examination Inspection: chest wall
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