兒童創(chuàng)傷急救

Chapter17TraumainChildren第一頁(yè)，共三十五頁(yè)。TraumainChildrenTraumainChildren

兒童(értóng)創(chuàng)傷第二頁(yè)，共三十五頁(yè)。OverviewEffectivetechniquestogainconfidence有效增加信心的技巧Injuriesbasedonmechanismsofinjury受傷機(jī)理ITLSPrimaryandSecondarySurveys初步及進(jìn)一步檢查Consentandtheneedforimmediatetransport家長(zhǎng)同意及需實(shí)時(shí)運(yùn)送Pediatricequipmentneeds適合兒童之器材VariousmethodsofSMRonchild兒童脊椎固定(gùdìng)方法EMSinvolvementinpreventionprograms參與預(yù)防意外計(jì)劃第三頁(yè)，共三十五頁(yè)。3精選pptTraumainChildrenDifferentfromadults與成人不同Differentpatternsofinjuries不同傷勢(shì)模式Differentresponsestothoseinjuries不同反應(yīng)Specialequipmentrequired需要特別器材Assessmentequipmentandtreatmentequipment檢查(jiǎnchá)及冶療用的器材Difficulttoassessandcommunicate

較難評(píng)估及溝通Comewithcaregiversandotherfamilymembers與家人或照顧者同行第四頁(yè)，共三十五頁(yè)。4精選pptCommunicating溝通(gōutōng)Family-centeredcareiscritical.以家庭為中心Caregivernotalwaysparent.照顧者未必是父母Involvecaregiversasmuchaspossibleincare.盡量讓照顧者參與Giveexplanationsandcarefulinstructions.必需詳加解釋及指示Inclusionandrespectwillimprovestabilization.包容及尊重可穩(wěn)定(wěndìng)傷者Keepcaregiversinphysicalandverbalcontact.與照顧者保持接觸Demonstratecompetenceandcompassion.第五頁(yè)，共三十五頁(yè)。5精選pptAssessingMentalStatus

撿查精神狀態(tài)Consoledordistracted可按撫或轉(zhuǎn)注意力Mostsensitiveindicatorofadequateperfusion

能準(zhǔn)確反映組織灌注是否足夠Caregiversbestatdetectingsubtlechanges照顧者會(huì)較易分辯出傷者微小(wēixiǎo)改變第六頁(yè)，共三十五頁(yè)。6精選pptAssessingMentalStatusInitiallevelofconsciousness最初清醒程度Preschoolchild:sleepingvs.unconscious幼兒:疲倦vs人事不醒Mostwillnotsleepthrougharrivalofambulance大部份沿途不會(huì)(bùhuì)睡覺(jué)Askcaregiverstowakechild著照顧者弄醒傷者Suspecthypoxia,shock,headtrauma,seizure

懷疑缺氧、休克、頭部受傷、癲癇7TraumainChildren-第七頁(yè)，共三十五頁(yè)。精選pptCommunicatingInteractionstrategies使用適齡的語(yǔ)言Appropriatelanguagefordevelopmentallevel合適的語(yǔ)言Speaksimply,slowly,clearly說(shuō)話要慢及簡(jiǎn)溸Begentleandfirm必需肯定Avoid“no”questions避免說(shuō)”不”Getafavoritebelonging

利用其喜愛(ài)的玩具/隨身(suíshēn)物品Getonchild’slevel降下身段至與傷者視線平衡ExplainSMRnecessity解釋脊椎固定之需要Allowcaregivertoaccompanychild讓照顧者與傷者同行第八頁(yè)，共三十五頁(yè)。8精選pptCaregiverConsent照顧(zhàogù)者”同意”Criticalcareshouldnotbedelayed.切勿延醫(yī)冶理Emergencycareneeded如需進(jìn)行急救Consentnotavailable未能取得”同意”Transportbeforepermission,

documentwhy,notifymedicaldirection記錄,速送醫(yī)院,通知醫(yī)五Consentdenied不同意Trytopersuade,documentactions,obtainsignature嘗試(chángshì)說(shuō)服、記錄、簽署Notifylawenforcementandappropriateauthorities行使有關(guān)法例Reportsuspectedabuse如懷疑兒童受虐待,通知警方第九頁(yè)，共三十五頁(yè)。9精選pptPediatricEquipment兒科(érkē)器材Length-basedtape身長(zhǎng)尺Weightestimate大約體重Fluidandmedicationdosesprecalculated

輸液及藥物(yàowù)劑量Commonequipmentsizeestimates

常用器材尺碼PhotocourtesyofKyeeHan,MD第十頁(yè)，共三十五頁(yè)。10精選pptMechanismsofInjury受傷(shòushāng)機(jī)理Falls高處(ɡāochǔ)下墮Usuallylandonhead通常頭先著地Seriousheadinjuryunusualfrom<27inches嚴(yán)重頭部受傷并不常見(jiàn)于身長(zhǎng)<27吋Protectivegear保護(hù)裝備MVCs交通意外Seat-beltsyndrome安全帶綜合癥Liver,spleen,intestines,lumbarspine

