《处理原则》PPT课件

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1、BluntThoracicInjuryChao-WenChenAttendingSurgeonTraumaService,KMUH1Preface2/3ofvictimsofmajorblunttraumasufferfromthoracicinjury.Thoracicinjuriesaccountfor20-25%ofdeathsduetotrauma.Majorthoracictraumaisassociatedwithmultisysteminjuriesin70%ofcases.2004-July2Tra

2、umaConferenceCommonInjuriesDevelopAfterBluntChestTraumaThoraciccagefracturesLungcontusionandtearsMyocardiumcontusionAorticrupture2004-July3TraumaConferenceInitialSurveyAssumetheexistenceofC-spineinjuryABCsGerneralevaluation:PE,PH,ECG,orABG…Chestx-rayAdminister

3、oxygen2004-July4TraumaConference處理原則謹記ABC順序與原則初級檢傷時，若遇以下危及生命之狀況，需立即診斷出並加以處理：張力性氣胸（TensionPneumothorax）連枷胸（flailchest）開放性胸壁傷口（openchestwound）大量血胸（massivehemothorax）心包填塞（cardiactamponade）2004-July5TraumaConference如何處理？張力性氣胸連枷胸開放性胸壁傷口大量血胸心包填塞2004-July6TraumaConfe

4、rence如何處理？張力性氣胸Needledecompression/ChestTube連枷胸Paincontrol/O2/MV開放性胸壁傷口Woundcoverage/Chesttube大量血胸Chesttube/Thoracotomy心包填塞Pericardialwindow2004-July7TraumaConferenceImagingSurveyChestx-ray:serveasascreeningratherthanadefinitetestrepeatradiographyshouldbeorde

5、redifsuspiciousComputedtomography:highlysensitiveindetectinginjuriesandsuperiortoroutinechestx-rayrecommendedinpatientswithmultipletraumaandsuspectedchesttraumaAngiogram:forsuspiciousgreatvesselinjuriesChestultrasound:detecthemothorax,FAST2004-July8TraumaConf

6、erence處理原則二級檢傷時，若遇以下危及生命之狀況，需立即診斷出並加以處理：主動脈破裂（containedaortarupture）氣管或支氣管破裂（ruptureoftracheobronchialtree）食道破裂（perforationofesophagus）橫膈破裂（ruptureofdiaphragm）心肌挫傷（myocardialcontusion）肺部挫傷（pulmonarycontusion）2004-July9TraumaConferenceContainedaortictear2004-Ju

7、ly10TraumaConferencePneumothorax2004-July11TraumaConferenceHemothorax2004-July12TraumaConferenceTroublesomeInjuriesSternalfractureMoreseriousinjuriesmayaccompanyIfsuspected,alateralCXRmaybediagnosticOperativereductionisusuallyunnecessaryHospitalizationisnotman

8、datoryiftheECGisnormalandthepatient’svitalsignisstable2004-July13TraumaConferenceTroublesomeInjuriesFlailchestFractureof2ormoreconsecutiveribsinatleast2placeseachAbout30-40%ofpatie