上海交大外科学腹损pbl课件.ppt

腹部损伤

AbdominalTrauma;Aboutmyself;开始了

大家要专心啊;一个例子

四大问题;A22yearoldmanwasdrivingdrunkandwithouthisseatbeltfastenedwhenhewasinvolvedinasingle-vehicleautomobileaccident.WhenattendedbyEMT〔abbr.emergencymedicaltechnician急诊医士〕personnel,noinformationwasavailableaboutthetimeoftheaccident.Hewasfoundagitatedandcomplainingofabdominalpain.;StudyQuestions1:

What’syourfirstimpressionofthiscase?

;OpenorClosedInjuries?

HolloworSolidOrgans?

SingleorMultiple?;病史询问

病患受伤之可能机转，如车祸之车体损伤严重度，是否用平安带，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:Pasthistory过去病史

L:Lastmeal最后一次进食喝水时间及

LMP(女性)

E:Event外伤发生之经过史;StudyQuestions2:

What’sthekeypointsofphysicalexam?

;Hisairwaywaspatent.Atthescene,hewasbreathingat20perminutewithabloodpressureof90/60andapulseof130.Hewasplacedinahardcervicalcollarandonabackboardandtransportedtoyouremergencyroom.Uponarrivalhisvitalsignsarethesame,withatemperatureof36oC.

;Hisabdomenismarkedlydistended.

Hishandsandfeetarecold,hislegsmottled.;理学检查

病患是否有休克病症

(tachycardia﹑tachypnea﹑coldswealing)

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;StudyQuestions3:

Whatwillyoudonext?

;-Anasogastrictuberevealsgreenliquid.

-Aurinarycatheterrevealsdarkyellowurine.

-Hishemoglobinis7.

-Hisabdominallavage〔灌洗〕revealsgrossblood.;诊断工具

LaboratoryData

Hb,Hct(serialmeasurement)

BaselineWBC

Coagulationstudies

Baselineelectrolyte

Liverandrenalfunctiontests

Serumamylase

Urinalysis;StudyQuestions4:

What’sthefinaldiagnosis?

;影像学检查：

X线平片、CT、

B超、DSA;;目的要求：;思考题;NewEngJMed

Volume356:1353-1360

March29,2007

Number13

NextCase10-2007—

A55-Year-OldManImpaledinaRowingAccident;男30岁，由5m高处跌下2小时。腹痛，腹肌紧张，有压痛和反跳痛，肠鸣音弱。血压104/70mmHg，脉率120次/分，血红