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ID:36894350
大小:419.97 KB
页数:33页
时间:2019-05-10
《严重创伤病人的麻醉(PPTX页)》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,theseverityofthetraumashouldbeeva
2、luated.Thecommonlyusedscoringsystemincluding:1.ASAphysicalstatusscoreItisnotveryusefulfordiscriminatingsmalldifferenceinseverelyinjuredpatients.2.Glasgowcomascorescale(GCS)Indicators:EyeopeningSpontaneous4Tovoice3Topain2None1VerbalresponseOriented5Confused4Inappro
3、priatewords4Incomprehensiblewords2None1MotorresponsesObeysCommand6Localizespain5Withdraws(pain)4Flexion(pain)3Extension(pain)2None1Numericrange:3~15Lowerscoremoreseriouscoma3.RevisedTraumaScore(RTS)Indicators:Systolicbloodpressure≥89mmHg476~89mmHg350~75mmHg21~49mm
4、Hg1Nopulse0Weight0.7326Respiratoryrate10~29/min4>29/min36~9/min21~5/min1None0Weight0.2908GlasgowComaScale13~1549~1236~824~5130Weight0.9368Numericrange0~0.784SBP×wgt+RR×wgt+GCS×wgt=TSLowerScoremoreseriousinjury4.OthersRefertothetext.MechanismsofInjuryThemechanismof
5、injurydeterminesthepatternofinjury,andtheknowledgefocusesthetreatmentprioritiesforthepatient.Forexample:PenetratingthoracictraumaBluntChesttraumaThetherapeuticapproachisquitedifferent.Blunttraumaresultsinwidespreadenergytransfertothebody.Whenthelimitsoflordtoleran
6、ceareexceeded,Tissuesaredisrupteddependingontheamountofenergytransfer.Penetratingtraumainjuresastheenergybehindthepenetratinginstrumentcausesstretchingandcrushingoftissues.Theenergydissipationprofilesofdifferentweapons(Knivesandbulletsdeterminetheanatomicdepthande
7、xtentofmaximuminjury.Traumapatients’deathdemonstrateatrimodaldistribution.Inthefirstandlargestpeakofdistributioncurve,deathfromeitherbluntorpenetratingtraumaoccursimmediatelyfollowingwidespreadlacerationofthebrainormajorbloodvessels,includingtheheart.Suchpatientsc
8、anrarelybesaved.Inthesecondpeak,exsanguinationsfromvascularinjuriescausesdeathwithinafewhourswithoutmedicaltreatment.Inadequateordelayedshockresuscitati
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