肝、脾、小腸、腰椎A(chǔ)uto-pedestriancrashes路人被撞第十一頁(yè)，共三十五頁(yè)。11精選pptMechanismsofInjuryBurns燒傷Airwayobstruction氣道受阻Foreignbody異物Childabuse虐待兒童Suspectifhistorydoesnotmatchinjury

受傷經(jīng)過(guò)與傷勢(shì)不吻合Storykeepschanging經(jīng)常改變(gǎibiàn)說(shuō)法第十二頁(yè)，共三十五頁(yè)。12精選pptAirwayinChildren兒童(értóng)氣道Signsofobstruction呼吸受阻征狀A(yù)pnea無(wú)呼吸Stridor吸氣(xīqì)時(shí)有喘鳴聲“Gurgling”respiration有雜聲的呼吸Contributetoobstruction誘因Hyperextension過(guò)度舒張Hyperflexion過(guò)度屈曲CourtesyofBobPage,NREMT-P第十三頁(yè)，共三十五頁(yè)。13精選pptAirwayinChildrenOpeningairway張開(kāi)氣道Tongueislarge;tissuesoft舌大,組織軟Jaw-thrust下頷上提法(tífǎ)Oropharyngealairway口咽氣道Nasopharyngealairways鼻咽氣道Toosmalltoworkpredictably

因鼻孔太少未必有效Neonateobligatenosebreather

新生嬰兒用鼻孔呼吸Clearnosewithbulbsyringe用球狀泵吸走分泌第十四頁(yè)，共三十五頁(yè)。14精選pptBreathinginChildren兒童(értóng)呼吸Workofbreathing呼吸方法Retractions,flaring,grunting

肋間收縮、鼻翼擴(kuò)張、咕嚕(gūlū)聲

Persistentgruntingrequiresventilation持續(xù)咕嚕聲需要施行助呼吸Respiratoryrate呼吸次數(shù)Fast,thenperiodsofapneaorveryslow

先后短暫停止或轉(zhuǎn)慢Minorbluntnecktraumacanbecritical.輕微頭部挫傷可引起嚴(yán)重傷勢(shì)第十五頁(yè)，共三十五頁(yè)。15精選ppt20,15,10VentilationRate換氣(huànqì)次數(shù)10perminuteforadolescent如為中童,10次/分鐘

20perminuefor<1year如<1歲,20次/分鐘15perminutefor>1year如>1歲,15次/分鐘第十六頁(yè)，共三十五頁(yè)。16精選pptBreathingManagement呼吸(hūxī)處理EffectiveBVMventilation—有效BVM換氣(huànqì)

intubationiselective.可考慮插喉第十七頁(yè)，共三十五頁(yè)。17精選pptEndotrachealIntubation

氣管(qìguǎn)內(nèi)導(dǎo)管Oralendotrachealintubation從口腔插入Noblindnasotrachealintubationfor<8years

少于8歲不可施行鼻入插喉法Uncuffedtube無(wú)氣袋式喉管Length-basedtapesystem身長(zhǎng)尺Samediameterastipofchild’slittlefinger與小童尾指頭直徑(zhíjìng)相同F(xiàn)requentlyreassessplacement需經(jīng)常撿查喉管位置4+ageinyears=sizeoftube(mm)4第十八頁(yè)，共三十五頁(yè)。18精選pptCirculationinChildren兒童(értóng)血循環(huán)Persistenttachycardiaismostreliableindicatorofshock.最有效(yǒuxiào)顯示傷者休克的征狀為持續(xù)的脈搏過(guò)快第十九頁(yè)，共三十五頁(yè)。19精選pptCirculationinChildrenEarlyshockmoredifficulttodetermine.較難于休克初期預(yù)測(cè)Persistenttachycardia持續(xù)的脈搏過(guò)快Rate>130usuallyshockinallagesexceptneonates脈搏>130多為休克,新生嬰兒除外Prolongedcapillaryrefillandcoolextremities微血管回流時(shí)閉遲及肢體冰冷Levelofconsciousness清醒程度Circulationcanbepoorevenifchildisawake

血循環(huán)衰竭的兒童仍可完全(wánquán)清醒Lowbloodpressureissignoflateshock.血壓低是休克的后期征狀BP<80mmHginchild;<70mmHginyounginfant第二十頁(yè)，共三十五頁(yè)。20精選pptShockinChildrenStrongcompensatorymechanisms生理的補(bǔ)嘗機(jī)制較強(qiáng)Appearsurprisinglygoodinearlyshock

