外科急诊创伤之脊椎损伤演示幻灯片.ppt

Zone 1 subclavian vessels brachiocephalic veins common carotid artery jugular vein aortic arch trachea esophagus Lung apices c spine spinal cord CN roots Thoracic inlet to cricoid cartilage Zone 2 Carotid and vertebral arteries jugular veins pharynx larynx trachea esophagus c spine spinal cord Cricoid cartilage to angle of mandible Zone 3 Salivary glands parotid gland esophagus trachea c spine Carotid arteries jugular veins CN IX - XII Angle of mandible to base of skull Penetrating knives 50% guns 45% shotgun 5% GSW greatest injuries deeper penetration cavitation suck debris bullet and bone fragments Blunt MVC’s sports related “clothesline tackle” strangulation manipulation shoulder belt compression Direct Force Shearing excessive rotation/ hyperextension distention and stretching intraoral injury basilar skull fx Impact Anterior Neck Crush larynx or trachea; cricoid ring compress esophagus against spinal column sudden increased intratracheal pressure against closed glottis (seatbelt), crush bruise (clothesline tackle) rapid acceleration/ deceleration results in tracheal injury Strangulation Hanging ligature suffocation manual choking postural asphyxiation children with neck over object and body weight produces compression Hanging Significant c spine/ SCI occur only with fall body height simple asphyxia rarely cause death c spine disruption subsequent to strangulation Pathophysiology of Hanging Venous obstruction Hypoxia Cerebral stagnation Arterial spasms Decreased cerebral blood flow Vagal collapse Increased parasympathetic tone Initial Assessment Consider spinal precautions Head injury Intoxicated patients Injuries above the shoulders Distracting injuries Maintain manual stabilization Vest style versus rapid extrication Maintain neutral alignment Increase of pain or resistance, restrict movement in position found Assessment of the Spinal Injury Patient Initial Assessment ABC’s Suction Consider Oral or Digital Intubation if required Maintain in-line manua