(外科学课件）10-Chest trauma.ppt

P100-* P100-* P100-* P100-* P100-* P100-* Sustain oxygenation and BP P100-* P100-* 连枷胸病理生理学 （通气障碍方面） 1，胸壁浮动Flail chest. 2，纵隔扑动——呼吸时两侧胸腔压力的不均衡造成。影响肺通气，导致体内缺氧和二氧化碳滞留，严重时可发生呼吸和循环衰竭。 3，残气对流——见开放性气胸。 （换气障碍方面） 4，肺部挫伤。连枷胸常伴有广泛肺挫伤、挫伤区域的肺间质或肺泡水肿导致氧弥散障碍，出现低氧血症。 P100-* 机理： 由于上腔静脉系统（以及肺静脉系统）缺乏静脉瓣，这一突然高压使右心血液经无静脉瓣的上腔静脉系统逆流，而引起静脉过度充盈扩张并破裂出血，并发上腔静脉分布区域上半身皮肤、粘膜的末梢毛细血管点状出血，同理也存在肺内颅内眼底中耳等处广泛的毛细血管破裂和点状出血，甚至小静脉破裂出血。 除了外伤以外，本教授曾经报道过“体外循环逆行灌注排气”引起创伤性窒息的个案。 * Pneumothorax Air in pleural space Partial or complete lung collapse occurs * * Traumatic pneumothorax occurs either because a hole in the chest wall, such as a stab wound or gunshot wound, allows air to enter the pleural space, or because of injury to the lung Traumatic pneumothorax can create a 1-way valve in the pleural space (only letting in air without escape) and can lead to a tension pneumothorax * the causes of a traumatic pneumothorax A traumatic pneumothorax may result from both blunt trauma and penetrating injuries to the chest wall. It may be observed in those exposed to an explosive blast, even if no direct injury to the chest has occurred. The most common mechanism is a cut to the pleura by a fractured rib. Stab, gunshot, Medical procedures of the chest (iatrogenic): such as the taking of biopsy samples from lung tissue, inserting a central venous catheter into one of the chest veins, administration of positive pressure ventilation, mechanical ventilation or non-invasive ventilation * Simple Pneumothorax Signs and Symptoms Pain on inhalation Difficulty breathing Tachypnea Decreased or absent breath sounds Severity of symptoms depends on size of pneumothorax, speed of lung collapse, and patient’s health status * Simple Pneumothorax Management Monitor for tension pneumothorax Suction, drainage * Open Pneumothorax Hole in chest wall Allows air to enter pleural space Larger hole = Greater chance air will enter there than through trachea “Sucking Chest Wound” * Open Pneumothorax Management Close ho