头部外伤教材.docxVIP

6 Head Trauma头部外伤The primary goal oftreatment for patientswith suspectedtraumatic braininjury (TBI) is toprevent secondarybrain injury.对于怀疑患有创伤性脑损伤病人治疗的主要目标是防止继发性脑损伤。Scenario A 58-year-old male fell from asecond-story roof in a small rural town. He isinitially able to say his name, has a heart rate of115, blood pressure of 100/60, and oxygen saturationof 88%. His initial Glasgow Coma Scale(GCS) score was 12; two hours after transfer toa trauma center, he has sonorous respirations, aheart rate of 120, blood pressure of 100/70, andhis GCS score is 6.一个58岁的男性在一个小乡镇从一个二层屋顶跌落。他刚开始能说出自己的名字，心率115次/次，血压100/60mmHg，氧饱和度88%。格拉斯哥昏迷量表评分：12分，2小时后转到创伤中心，他呼吸有力，心率120次，血压100/70mmHg，他的格拉斯哥昏迷量表评分：6分。Outline 大纲Introduction 介绍Anatomy Review 复习解剖? Scalp头皮? Skull头骨? Meninges脑膜? Brain大脑Ventricular System脑室系统Intracranial Compartments 颅内室Physiology 生理? Intracranial Pressure 颅内压? Monro-Kellie Doctrine门-克里二氏学说:颅内血量无论在健康或疾病时,都须大致保持恒定? Cerebral Blood Flow脑血流? Severity of Injury 损伤的严重程度? Morphology 形态学Management of Minor Brain Injury (GCS Score 13–15)轻微脑损伤的管理Management of Moderate Brain Injury (GCS Score 9–12)中度脑损伤的管理Management of Severe Brain Injury (GCS Score 3–8)重度脑损伤的管理? Primary Survey and Resuscitation 初步调查与复苏? Secondary Survey 二次调查? Diagnostic Procedures 诊断程序Medical Therapies for Brain Injury药物对脑损伤的治疗? Intravenous Fluids静脉输液? Hyperventilation 过度换气? Mannitol甘露醇? Hypertonic Saline高渗盐水? Barbiturates巴比妥类药物? Anticonvulsants抗惊厥药Surgical Management 手术治疗? Scalp Wounds头皮伤口? Depressed Skull Fractures 凹陷性颅骨骨折? Intracranial Mass Lesions 颅内占位性病变? Penetrating Brain Injuries穿透脑损伤Prognosis预后Brain Death 脑死亡Summary总结Bibliography参考书目Objectives 目标1 Describe basic intracranial physiology.描述基本的颅内生理2 Evaluate patients with head and brain injuries.评估头部和大脑损伤3 Perform a focused neurologic examination.进行神经系统检查4 Explain the importance of adequate resuscitation inlimiting secondary brain injury.说明在限制继发性脑损伤时充分复苏的重要性。5 Given a patient scenario, determine the need forpatient transfer, admission, consultation, or discharge.