孕妇创伤急救

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,*,*,Trauma in Pregnancy-,Campbell,International Trauma Life Support,6th Ed.,2008 Pearson Education,Inc.,Upper Saddle River,NJ,International Trauma Life Support,for Prehospital Care Providers,Sixth Edition,Patricia M.Hicks,MS,NREMTP,Roy Alson,PhD,MD,FACEP,Donna Hastings,EMT-P,John Emory Campbell,MD,FACEP,and Alabama Chapter,American College of Emergency Physicians,Campbell,International Trauma Life Support,6th Ed.,2008 Pearson Education,Inc.,Upper Saddle River,NJ,Campbell,International Trauma Life Support,6th Ed.,2008 Pearson Education,Inc.,Upper Saddle River,NJ,Chapter 19,Trauma in Pregnancy,第一页，共三十一页。,Trauma in Pregnancy,孕妇,(ynf),创伤,第二页，共三十一页。,Overview,概要,(giyo),Dual goals in managing pregnant trauma,需要处理两个或以上的病人,Physiological changes of pregnancy,孕妇生理改变,Response to hypovolemia,对血溶积减少,(jinsho),的反应,Types of injuries most commonly associated,常见伤势,Initial assessment and management,初步检查及处理,Trauma prevention in pregnancy,预防孕妇创伤,3,Trauma in Pregnancy-,第三页，共三十一页。,Trauma in Pregnancy,孕妇,(ynf),创伤,Unique challenges,挑战,Vulnerability of pregnant trauma patient,孕妇于创伤时之弱点,Potential injuries to unborn child,对胎儿的伤害,(shnghi),Dual roles,双重角色,Provide care to mother,照顾母体,Provide care to fetus,照顾胎儿,4,Trauma in Pregnancy-,第四页，共三十一页。,Trauma in Pregnancy,Leading cause of morbidity and mortality,为孕妇,(ynf),发病率及死亡率的主要原因,67%of pregnancies experience some trauma,6-7%,孕妇曾遇上创创,1 in 12 injured experience significant trauma 1-2%,遭遇严重创伤,Major causes,主要原因,Motor-vehicle collisions,交通意外,Falls,高处堕下,Abuse and domestic violence,虐待及家庭暴力,Penetrating injuries,穿刺性创伤,Burns,烧伤,5,Trauma in Pregnancy-,第五页，共三十一页。,Pregnant Patient,Increased risk for trauma,创伤的风险增加,Fainting spells,hyperventilation,excess fatigue commonly associated with early pregnancy,孕妇初期较易,头晕,(tu yn),呼吸过速,易疲倦,Balance and coordination affected by changes throughout pregnancy,怀孕过程可影响其平衡力及身体协调,6,Trauma in Pregnancy-,第六页，共三十一页。,Fetal Development,7,Trauma in Pregnancy-,第七页，共三十一页。,Viability Assessment,8,Trauma in Pregnancy-,阴道,(yndo),出血,肚脐(dq),耻骨(chg)联合,流产,可被见,宫高,第八页，共三十一页。,Physiologic Changes,9,Trauma in Pregnancy-,肠蠕动,血色素,心输出量,血量,血压,(xuy),心率(xn l),血含二氧化碳(r yng hu tn)量,第九页，共三十一页。,Physiologic Changes,孕妇,(ynf),生理的改变,Respiratory system,呼吸系统,Diaphragm elevated due to uterine size,日渐长大的子宫令横隔膜上升,(shngshng),Decreased thoracic volume,肺容量下降,Relative alkalosis,血液相对为碱性,Predisposed to hyperventilation,较易,出现,呼吸过速,10,Trauma in Pregnancy-,第十页，共三十一页。