外科胸部外伤课件

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1、THORACICINJURYGeneralconsideration(1)Physiologicalbasis:*Pleuralcavitiesaretheclosedspaces*Lungventilationisaccomplishedbythegenerationofnegativepressure*Negativepressure:Duringthequietrespiration,itvariesfrom-6to-12cmH2Owithinspirationto-3to-5cmH2OduringexpirationGeneralconsideratio

2、n(2)Anatomybasis:*Pleuraisdividedintotwoportions:Parietal:internalliningofthechestwallVisceral:coveringtheentiresurfaceofthelungGeneralconsideration(3)Normalsituation:*Thepleuralcavitiesaretobeclosedspace*TherearealittlefluidaccumulatednotbeingseenAbnormalsituation:Increasedcapillary

3、hydro-pressureorgreatnegativeintra-pleuralpressure,tendstoincreasetransudationintothecavity,lossofintra-pleuralnegativepressure(pneumo-thorax)diminishedtransudationGeneralconsideration(4)Pleuralcavityinsummary:ThevitalimportantspaceforcirculationandrespiratorysystemsSpecialanatomican

4、dphysiologicalsituation*negativepressureinthepleuralcavities*thoraco-abdominalinjury*mildtraumaticinjurymaysalvagedbyrelativeminorprocedureThetreatment:simplestraightlymaneuverGeneralconsideration(5)Mechanismsofthoracicinjury*blunttrauma(combinedinjury)*penetrating(localinjury)Common

5、causes*Peacefultime:Automobile,industrialaccidents,violentinjury*Wartime:missiles,gunshotGeneralconsideration(6)TheclassificationofthoracicinjuryClosedthoracicinjury:*ribfracture*pneumo-thorax*hemo-thorax*traumaticasphysia,etal.Openthoracicinjury:*blindwound:triangleknife,stabbinginj

6、ury.*penetratinginjury:gunshot,gunfireGeneralconsideration(7)Thoraco-abdominalinjury:Chestinjurybelowthe4thintercostalspace,diaphragm,spleen,liver,colonandstomachmaybewoundedmostoftenMultiplecombinedinjury:MultiplesystemandmorethanthreeorgansareinvolvedinthetraumaofchestGeneralconsid

7、eration(8)Theprinciplesofmanagementforthoracicinjury:EvacuationtoanappropriatefacilityResuscitation:restoretheorgansfunctionAirway:suctionofmouthandpharynx,introductionoforalairwaysuffice,intubationwithhyperventilation(orcricothyroidotomy)Adequatecirculation:bloodandtransfusionforhyp

8、ovolemiashoc