外科急诊创伤（英文）休克及出血课件.ppt

Pelvic fracture: 2,000 mL Femur fracture: 1,500 mL Tibia/Fibula fracture: 500-750 mL Hematomas Contusions: 500 mL Hemorrhage Assessment  Fractures and Blood Loss Hemorrhage Assessment Ongoing Assessment Reassess Vitals Mental Status Q 5 min: UNSTABLE patients Q 15 min: STABLE patients Reassess Interventions Oxygen ET IV Medication Actions Trending: Improvement vs Deterioration Hemorrhage Management ABC’s O2, ET, IV, CM Protect C-Spine Full immobilization Best splint is the body CPR: BLS ALS care If multiple casualties, do not begin unless adequate resources are available Bleeding Control PASG Any injury to the head or torso is ALSO considered an injury to the spine. Head Wounds Presentation Severe bleeding Skull Fracture Management Gentle Direct Pressure Fluid drainage from Ears and Nose DO NOT Pack Cover and bandage loosely Specific Wound Considerations Neck Wounds Presentation Large vessel can entrain air. Management Consider direct digital pressure Occlusive dressing Gaping Wounds Presentation Multiple sites Gaping prevents uniform pressure Management Bulky Dressing Trauma Dressing Sterile, non-adherent surface to wound Compression dressing Specific Wound Considerations Crush Injury Presentation Difficult to locate source of bleeding Normal hemorrhage control mechanism non-functional Management Consider an air-splint and pressure dressing Consider constricting band or tourniquet Transport Considerations Consider Rapid Transport Suspected serious blood loss Suspected serious internal bleeding Decompensating Shock AMS, ?pulse, Narrowing pulse pressure WHEN IN DOUBT TRANSPORT Other Considerations Sympathetic Response Anxiety SHOCK is…INADEQUATETISSUEPERFUSION In a Nutshell….. Circulation Systolic Pressure Strength and volume of cardiac output Diastolic Pressure More indicative of the state of constriction of the arterioles Mean Arterial Pressure 1/3 pulse pressure added to the diastolic pressure Tissue Perfusion Pressure Com