Conference急诊外科.ppt

Case Conference-急診外科 Presenter: Int.黃士財 Director: 林杏麟醫師 Date: 2006-09-05 Patient profile: Name: 許╳恩 Gender: male Age: 10 years old ID:Time: 2006-09-02, around 6:00pm Pre-hospital Assessment Incident: crushed by a sport utility vehicle near 龍華國中 Brought by an 119 ambulance with neck collar, Spinal Broad, and Simple mask (O2: 10L/min) 否 24 130 155/75 E1V1M1否 20 134 157/72 E1V1M1 抵院時基本狀態：Respond to pain, RR: 10~24/min, BP: 152/110 mmHg, Pulse: 149 bpm, BT: 37.2’C， GCS score: E1V1M1 Primary ABCD Airway Neck collar Airway obstruction sign: Cyanotic, Breathing Respiration rate:18/min→On simple mask, O2 : 6L/min No trachea deviation Breathing sound: bilateral rale and rhonchi Subcutaneous cripitus: right side Echo finding: no lung sliding, 霧霧的→Right thoracostomy was performed at 6:25pm SpO2: 94% Circulation Check four limbs pulse: BP: 左手： BP: 130/80mmHg, pulse: 142/min 右手： BP:146/72mmHg, pulse: 134/min 右腳： BP:骨折無法測量, pulse: OK Peripheral circulation: Skin color: red Temperature: warm Capillary refilling time: not performed Bleeding: 懷疑胸腔內持續出血 FAST: Morrison’s pouch, Splenic fossa, cul-de-sac, pericardium, no fluid acclumination. Disability and Exposure GCS score: E2V2M4, 總分：8 Pupil: sluggish, right 5mm/5mm 移除衣物，在背部發現有一大片Abrasion wound. Menagement Neck collar, Simple mask 6L/min, Pulse oximetry, EKG monitor, Peripheral line N/S 1 bot On chest tube, right and left side Lab exam: CBC, PT/PTT, Sugar, BUN/Cr, Na/K, GOT/GPT, CPK/CKMB/Tropo-I Image: X-ray: Chest ,Elbow (R), Humor (L), Low leg (R), Femur (R), Pelvis CT: C-spine, Head (with and without contrast), chest, abdomen Lab data Image Finding Image finding CT of Chest: Bilateral pneumothorax and suspicious bilateral hemothorax s/p right chest tube insertion with subcutaneus emphysema at right lateral chest wall. Deformity of left 5th, 6th, 7th, 8th and 9th ribs, suspect old fracture. CT of head: Subgaleal hematoma at left temporo-parietal scalp. Left maxillary hemosinus; sphenoid