,VitalSignsinPregnancy,孕妇生,命,命,(sh,ngmng),表征的,改,改变,Donotmistakenormalvitalsignsfor signs of shock.,切勿把,正,正常的,生,生命表,征,征当作,(dnzu),休克,Normalpulse:1015 beats faster,正常脉,搏,搏,:,快,10-15,次,Bloodpressure:10,15mmHglower,血压,:,低,10=15mmHg,3035%bloodlossbeforesignificantbloodpressurechange,失血量,达,达,30-35%,才出现,休,休克,Bealerttoallsignsofshock.,注意出,现,现休克,征,征状,FrequentITLS OngoingExams,反复,ITLS”,复检,”,捡查,11,TraumainPregnancy-,第十一,页,页，共,三,三十一,页,页。,ResponsetoHypovolemia,血溶积,减,减少,(ji,nsho),的反应,Vasoconstriction andtachycardia,血管收,缩,缩及心,跳,跳过速,Reductionofuterinebloodflow by 2030%,子宫,(zgng),血流量,减,减少,20-30%,Fetalheartrate andbloodflow decreases,胎儿心,跳,跳速率,及,及血流,量,量下降,Fetusbecomes hypoxemic,胎儿出,现,现血氧,过,过低,High-flowoxygen is essential.,给予,高浓度,的,的氧气,Maternalshockhas80%fetal mortalityrate,孕妇,出现休,克,克,胎儿死,亡,亡率可,达,达,80%,12,TraumainPregnancy-,第十二,页,页，共,三,三十一,页,页。,TraumainPregnancy,ITLS Primaryand SecondarySurveys,初步检,查,查及进,一,一步检,查,查,Optimizematernalandfetaloutcome,High-flowoxygen rapidlyadministered,尽快给,予,予高浓,度,度氧,Fetalhypoxia occursbeforematernalhypoxia,胎儿会,比,比母体,早,早缺氧,Fluidadministrationmust be prompt,必需,(bx),正确输,液,液,Fluidvolumeneeded is greater,输液量,较,较多,FrequentOngoing Exams,反复,ITLS”,复检,”,捡查,Mortalityoffetusrelatedtomaternaltreatment,胎儿,死亡率,与,与母体,处,处理有,关,关,13,TraumainPregnancy-,第十三,页,页，共,三,三十一,页,页。,SupineHypotension,仰卧,(ynw),血压低,Venousreturn decreases30%insupine position with20-weekorlargeruterus.,下腔静,脉于,仰卧时,受,受压,引,引致心,脏,脏血液,回,回流,(hu,li),受阻,通常,20,周以后,出,出现,Acutehypotension,急性血,压,压低,Syncope,昏厥,Fetalbradycardia,胎儿心,跳,跳过慢,14,TraumainPregnancy-,第十四,页,页，共,三,三十一,页,页。,SupineHypotension,Transportposition,运送时,之,之卧式,Tilt or rotatebackboard20,30,o,topatientsleft,将脊板,左,左倾,20,30,度,Elevate right hip 46 inches with towel,于盆腔,(pnqing),下垫上,4-6,吋毛巾,Manually displace uterusto left,将子宫移向,左,左侧,15,Trauma inPregnancy-,第十五页，,共,共三十一页,。,。,Supine Hypotension,Transportposition,Better stabilized with vacuumbackboard,Morecomfortable than standard backboard,固定,(gdng),于真空,脊板较比一,般,般脊板舒适,16,Trauma inPregnancy-,第十六页，,共,共三十一页,。,。,Evaluationof Uterine Size,17,Trauma inPregnancy-,第十七页，,共,共三十一页,。,。,18,Relativelyminor abdominal traumacan cause fetaldeath.,Maternal deathis most commoncauseof fetaldeath.,胎儿,(ti,r),死亡的原因,最,最主要是母,体,体死亡,Trauma inPregnancy-,第十八页，,共,共三十一页,。,。,Pregnant TraumaArrest,孕妇,(ynf,),创伤性心跳,停,停上,Treated same asforothervictims,急救法与普,通,通伤者相同,(xin,tn,),Defibrillationsettings are same,相同去颤法,电,电量,Drugdosages are same,相同药物剂,量,量,Fluidvolume neededincreases,需要较大量,静,静脉输液,4 liters normalsaline rapid infusion duringt