八年制教学--胸部外伤课件.pptx

胸部外伤;胸部损伤（第27章）;“上帝的神秘设计”;;病因;现在胸外伤的主要原因;临床??现;临床抢救程序;急诊室或创伤中心;Case report---P1;AIS-ISS评分;Case report---P2;Case report---P3;Case report---P4;Case report---P5;Case report---P6;Flail chest槤架胸 ;Flail chest Assist ventilation辅助呼吸 Possible intubation多数需要气管插管 Stabilize flail segment 固定伤处 Operation外科手术 Monitor for注意合并问题 Pulmonary contusion肺部挫伤 Hemothorax血胸 Pneumothorax气胸;连枷胸的急诊室处理---3;肋骨骨折的外科治疗;Case 肋骨骨折;Case report---P6;气胸来源;三种气胸比较;Open pneumothorax开放性气胸 “Sucking chest wound”吸气性伤口 Air enters pleural space空气漏入胸膜腔 Ventilation impaired换气不足 Hypoxia results最后缺氧 Signs and symptoms Proportional to size of defect 与受影响部份的大小成正比;Open pneumothorax Close chest wall defect封闭伤处 胸腔闭式引流;开放性气胸的急诊室处理---3;开放性气胸的急诊室处理---4;Tension pneumothorax 张力性气胸 Dyspnea气喘 Anxiety惊恐 Tachypnea呼吸急速 Distended neck veins Tracheal deviation气管移位(rare) (极少发生) Breath sounds diminished呼吸音减少 Hypertympany if percussed叩诊音较响 Shock with hypotension休克及血压低;Tension pneumothorax Respiratory distress and cyanosis 呼吸困难及发绀 Loss of radial pulse 桡动脉搏动消失 Decreasing level of consciousness 清醒程度下降 Decompress affected side减压 穿刺 闭式引流;张力性气胸的急诊室处理---3;Case report---P7;血胸来源;胸外科;Massive hemothorax严重血胸 Anxiety and confusion惊恐及慌乱 Neck veins颈静脉 Flat扁平: hypovolemia失血 Distended怒胀: mediastinal compression纵隔受压 Breath sounds decreased Hypotympany if percussed 叩诊音深沉 Shock休克;Massive hemothorax Thoracic exploration开胸探查 Treat for shock积极抗休克 Fluid administration输液 Titrate to peripheral pulse (90–100 mmHg) 直至摸到周围脉搏 Monitor for监察出现 Hemopneumothorax血气胸 ;Case report---P8;Case report---P9;Traumatic asphyxia创伤性窒息;Traumatic asphyxia创伤性窒息---2;Tracheal or bronchial tree injury气管或支气管损伤;Diaphragmatic tear膈肌撕裂;膈肌损伤;膈肌损伤;膈肌损伤;膈肌损伤;膈肌损伤;膈肌损伤;膈肌损伤;膈肌损伤;食管损伤;肺损伤;;胸部刀扎伤;胸壁及纵隔气肿;胸部损伤开胸探查指征Exploratory Thoracotomy ;急诊室开胸探查指征;胸外科;胸部创伤思考题;THANKS