南昌大学医学院急危重症护理学课件 创伤与烧伤.ppt

Emergency Nursing Chapter 12 Trauma And Burn Contents including Craniocerebral, Chest and Abdominal Trauma Bone and Joint Trauma Multiple Injury Burn Scalp injury Skull injury- fracture of the skull Brain injury Epidural Hematoma Subdral hematoma Intracerebral Hematoma Assessment: 1、Present history: A complete history is obtained, if possible. The following questions are significant in assessing head injuries: What time did the injury occur? What caused the injury? Was there a loss of consciousness? 2、Clinical manifestation: Altered levels of consciousness Confusion Pupil abnormalities Altered gag reflex（咽反射） Absent corneal reflex（角膜反射消失） Sudden onset of neurologic deficits Changes in vital signs Vision and hearing impairment Sensory dysfunction,spasticity（痉挛）,headache,vertigo（眩晕）,movement disorder,seizures（癫痫） Scalp injury Skull injury- fracture of the skull Brain injury cerebral concussion （脑震荡） cerebral contusion （脑挫伤） Subdral hematoma Intracerebral Hematoma （脑内血肿） 神经系统症状明显，昏迷，生命体征改变 瞳孔改变,脑疝等） 3、Diagnostic study Lumbar puncture（腰穿） X-ray CT scan MRI Intracerebral pressure monitor（颅内压监测）（附属医院没有开展） Medical and Nursing Management Airway Management ICP（颅内压） Management Hypotension Management Hyperthermia Management Progress monitoring：（生命体征、瞳孔、意识、运动及言语能力等） Basic nursing care（口腔护理、皮肤护理、眼部护理等） Psychological care Chest Trauma: Causes of chest trauma： The consequences of chest trauma： Management： 1 Assessment Prensent history: 1) when the injury occurred 2) mechanism of injury 3)LOC（意识状态） 4) specific injury 5) estimated blood loss 6) recent drug or alcohol use 7) prehospital treatment 2、Clinical manifestation Immediately life-threatening thoracic（胸部） injuries Tension Pneumothorax 1)Tension Pneumothorax air may be drawn into the pleural space ，but can not be expelled A tension pressure is built up within the pleural space, which produces a collapse of the lung and may even push the heart and the great