上海交大外科腹损pbl.ppt

* 腹 部 损 伤Abdominal Trauma 上海交通大学医学院外科学教研室 上海交通大学医学院附属瑞金医院普外科 About myself Name: 费 健 Email: feijian@ Mobile:137-0176-9798 开始了 大家要专心啊 一个例子四大问题 A 22 year old man was driving drunk and without his seatbelt fastened when he was involved in a single-vehicle automobile accident. When attended by EMT（abbr. emergency medical technician 急诊医士） personnel, no information was available about the time of the accident. He was found agitated and complaining of abdominal pain. Study Questions 1: What’s your first impression of this case?  Open or Closed Injuries ? Hollow or Solid Organs ? Single or Multiple ? 病史询问 病患受伤之可能机转，如车祸之车体损伤严重度，是否用安全带，救援病患之时间从病患或家属快速取得AMPLE资料，但不可因为问病史而耽误急救处置。 病史询问A : Allergy 过敏史M : Medication 用药史P : Past history 过去病史L : Last meal 最后一次进食喝水时间及 LMP ( 女性 )E : Event 外伤发生之经过史 Study Questions 2: What’s the key points of physical exam?  His airway was patent. At the scene, he was breathing at 20 per minute with a blood pressure of 90/60 and a pulse of 130. He was placed in a hard cervical collar and on a back board and transported to your emergency room. Upon arrival his vital signs are the same, with a temperature of 36oC.  His abdomen is markedly distended. His hands and feet are cold, his legs mottled. 理学检查 病患是否有休克症状  ( tachycardia﹑tachypnea﹑cold swealing ) 胸腹部是否有开放性伤口 胸腹部是否有挫伤﹑瘀血肿等 女性病患应注意是否怀孕 Study Questions 3: What will you do next?  -A nasogastric tube reveals green liquid.-A urinary catheter reveals dark yellow urine. -His hemoglobin is 7. -His abdominal lavage（灌洗）reveals gross blood. 诊断工具 Laboratory Data Hb,Hct ( serial measurement ) Base line WBC Coagulation studies Baseline electrolyte  Liver and renal function tests Serum amylas