胸部创伤教材.docxVIP

CHAPTER 4 Thoracic Trauma第四章 胸部创伤 PITFALLS 陷阱Both tension pneumothorax and massive hemothoraxare associated with decreased breath sounds onauscultation. Differentiation on physical examinationcan be made by percussion; hyperresonance supportsa pneumothorax, whereas dullness suggests a massivehemothorax. The trachea is often deviated in a tensionpneumothorax, and the affected hemithorax can appearelevated without respiratory movement.无论是张力性气胸还是血胸在听诊时都会出现呼吸音减弱。可以通过叩诊将其区分。过清音提示气胸，而浊音提示血胸。张力性气胸还会伴有气管移位，受影响的胸腔将会抬高、呼吸运动也将消失。CIRCULATION 循环The patient’s pulse should be assessed for quality,rate, and regularity. In patients with hypovolemia, theradial and dorsalis pedis pulses may be absent becauseof volume depletion. Blood pressure and pulse pressureare measured and the peripheral circulation isassessed by observing and palpating the skin for colorand temperature. Neck veins should be assessed fordistention, however, keep in mind that neck veins maynot be distended in patients with concomitant hypovolemiaand either cardiac tamponade, tension pneumothorax,or a traumatic diaphragmatic injury.病人的脉搏也需要从特性、速率和节律上予以评估。有血容量减少的病人，由于血容量不足足背动脉将会消失。监测血压、脉压，末梢血运通过观察皮肤颜色和触摸皮肤温度来评估。颈静脉是否扩张也要被评估，记住当病人伴有血容量减少、其他心脏填塞疾病、张力性气胸或者创伤性膈肌损伤时，颈静脉也可以不充盈。A cardiac monitor and pulse oximeter should beattached to the patient. Patients who sustain thoracictrauma especially in the area of the sternum or from arapid deceleration injury, are also susceptible to myocardialinjury, which can lead to dysrhythmias. Hypoxiaand acidosis enhance this possibility. Dysrhythmiasshould be managed according to standard protocols.Pulseless electric activity (PEA) is manifested by anelectrocardiogram (ECG) that shows a rhythm while thepatient has no identifiable pulse. PEA can be present incardiac tamponade, tension pneumothorax, profoundhypovolemia, and cardiac rupture.应当对胸部创伤患者使用心电监测和血氧饱和度监测。胸部创伤的患者尤其是胸骨受伤，。。。经常容易并发心肌损伤，从而导致心律失常。低氧血症和酸中毒增加了发病几率。心律失常应根据标准的方法进行管理。当病人脉搏不可触及时，可通过心电图观察心脏节律，从而诊断PEA（无脉性电活动（心律失常？））。心脏填塞