医学专题一孕妇创伤急救.ppt

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1、International Trauma International Trauma Life SupportLife Supportfor Prehospital Care Providersfor Prehospital Care ProvidersSixth Edition Sixth Edition Patricia M.Hicks,MS,NREMTPPatricia M.Hicks,MS,NREMTPRoy Alson,PhD,MD,FACEPRoy Alson,PhD,MD,FACEPDonna Hastings,EMT-PDonna Hastings,EMT-PJohn Emory

2、 Campbell,MD,FACEPJohn Emory Campbell,MD,FACEPand Alabama Chapter,and Alabama Chapter,American College of Emergency PhysiciansAmerican College of Emergency PhysiciansCampbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJChapter 19Chapter 19Trauma in Pregn

3、ancyTrauma in Pregnancy第一页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTrauma in PregnancyTrauma in Pregnancy孕妇孕妇孕妇孕妇(ynf)(ynf)创伤创伤创伤创伤第二页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle Riv

4、er,NJOverview概要概要(giyo)Dual goals in managing pregnant trauma需要处理两个或以上的病人需要处理两个或以上的病人Physiological changes of pregnancy孕妇生理改变孕妇生理改变Response to hypovolemia对血溶积减少(jinsho)的反应Types of injuries most commonly associated常见伤势常见伤势Initial assessment and management初步检查及处理初步检查及处理Trauma prevention in pregnancy预防

5、孕妇创伤预防孕妇创伤3Trauma in Pregnancy-第三页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTrauma in Pregnancy孕妇孕妇(ynf)创伤创伤Unique challenges挑战挑战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

6、双重角色双重角色Provide care to mother照顾母体Provide care to fetus照顾胎儿4Trauma in Pregnancy-第四页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTrauma in PregnancyLeading cause of morbidity and mortality为孕妇为孕妇(ynf)发病率及死亡率的主要原因发病率及死亡率的主要原因67%of pregnancies

7、 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5Trauma in Pregnancy-第五页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pear

8、son Education,Inc.,Upper Saddle River,NJPregnant PatientIncreased risk for trauma创伤的风险增加创伤的风险增加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6Trauma in P

9、regnancy-第六页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJFetal Development7Trauma in Pregnancy-第七页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJViability Assessment8Trauma in Preg

10、nancy-阴道阴道(yndo)出血出血肚脐肚脐(dq)耻骨耻骨(chg)联联合合流产流产可被见可被见宫高宫高第八页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJPhysiologic Changes9Trauma in Pregnancy-肠蠕动肠蠕动血色素血色素心输出量心输出量血量血量血压血压(xuy)心率心率(xn l)血含二氧化碳血含二氧化碳(r yng hu tn)量量第九页，共三十一页。Campbell,Interna

11、tional Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJPhysiologic Changes孕妇孕妇(ynf)生理的改变生理的改变Respiratory system呼吸系统呼吸系统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

12、吸过速10Trauma in Pregnancy-第十页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJVital Signs in Pregnancy孕妇生命孕妇生命(shngmng)表征的改变表征的改变Do not mistake normal vital signs for signs of shock.切勿把正常的生命表征当作切勿把正常的生命表征当作(dn zu)休克休克Normal pulse:1015 beats fas

13、ter 正常脉搏:快10-15次Blood pressure:1015 mmHg lower 血压:低10=15 mmHg3035%blood loss before significant blood pressure change失血量达30-35%才出现休克Be alert to all signs of shock.注意出现休克征状注意出现休克征状Frequent ITLS Ongoing Exams反复ITLS”复检”捡查11Trauma in Pregnancy-第十一页，共三十一页。Campbell,International Trauma Life Support,6th Ed

14、.2008 Pearson Education,Inc.,Upper Saddle River,NJResponse to Hypovolemia血溶积减少血溶积减少(jinsho)的反应的反应Vasoconstriction and tachycardia血管收缩及心跳过速血管收缩及心跳过速 Reduction of uterine blood flow by 2030%子宫子宫(zgng)血流量减少血流量减少20-30%Fetal heart rate and blood flow decreases 胎儿心跳速率及血流量下降 Fetus becomes hypoxemic 胎儿出现血氧过

15、低High-flow oxygen is essential.给予给予高浓度的氧气高浓度的氧气 Maternal shock has 80%fetal mortality rate 孕妇出现休克,胎儿死亡率可达80%12Trauma in Pregnancy-第十二页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTrauma in PregnancyITLS Primary and Secondary Surveys初步检查及进一

16、步检查初步检查及进一步检查Optimize maternal and fetal outcomeHigh-flow oxygen rapidly administered尽快给予高浓度氧Fetal hypoxia occurs before maternal hypoxia胎儿会比母体早缺氧Fluid administration must be prompt必需(bx)正确输液Fluid volume needed is greater输液量较多Frequent Ongoing Exams反复ITLS”复检”捡查Mortality of fetus related to maternal t

