孕妇创伤急救.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 19 Trauma in Pregnancy Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Trauma in Pregnancy 孕妇创伤孕妇创伤 Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Overview概要概要 Dual goals in managing pregnant trauma 需要处理两个或以上的病人需要处理两个或以上的病人 Physiological changes of pregnancy孕妇生理改变孕妇生理改变 Response to hypovolemia对血溶积减少的反应 Types of injuries most commonly associated常见伤势常见伤势 Initial assessment and management初步检查及处理初步检查及处理 Trauma prevention in pregnancy预防孕妇创伤预防孕妇创伤 2 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Trauma in Pregnancy孕妇创伤孕妇创伤 Unique challenges挑战挑战 Vulnerability of pregnant trauma patient 孕妇于创伤时之弱点 Potential injuries to unborn child 对胎儿的伤害 Dual roles双重角色双重角色 Provide care to mother照顾母体 Provide care to fetus 照顾胎儿 3 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Trauma in Pregnancy Leading cause of morbidity and mortality 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%of pregnancies experience some trauma 6-7%孕妇曾遇上创创 1 in 12 injured experience significant trauma 1-2%遭遇严重创伤 Major causes主要原因 Motor-vehicle collisions交通意外 Falls高处堕下 Abuse and domestic violence虐待及家庭暴力 Penetrating injuries穿刺性创伤 Burns烧伤 4 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Pregnant Patient Increased risk for trauma创伤的风险增加创伤的风险增加 Fainting spells,hyperventilation,excess fatigue commonly associated with early pregnancy 孕妇初期较易头晕,呼吸过速,易疲倦 Balance and coordination affected by changes throughout pregnancy 怀孕过程可影响其平衡力及身体协调 5 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Fetal Development 6 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Viability Assessment 7 Trauma in Pregnancy-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,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Physiologic Changes 8 Trauma in Pregnancy-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,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Physiologic Changes 孕妇生理的改变孕妇生理的改变 Respiratory system呼吸系统呼吸系统 Diaphragm elevated due to uterine size 日渐长大的子宫令横隔膜上升 Decreased thoracic volume肺容量下降 Relative alkalosis血液相对为碱性 Predisposed to hyperventilation较易出现呼吸过速 9 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Vital Signs in Pregnancy 孕妇生命表征的改变孕妇生命表征的改变 Do not mistake normal vital signs for signs of shock.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 Normal pulse:1015 beats faster 正常脉搏:快10-15次 Blood pressure:1015 mmHg lower 血压:低10=15 mmHg 3035%blood loss before significant blood pressure change失血量达30-35%才出现休克 Be alert to all signs of shock.注意出现休克征状注意出现休克征状 Frequent ITLS Ongoing Exams反复ITLS”复检”捡查 10 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Response to Hypovolemia 血溶积减少的反应血溶积减少的反应 Vasoconstriction and tachycardia血管收缩及心跳过速血管收缩及心跳过速 Reduction of uterine blood flow by 2030%子宫血流量减少子宫血流量减少20-30%Fetal heart rate and blood flow decreases 胎儿心跳速率及血流量下降 Fetus becomes hypoxemic 胎儿出现血氧过低 High-flow oxygen is essential.给予给予高浓度的氧气高浓度的氧气 Maternal shock has 80%fetal mortality rate 孕妇出现休克,胎儿死亡率可达80%11 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Trauma in Pregnancy ITLS Primary and Secondary Surveys 初步检查及进一步检查初步检查及进一步检查 Optimize maternal and fetal outcome High-flow oxygen rapidly administered尽快给予高浓度氧 Fetal hypoxia occurs before maternal hypoxia胎儿会比母体早缺氧 Fluid administration must be prompt必需正确输液 Fluid volume needed is greater输液量较多 Frequent Ongoing Exams反复ITLS”复检”捡查 Mortality of fetus related to maternal treatment 胎儿胎儿死亡率与母体处理有关死亡率与母体处理有关 12 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Supine Hypotension仰卧血压低仰卧血压低 Venous return decreases 30%in supine position with 20-week or larger uterus.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 Acute hypotension 急性血压低 Syncope昏厥 Fetal bradycardia 胎儿心跳过慢 13 Trauma in Pregnancy-Campbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJ Supine Hypotension Transport position运送时之卧式运送时之卧式 Tilt or rotate backboard 2030o to patients left 将脊板左倾20 30度 Elevate right hip 46 inc