创伤Advanced Trauma Life Support.ppt
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1、Advanced Trauma Life SupportPatrick Cheah,MDLi-Shin Hospital Emergency Department 1/0011.Preparation2.Triage3.Primary Survey(ABCDEs)4.Resuscitation 5.Adjuncts to primary survey&resuscitation6.Secondary Survey(head to toe evaluation&history)7.Adjuncts to secondary survey8.Continued post-resuscitation
2、 monitoring&re-evaluation9.Definite care.1/0021.PREPARATIONA Pre-hospital phase Receiving hospital is notified first.Send to the closest,appropriate facility.B In Hospital Phase Advanced planning for the trauma pt arrival.Method to summon extra medical assistance Transfer agreement with verified tra
3、uma center established.Protect from communicable disease.1/0032.TRIAGEA A Multiple CasualtiesMultiple Casualties no of severity&pt do not exceed the ability of the facility.B Mass Casualties no&severity of pt EXCEED the capability of the facility&staff.1/0043.PRIMARY SURVEYA:A:Airway with cervical s
4、pine protect.B:B:BreathingC:C:Circulation-control external bleeding.D:D:Disability or neurological statusE:E:Exposure(undress)&E Environment (temp control)1/005PRIMARY SURVEYPriorities for the care of Adult,Pediatrics&Pregnancy women are all the same.During the primary survey life threatening condit
5、ions are identified and management is instituted SIMULTANEOUSLY.1/006A.Airway Maintenance with Cervical Spine A.Airway Maintenance with Cervical Spine Protection.Protection.*GCS score of 8 or less require the placement of definite airway.*Protection of the spine&spinal cord is the important manageme
6、nt principle.*Neurological exam alone does not exclude a cervical spine injury.*Always assume a cervical spine injury in any pt with multi-system trauma,especially with an altered level of consciousness or blunt injury above the clavicle.1/007B.Breathing&VentilationB.Breathing&Ventilation*Airway pat
7、ency does not assure adequate ventilation.C.Circulation with Hemorrhage Control.C.Circulation with Hemorrhage Control.1.Blood Volume&Cardiac Output a.level of consciousness.b.skin color c.Pulse.2.Bleeding *external bleeding is identified&controlled in the primary survey.*Tourniquets should not be us
8、e.1/008D.Disability(Neurological Evaluation)D.Disability(Neurological Evaluation)Simple Mnemonic to describe level of consciousnessA:AlertV:Responds to Vocal stimuliP:Responds to Painful stimuliU:Unresponsive to all stimuliNot forget to use also Glascow Coma Scale.1/009 E.Exposure/Environmental Cont
9、rolE.Exposure/Environmental Control*It is the pts body temp that is most important,not he comfort of the health care provider.*Intravenous fluid should be warm.*Warm environment(room tem)should be maintained.*early control of hemorrhage.1/00104.RESUSCITATIONA.Airway*definite airway if there is any d
10、oubt about the pts ability to maintain airway integrity.B.Breathing/Ventilation/Oxygenation*every injured pt should received supplement oxygenC.Circulation*control bleeding by direct pressure or operative intervention*minimum of two large caliber IV should be established*pregnancy test for all femal
11、e of child bearing age.*Lactated Ringer is preferred&better if warm.1/0011 5.5.ADJUNCT TO PRIMARY SURVEY&ADJUNCT TO PRIMARY SURVEY&RESUSCITATION RESUSCITATION A.Electro-cardiographic Monitoring B.Urinary&Gastric Catheter 1.Urinary catheter.Urethral injury should be suspected if *Blood at the penile
12、meatus *Perineal ecchymosis *Blood in the scrotum *High riding or nonpalpable prostate *Pelvic fracture 1/0012 C.Monitoring 1.Ventilatory rate&ABG 2.Pulse oximetry does not measure ventilation or partial O2 pressure 3.Blood pressure poor measure of actual tissue perfusion.D.X-Ray&Diagnostic Studies
13、C-spine,CXR,Pelvic film Essential x-ray should not be avoid in pregnant pt.*Consider the need for patient transfer.1/00136 SECONDARY SURVEY Does not begin until the primary survey(ABCDEs)is completed,resuscitative effort are well established&the pt is demonstrating normalization of vital sign.*Head
14、to Toe evaluation&reassessment of all vital signs.*A complete neurological exam is performed including a GCS score.*Special procedure is order.1/0014History A:Allergies.M:Medication currently used.P:Past illness/Pregnancy.L:Last Meal E:Events/Environment related to the injury.*blunt trauma/penetrati
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