17、reatment 胎儿胎儿死亡率与母体处理有关死亡率与母体处理有关13Trauma in Pregnancy-第十三页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJSupine Hypotension仰卧仰卧(yn w)血压低血压低Venous return decreases 30%in supine position with 20-week or larger uterus.下腔静下腔静脉于脉于仰卧时受压仰卧时受压 引致心脏

18、血液回流引致心脏血液回流(hu li)受阻受阻,通常通常20周周以后出现以后出现Acute hypotension 急性血压低Syncope昏厥Fetal bradycardia 胎儿心跳过慢14Trauma in Pregnancy-第十四页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJSupine HypotensionTransport position运送时之卧式运送时之卧式Tilt or rotate backboard

19、 2030o to patients left 将脊板左倾20 30度Elevate right hip 46 inches with towel于盆腔(pnqing)下垫上4-6吋毛巾Manually displace uterus to left 将子宫移向左侧 15Trauma in Pregnancy-第十五页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJSupine HypotensionTransport positi

20、onBetter stabilized with vacuum backboardMore comfortable than standard backboard 固定(gdng)于真空脊板较比一般脊板舒适16Trauma in Pregnancy-第十六页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJEvaluation of Uterine Size17Trauma in Pregnancy-第十七页，共三十一页。Campbe

21、ll,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ18Relatively minor abdominal traumaRelatively minor abdominal traumacan cause fetal death.can cause fetal death.Maternal death is most common cause of fetal Maternal death is most common cause of fetal death

22、.death.胎儿胎儿胎儿胎儿(ti r)(ti r)死亡的原因最主要是母体死亡死亡的原因最主要是母体死亡死亡的原因最主要是母体死亡死亡的原因最主要是母体死亡Trauma in Pregnancy-第十八页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJPregnant Trauma Arrest 孕妇孕妇(ynf)创伤性心跳停上创伤性心跳停上Treated same as for other victims急救法与普通伤者相急救法

23、与普通伤者相同同(xin tn)Defibrillation settings are same相同去颤法电量Drug dosages are same相同药物剂量Fluid volume needed increases需要较大量静脉输液4 liters normal saline rapid infusion during transport 送院时输液4公升If mother unsalvageable:如孕妇不能挽救如孕妇不能挽救Continue CPR继续 CPRNotify hospital of possible cesarean section通知院方:准备接生/剖腹接生19T

24、rauma in Pregnancy-第十九页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTypes of Trauma创伤创伤(chungshng)种类种类Motor-vehicle collisions交通交通(jiotng)意外意外Penetrating injuries穿刺性创伤穿刺性创伤Domestic violence家庭暴力家庭暴力Falls高处堕下高处堕下Burns烧伤烧伤20Trauma in Pregnanc

25、y-第二十页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJMotor-Vehicle Collisions撞车撞车(zhung ch)6575%of pregnancy-related trauma交通意外占孕妇交通意外占孕妇(ynf)创伤创伤65-75%20%BSA 烧伤面积 20%会増加胎儿(ti r)死亡机会27Trauma in Pregnancy-第二十七页，共三十一页。Campbell,International Tr

26、auma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTrauma Prevention预防预防(yfng)Proper seat-belt use正确使用安全带正确使用安全带Report domestic violence举报家庭暴力举报家庭暴力Counseling for domestic violence辅导辅导Patient education病人教育病人教育Multiple changes associated with pregnancy 孕妇身体多方面改变Physiological,an

27、atomical,emotional 生理(shngl),解剖,情绪28Trauma in Pregnancy-第二十八页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJSummary总结总结(zngji)Trauma in Pregnancy孕妇创伤孕妇创伤Knowledge of physiological changes生理上的改变Hypotension and hemorrhage easily overlooked 血压低

28、及出血容易被忽视Rapid evaluation and interventions to stabilize 快速(kui s)评估及处理Aggressive oxygen administration尽怏施氧Aggressive fluid resuscitation尽怏输液Prevent supine hypotension预防仰卧引致的血压低Fetal care depends on maternal care胎儿依赖母体29Trauma in Pregnancy-第二十九页，共三十一页。Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJDiscussion30Trauma in Pregnancy-第三十页，共三十一页。内容(nirng)总结Chapter 19。孕妇初期较易头晕,呼吸过速,易疲倦。初步检查及进一步检查。Frequent Ongoing Exams反复ITLS”复检”捡查。固定于真空脊板较比一般脊板舒适。胎儿死亡的原因最主要是母体死亡。可没有防卫性收缩,硬实,回缩痛等反应。生理,解剖(jipu),情绪。29第三十一页，共三十一页。