胸部外伤ppt课件_13.ppt

生活家饮食保健孕期选择食用油的学问邢台市第四病院罕见护理应急预案猪气喘病综合防制技术动物营养系列理想蛋白与氨基酸模式的研究进展皮肤病的诊断包括病史体格检查和必要的实验室检查我国有关食物添加剂营养强化剂食物新资本的治理律例与标准 Chest Trauma Gráinne Murphy Final Med April 2002 Introduction Chest trauma is often sudden and dramatic Accounts for 25% of all trauma deaths 2/3 of deaths occur after reaching hospital Serious pathological consequnces: -hypoxia, hypovolaemia, myocardial failure Mechanism of Injury Penetrating injuries E.g. stab wounds etc. Primarily peripheral lung Haemothorax Pneumothorax Cardiac, great vessel or oesophageal injury Either: - direct blow (e.g. rib fracture) - deceleration injury or - compression injury Rib fracture is the most common sign of blunt thoracic trauma Fracture of scapula, sternum, or first rib suggests massive force of injury Blunt injuries Chest wall injuries Rib fractures Flail chest Open pneumothorax Rib fractures Most common thoracic injury Localised pain, tenderness, crepitus CXR to exclude other injuries Analgesia..avoid taping Underestimation of effect Upper ribs, clavicle or scapula fracture: suspect vascular injury Flail chest Multiple rib fractures produce a mobile fragment which moves paradoxically with respiration Significant force required Usually diagnosed clinically Rx: ABC Analgesia Flail chest Flail Chest - detail Open pneumothorax Defect in chest wall provides a direct communication between the pleural space and the environment Lung collapse and paroxysmal shifting of mediastinum with each respiratory effort ± tension pneumothorax “Sucking chest wound” Rx: ABCs…closure of wound…chest drain Lung injury Pulmonary contusion Pneumothorax Haemothorax Parenchymal injury Trachea and bronchial injuries Pneumomediastinum Pneumothorax Air in the pleural cavity Blunt or penetrating injury that disrupts the parietal or visceral pleura Unilateral signs: ?movement and breath sounds, resonant to percussion Confirmed by CXR Rx: chest drain Pneumothorax Tension pneumot