儿童创伤急救.ppt

International Trauma Life Support for Prehospital Care Providers Sixth Edition Patricia M.Hicks,MS,NREMTP Roy Alson,PhD,MD,FACEP Donna Hastings,EMT-P John Emory Campbell,MD,FACEP and Alabama Chapter,American College of Emergency Physicians Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Chapter 17 Trauma in Children Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Trauma in Children Trauma in Children 儿童创伤儿童创伤 Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Overview Effective techniques to gain confidence有效增加信心的技巧有效增加信心的技巧 Injuries based on mechanisms of injury受伤机理受伤机理 ITLS Primary and Secondary Surveys初步及进一步检查初步及进一步检查 Consent and the need for immediate transport家长同意及需家长同意及需实时运送实时运送 Pediatric equipment needs适合儿童之器材适合儿童之器材 Various methods of SMR on child儿童脊椎固定方法儿童脊椎固定方法 EMS involvement in prevention programs参与预防意外计划参与预防意外计划 2 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Trauma in Children Different from adults与成人不同与成人不同 Different patterns of injuries不同伤势模式 Different responses to those injuries不同反应 Special equipment required需要特别器材 Assessment equipment and treatment equipment检查及冶疗用的器材 Difficult to assess and communicate 较难评估及沟通 Come with caregivers and other family members 与家人或照顾者同行 3 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Communicating沟通沟通 Family-centered care is critical.以家庭为中心以家庭为中心 Caregiver not always parent.照顾者未必是父母 Involve caregivers as much as possible in care.尽量让照顾者参与 Give explanations and careful instructions.必需详加解释及指示 Inclusion and respect will improve stabilization.包容及尊重可稳定伤者 Keep caregivers in physical and verbal contact.与照顾者保持接触 Demonstrate competence and compassion.4 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Assessing Mental Status 捡查精神状态捡查精神状态 Consoled or distracted可按抚或转注意力可按抚或转注意力 Most sensitive indicator of adequate perfusion 能准确反映组织灌注是否足够 Caregivers best at detecting subtle changes 照顾者会较易分辩出伤者微小改变 5 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Assessing Mental Status Initial level of consciousness最初清醒程度最初清醒程度 Preschool child:sleeping vs.unconscious 幼儿:疲倦vs人事不醒 Most will not sleep through arrival of ambulance大部份沿途不会睡觉 Ask caregivers to wake child着照顾者弄醒伤者 Suspect hypoxia,shock,head trauma,seizure 怀疑缺氧、休克、头部受伤、癫痫 6 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Communicating Interaction strategies使用适龄的语言使用适龄的语言 Appropriate language for developmental level合适的语言合适的语言 Speak simply,slowly,clearly说话要慢及简溸 Be gentle and firm必需肯定 Avoid“no”questions避免说”不”Get a favorite belonging 利用其喜爱的玩具/随身物品 Get on childs level 降下身段至与伤者视线平衡 Explain SMR necessity 解释脊椎固定之需要 Allow caregiver to accompany child 让照顾者与伤者同行 7 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Caregiver Consent照顾者照顾者”同意同意”Critical care shouldnotbe delayed.切勿延医冶理切勿延医冶理 Emergency care needed如需进行急救如需进行急救 Consent not available未能取得”同意”Transport before permission,document why,notify medical direction记录,速送医院,通知医五 Consent denied不同意 Try to persuade,document actions,obtain signature 尝试说服、记录、签署 Notify law enforcement and appropriate authorities 行使有关法例 Report suspected abuse 如怀疑儿童受虐待,通知警方 8 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Pediatric Equipment儿科器材儿科器材 Length-based tape身长尺身长尺 Weight estimate大约体重 Fluid and medication doses precalculated 输液及药物剂量 Common equipment size estimates 常用器材尺码 9 Trauma in Children-Photo courtesy of Kyee Han,MD Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Mechanisms of Injury受伤机理受伤机理 Falls高处下堕高处下堕 Usually land on head通常头先着地 Serious head injury unusual from 27 inches严重头部受伤并不常见于身长27吋 Protective gear保护装备 MVCs交通意外交通意外 Seat-belt syndrome安全带综合症 Liver,spleen,intestines,lumbar spine 肝、脾、小肠、腰椎 Auto-pedestrian crashes路人被撞路人被撞 10 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Mechanisms of Injury Burns烧伤烧伤 Airway obstruction气道受阻气道受阻 Foreign body异物 Child abuse虐待儿童虐待儿童 Suspect if history does not match injury 受伤经过与伤势不吻合 Story keeps changing经常改变说法 11 Trauma in Children-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Airway in Children儿童气道儿童气道 Signs of obstruction 呼吸受阻征状呼吸受阻征状 Apnea无呼吸 Stridor吸气时有喘鸣声 “Gurgling”respiration有杂声的呼吸 Contribute to obstruction诱因诱因 Hyperextension过度舒张 Hyperflexion过度屈曲 12 Trauma in Children-Courtesy of Bob Page,NREMT-P Campbell,International Trauma Life Support,6th Ed.2008 Pearson