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ID:36591718
大小:405.97 KB
页数:34页
时间:2019-05-09
《(精品)严重创伤病人的麻醉》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、严重创伤病人的麻醉AnesthesiaforTraumaInadvancedcountries,injuryranksasthefourthleadingcauseofdeathfollowingheartdisease,cancer,andcerebrovasculardisease.PreoperativeAssessmentFortraumapatients,inadditiontotheordinarypreanestheticevaluation,theseverityofthetraumashouldbeevaluated.Thecommonlyused
2、scoringsystemincluding:1.ASAphysicalstatusscoreItisnotveryusefulfordiscriminatingsmalldifferenceinseverelyinjuredpatients.2.Glasgowcomascorescale(GCS)Indicators:EyeopeningSpontaneous4Tovoice3Topain2None1VerbalresponseOriented5Confused4Inappropriatewords4Incomprehensiblewords2None1Motor
3、responsesObeysCommand6Localizespain5Withdraws(pain)4Flexion(pain)3Extension(pain)2None1Numericrange:3~15Lowerscoremoreseriouscoma3.RevisedTraumaScore(RTS)Indicators:Systolicbloodpressure≥89mmHg476~89mmHg350~75mmHg21~49mmHg1Nopulse0Weight0.7326Respiratoryrate10~29/min4>29/min36~9/min21~
4、5/min1None0Weight0.2908GlasgowComaScale13~1549~1236~824~5130Weight0.9368Numericrange0~0.784SBP×wgt+RR×wgt+GCS×wgt=TSLowerScoremoreseriousinjury4.OthersRefertothetext.MechanismsofInjuryThemechanismofinjurydeterminesthepatternofinjury,andtheknowledgefocusesthetreatmentprioritiesforthepat
5、ient.Forexample:PenetratingthoracictraumaBluntChesttraumaThetherapeuticapproachisquitedifferent.Blunttraumaresultsinwidespreadenergytransfertothebody.Whenthelimitsoflordtoleranceareexceeded,Tissuesaredisrupteddependingontheamountofenergytransfer.Penetratingtraumainjuresastheenergybehin
6、dthepenetratinginstrumentcausesstretchingandcrushingoftissues.Theenergydissipationprofilesofdifferentweapons(Knivesandbulletsdeterminetheanatomicdepthandextentofmaximuminjury.Traumapatients’deathdemonstrateatrimodaldistribution.Inthefirstandlargestpeakofdistributioncurve,deathfromeithe
7、rbluntorpenetratingtraumaoccursimmediatelyfollowingwidespreadlacerationofthebrainormajorbloodvessels,includingtheheart.Suchpatientscanrarelybesaved.Inthesecondpeak,exsanguinationsfromvascularinjuriescausesdeathwithinafewhourswithoutmedicaltreatment.Inadequateordelayedshockresuscitati
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