国际创伤生命支持ITLS-05-休克的评估及处理Chapter8-Shock-SC.ppt

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1、Chapter8ShockEvaluationandManagementShockEvaluationandManagement休克的评估及处理Overview概要FourvascularsystemcomponentsofperfusionProgressionofshocksignsandsymptoms休克征状之改变Threecommonclinicalshocksyndromes常见休克种类之征状Hemorrhagicandneurogenicshockpathophysiology出血性及神经性休克之病理生理2Shock-Overview概要Co

2、ntrollableanduncontrollablehemorrhage,nonhemorrhagicshocksyndromesHemostaticagents凝血剂Currentindicationsforfluidadministration补充体液的指标3Shock-Shock休克Shock-4Perfusionoftissueswithoxygen(组织灌注,electrolytes(电解质),glucose(血糖份),andfluid(体液)becomesinadequate.PreparedbyHarrisLam(A&ETrainingCe

3、ntre,R&TSKH)5“Fick”Principle空气中的氧气注入人体细胞可用”FickPrinciple”说明如下：畅通的气道Airway足够的呼吸Breathing有效的血循环Circulation红血球释放氧气到各细胞OnloadOxygenDeliveryOxygenOffloadOxygen“Steadystate”activityNormalPerfusion正常的灌注6Shock-气体交挽心脏血管网络液量NormalPerfusionShock-7HeartRatexStrokeVolume=CardiacOutput心跳x每次收缩的输

4、出量=心输出量CardiacOutputxPVR=BloodPressure心输出量x血管阻力=血压PerfusionPreservation保存灌注Basicrulesofshockmanagement:Maintainairway维持气道畅通Maintainoxygenationandventilation维持足够供气及换气Controlbleedingwherepossible制止出血Maintaincirculation维持足够血液循环Adequateheartrateandintravascularvolume足够之心跳及血量8Shock-Sho

5、ckProgression休克进程Shock-9Beginswithinjury,spreadsthroughoutbody,multisysteminsulttomajororgans开始时身体受伤,继而影响全身,导致各器官受伤害ShockProgression休克进程10Shock-RedbloodcellsdecreasedInadequateperfusionAnaerobicprocessesHypoxiaworsensCatecholamineincreasesCelldeath灌注不足无氧呼吸加速缺氧细胞死亡肾上腺分泌增加红血球减少Sho

6、ckShockisacontinuum.休克一开始后持续发生Signsandsymptomsareprogressive.征状会慢慢演变出来Manysymptomsduetocatecholamines.大部征状是因肾上腺素泌造成Cellularprocesshasclinicalmanifestations.当细胞受影响时会有明显临床征状11Shock-ShockCompensatedanddecompensated补尝期及非保尝期:Older,hypertensive,and/orheadinjurycannottoleratehypotensionf

7、orevenshorttime年老,血压高及/或头部受伤者都不能短暂处于血压低12Shock-PreparedbyHarrisLam(A&ETrainingCentre,R&TSKH)13HypovolemicShockCompensatedprogression补尝期进程Weaknessandlightheadedness软弱及头晕Thirst口渴Pallor苍白Tachycardia心跳加速Diaphoresis皮肤浅湿泠Tachypnea呼吸加速Urinaryoutputdecreased尿量减少Peripheralpulsesweakened周围脉

8、搏减弱14Shock-ShockProgressionCompen