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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,腹 部 损 伤,Abdominal Trauma,上海交通大学医学院外科学教研室,上海交通大学医学院附属瑞金医院普外科,About myself,Name:,费 健,Mobile:137-0176-9798,开始了,大家要专心啊,一个例子四大问题,A 22 year old man was driving drunk and without his seatbelt fastened when he was involved in a single-vehicle automobile accident.When attended by EMTabbr.emergency medical technician 急诊医士 personnel,no information was available about the time of the accident.He was found agitated and complaining of abdominal pain.,Study Questions 1:Whats your first impression of this case?,Open or Closed Injuries?,Hollow or Solid Organs?,Single or Multiple?,病史询问 病患受伤之可能机转，如车祸之车体损伤严重度，是否用平安带，救援病患之时间从病患或家属快速取得AMPLE资料，但不可因为问病史而耽误急救处置。,病史询问,A:Allergy,过敏史,M:Medication,用药史,P:Past history,过去病史,L:Last meal,最后一次进食喝水时间及,LMP(,女性,)E:Event,外伤发生之经过史,Study Questions 2:Whats the key points of physical exam?,His airway was patent.At the scene,he was breathing at 20 per minute with a blood pressure of 90/60 and a pulse of 130.He was placed in a hard cervical collar and on a back board and transported to your emergency room.Upon arrival his vital signs are the same,with a temperature of 36,o,C.,His abdomen is markedly distended.His hands and feet are cold,his legs mottled.,理学检查 病患是否有休克病症 (tachycardiatachypneacold swealing)胸腹部是否有开放性伤口 胸腹部是否有挫伤瘀血肿等 女性病患应注意是否怀孕,Study Questions 3:What will you do next?,-A nasogastric tube reveals green liquid.-A urinary catheter reveals dark yellow urine.-His hemoglobin is 7.-His abdominal lavage灌洗reveals gross blood.,诊断工具,Laboratory Data Hb,Hct(serial measurement)Base line WBC Coagulation studies Baseline electrolyte,Liver and renal function tests Serum amylase Urinalysis,Study Questions 4:Whats the final diagnosis?,影像学检查：,X,线平片、,CT,、,B,超、,DSA,目的要求：,了解：腹部损伤的分类、病因和病理；,掌握：腹部损伤的临床表现；,熟练掌握：腹部闭合性损伤引起的脏器破裂、出血、穿孔的诊断及治疗原那么。,思考题,腹部闭合性损伤的诊断,腹腔诊断性穿刺的方法及意义,脾破裂的治疗方法,只剩两月就要,考试了,!,New Eng J Med,Volume 356:1353-1360,March 29,2007,Number 13,NextCase 10-2007,A 55-Year-Old Man Impaled in a Rowing Accident,男30岁，由5m高处跌下2小时。腹痛，腹肌紧张，有压痛和反跳痛，肠鸣音弱。血压104/70mmHg，脉率120次/分，血红蛋白80g/L。X线检查：右侧第9、10肋骨骨折，右侧膈肌升高。最可能的诊断是 。,A肝破裂,B胃破裂,C脾破裂,D横结肠破裂,E胰腺断裂,腹部闭合伤，确诊有无内脏伤最简便，最可靠的诊断方法为 。,AX线照片,BCT,C白细胞计数,DB超,E腹腔穿刺。,腹部闭合性损伤，以下都是不能早期确诊的原因除了 。,A实质脏器损伤但其被膜未破,B同时合并其他部位的严重损伤,C空腔脏器穿孔不大,D腹腔穿刺抽出不凝固血液,E后腹膜脏器的损伤,A腹膜炎出现早,B腹膜炎严重，呈板状腹,C腹膜炎出现较晚，但较重,D腹膜炎出现较晚且较轻,E无腹膜刺激征,结肠破裂 。,胰腺损伤 。,经常有膈下游离气体的情况有 。,A胃、十二指肠溃疡穿孔,B腹部手术后2周内,C肠道外伤穿孔,D阑尾穿孔,
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