上海交大外科學(xué)腹損pbl課件

腹部損傷

AbdominalTrauma

AboutmyselfName:費(fèi)健Email:Mobile:137-0176-9798開始了大家要專心啊A22yearoldmanwasdrivingdrunkandwithouthisseatbeltfastenedwhenhewasinvolvedinasingle-vehicleautomobileaccident.WhenattendedbyEMT（abbr.emergencymedicaltechnician急診醫(yī)士）personnel,noinformationwasavailableaboutthetimeoftheaccident.Hewasfoundagitatedandcomplainingofabdominalpain.

StudyQuestions1:

What’syourfirstimpressionofthiscase?

OpenorClosedInjuries?HolloworSolidOrgans?SingleorMultiple?病史詢問

A:Allergy過(guò)敏史

M:Medication用藥史

P:Pasthistory過(guò)去病史

L:Lastmeal最后一次進(jìn)食喝水時(shí)間及

LMP(女性)

E:Event外傷發(fā)生之經(jīng)過(guò)史StudyQuestions2:

What’sthekeypointsofphysicalexam?

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

理學(xué)檢查

病患是否有休克癥狀

(tachycardia﹑tachypnea﹑coldswealing)

胸腹部是否有開放性傷口

胸腹部是否有挫傷﹑瘀血腫等

女性病患應(yīng)注意是否懷孕StudyQuestions3:

Whatwillyoudonext?

-Anasogastrictuberevealsgreenliquid.

-Aurinarycatheterrevealsdarkyellowurine.

-Hishemoglobinis7.

-Hisabdominallavage（灌洗）revealsgrossblood.

StudyQuestions4:

What’sthefinaldiagnosis?

影像學(xué)檢查：

X線平片、CT、

B超、DSA

目的要求：了解：腹部損傷的分類、病因和病理；掌握：腹部損傷的臨床表現(xiàn)；熟練掌握：腹部閉合性損傷引起的臟器破裂、出血、穿孔的診斷及治療原則。NewEngJMedVolume356:1353-1360March29,2007Number13NextCase10-2007—A55-Year-OldManImpaledinaRowingAccident腹部閉合性損傷，以下都是不能早期確診的原因除了（）。A．實(shí)質(zhì)臟器損傷但其被膜未破B．同時(shí)合并其他部位的嚴(yán)重?fù)p傷C．空腔臟器穿孔不大D．腹腔穿刺抽出不凝固血液E．后腹膜臟器的損傷A．腹膜炎出現(xiàn)早B．腹膜炎嚴(yán)重，呈板狀腹C．腹膜炎出現(xiàn)較晚，但較重D．腹膜炎出現(xiàn)較晚且