孕妇创伤急救.ppt

孕妇创伤急救.ppt

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InternationalTraumaInternationalTraumaLifeSupportLifeSupportforPrehospitalCareProvidersforPrehospitalCareProvidersSixthEditionSixthEditionPatriciaM.Hicks,MS,NREMTPPatriciaM.Hicks,MS,NREMTPRoyAlson,PhD,MD,FACEPRoyAlson,PhD,MD,FACEPDonnaHastings,EMT-PDonnaHastings,EMT-PJohnEmoryCampbell,MD,FACEPJohnEmoryCampbell,MD,FACEPandAlabamaChapter,andAlabamaChapter,AmericanCollegeofEmergencyPhysiciansAmericanCollegeofEmergencyPhysiciansCampbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJChapter19Chapter19TraumainPregnancyTraumainPregnancyCampbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJTraumainPregnancyTraumainPregnancy孕妇创伤孕妇创伤孕妇创伤孕妇创伤Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJOverview概要概要Dualgoalsinmanagingpregnanttrauma需要处理两个或以上的病人需要处理两个或以上的病人Physiologicalchangesofpregnancy孕妇生理改变孕妇生理改变Responsetohypovolemia对血溶积减少的反应Typesofinjuriesmostcommonlyassociated常见伤势常见伤势Initialassessmentandmanagement初步检查及处理初步检查及处理Traumapreventioninpregnancy预防孕妇创伤预防孕妇创伤2TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJTraumainPregnancy孕妇创伤孕妇创伤Uniquechallenges挑战挑战Vulnerabilityofpregnanttraumapatient孕妇于创伤时之弱点Potentialinjuriestounbornchild对胎儿的伤害Dualroles双重角色双重角色Providecaretomother照顾母体Providecaretofetus照顾胎儿3TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJTraumainPregnancyLeadingcauseofmorbidityandmortality为孕妇发病率及死亡率的主要原因为孕妇发病率及死亡率的主要原因67%ofpregnanciesexperiencesometrauma6-7%孕妇曾遇上创创1in12injuredexperiencesignificanttrauma1-2%遭遇严重创伤Majorcauses主要原因Motor-vehiclecollisions交通意外Falls高处堕下Abuseanddomesticviolence虐待及家庭暴力Penetratinginjuries穿刺性创伤Burns烧伤4TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJPregnantPatientIncreasedriskfortrauma创伤的风险增加创伤的风险增加Faintingspells,hyperventilation,excessfatiguecommonlyassociatedwithearlypregnancy孕妇初期较易头晕,呼吸过速,易疲倦Balanceandcoordinationaffectedbychangesthroughoutpregnancy怀孕过程可影响其平衡力及身体协调5TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJFetalDevelopment6TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJViabilityAssessment7TraumainPregnancy-阴道出血阴道出血肚脐肚脐耻骨联合耻骨联合流产流产可被见可被见宫高宫高Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJPhysiologicChanges8TraumainPregnancy-肠蠕动肠蠕动血色素血色素心输出量心输出量血量血量血压血压心率心率血含二氧化碳量血含二氧化碳量Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJPhysiologicChanges孕妇生理的改变孕妇生理的改变Respiratorysystem呼吸系统呼吸系统Diaphragmelevatedduetouterinesize日渐长大的子宫令横隔膜上升Decreasedthoracicvolume肺容量下降Relativealkalosis血液相对为碱性Predisposedtohyperventilation较易出现呼吸过速9TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJVitalSignsinPregnancy孕妇生命表征的改变孕妇生命表征的改变Donotmistakenormalvitalsignsforsignsofshock.切勿把正常的生命表征当作休克切勿把正常的生命表征当作休克Normalpulse:

1015beatsfaster正常脉搏:

快10-15次Bloodpressure:

1015mmHglower血压:

低10=15mmHg3035%bloodlossbeforesignificantbloodpressurechange失血量达30-35%才出现休克Bealerttoallsignsofshock.注意出现休克征状注意出现休克征状FrequentITLSOngoingExams反复ITLS”复检”捡查10TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJResponsetoHypovolemia血溶积减少的反应血溶积减少的反应Vasoconstrictionandtachycardia血管收缩及心跳过速血管收缩及心跳过速Reductionofuterinebloodflowby2030%子宫血流量减少子宫血流量减少20-30%Fetalheartrateandbloodflowdecreases胎儿心跳速率及血流量下降Fetusbecomeshypoxemic胎儿出现血氧过低High-flowoxygenisessential.给予给予高浓度的氧气高浓度的氧气Maternalshockhas80%fetalmortalityrate孕妇出现休克,胎儿死亡率可达80%11TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJTraumainPregnancyITLSPrimaryandSecondarySurveys初步检查及进一步检查初步检查及进一步检查OptimizematernalandfetaloutcomeHigh-flowoxygenrapidlyadministered尽快给予高浓度氧Fetalhypoxiaoccursbeforematernalhypoxia胎儿会比母体早缺氧Fluidadministrationmustbeprompt必需正确输液Fluidvolumeneededisgreater输液量较多FrequentOngoingExams反复ITLS”复检”捡查Mortalityoffetusrelatedtomaternaltreatment胎儿胎儿死亡率与母体处理有关死亡率与母体处理有关12TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEducation,Inc.,UpperSaddleRiver,NJSupineHypotension仰卧血压低仰卧血压低Venousreturndecreases30%insupinepositionwith20-weekorlargeruterus.下腔静下腔静脉于脉于仰卧时受压仰卧时受压引致心脏血液回流受阻引致心脏血液回流受阻,通常通常20周以后出现周以后出现Acutehypotension急性血压低Syncope昏厥Fetalbradycardia胎儿心跳过慢13TraumainPregnancy-Campbell,InternationalTraumaLifeSupport,6thEd.2008PearsonEdu