早期休克可有效(yǒuxiào)發(fā)揮“Crash”whendeteriorate但情況會(huì)急轉(zhuǎn)直下Beprepared必需有心理準(zhǔn)備Fluidadministration20mL/kgineachbolus輸液補(bǔ)充每次20mL/kgConsiderintraosseousinfusion骨髓輸液法FrequentOngoingExams持續(xù)檢查

第二十一頁(yè)，共三十五頁(yè)。21精選pptPediatricTraumaCenter

兒童(értóng)創(chuàng)傷中心Criteria條件Obstructedairway氣道阻塞Needforairwayintervention處理氣道Respiratorydistress呼吸困難(hūxīkùnnán)Shock休克Alteredmentalstatus意識(shí)紊亂Dilatedpupil曈孔擴(kuò)大GlasgowComaScalescore<13PediatricTraumaScore<8第二十二頁(yè)，共三十五頁(yè)。22精選pptPediatricTraumaCenterMechanismthatpredictssevereinjury預(yù)期嚴(yán)重傷勢(shì)(shāngshì)Fallfromheight>10feet高處墮下Motor-vehiclecollisionMVCwithfatalities車(chē)禍中有人死亡EjectionfromanautomobileinaMVC

車(chē)禍中彈離車(chē)廂InMVC,significantintrusionintocompartment

車(chē)禍中受困于車(chē)廂中Hitbyacarasapedestrianorbicyclist行人被撞Fracturesinmorethanoneextremity多邊一條肢體骨抑Significantinjurytomorethanoneorgansystem

多過(guò)一個(gè)器官受傷第二十三頁(yè)，共三十五頁(yè)。23精選pptPediatricTraumaCenterRecommended建議送院Burns燒傷(shāoshāng)Near-drowning遇溺Headinjurieswithlossofconsciousness

人事不醒的頭部受傷Notifyhospitalasearlyaspossible.盡早知會(huì)醫(yī)院第二十四頁(yè)，共三十五頁(yè)。24精選pptLife-ThreateningInjuries

危害(wēihài)生命傷勢(shì)Headinjury頭部受傷Mostcommoncauseofdeath最常見(jiàn)死亡原因Levelofconsciousnesschangebestindicator

清醒程度(chéngdù)之改變?yōu)樽钣行У恼鳡頟upilassessmentimportant檢查瞳孔第二十五頁(yè)，共三十五頁(yè)。25精選pptLife-ThreateningInjuriesHigh-flowoxygen高濃度氧氣Hyperventilateonlywithcerebralherniationsyndrome

加快換氣只適用于出現(xiàn)(chūxiàn)腦疝征狀FluidadministrationtitratedtosystolicBP

控制輸液速度至可維持基本收縮壓Preschoolchild:80mmHg;olderchild:90mmHg幼兒:80mmHg,小童:90mmHgBepreparedtopreventaspiration預(yù)防氣道吸入異物26TraumainChildren-第二十六頁(yè)，共三十五頁(yè)。精選pptLife-ThreateningInjuriesChestinjury胸部創(chuàng)傷Respiratorydistresscommon最常見(jiàn)的征狀為呼吸困難Pneumothoraxortensionpneumothorax氣胸或張力性氣胸Difficulttoassess較難分別Needlethoracostomycanbelife-saving剌胸膜腔穿刺Pulmonarycontusion胸部挫傷Rareinjuries較少發(fā)生(fāshēng)傷勢(shì)Ribfractures,flailchest,aorticrupture,

pericardialtamponade肋骨折、槤架胸、主動(dòng)脈撕裂、心胞膜填塞第二十七頁(yè)，共三十五頁(yè)。27精選pptLife-ThreateningInjuriesAbdominalinjury腹部創(chuàng)創(chuàng)Liverand/orspleenrupture肝、脾撕裂Secondleadingcauseoftraumaticdeath傷第二致死傷勢(shì)Bleedingoftencontainedwithinorgan

出血通常局限于器官之內(nèi)Difficulttodiagnose難以診斷Severeinjurywithminimalsigns

嚴(yán)重傷勢(shì)可只有輕微征狀Suspectwithanyabnormalabdominalassessment

若有任何異常腹部征狀當(dāng)作(dānɡzuò)嚴(yán)重傷勢(shì)處理Bepreparedtopreventaspiration.

預(yù)防氣道吸入異物第二十八頁(yè)，共三十五頁(yè)。28精選pptLife-ThreateningInjuriesSpinalinjury脊椎創(chuàng)傷Uncommonbeforeadolescence青少年以下(yǐxià)較少發(fā)生<9yearsusuallyuppercervical-spineinjuries頭椎上受傷>9yearsusuallylowercervical-spineinjuries頭椎下受傷HigherincidenceofSCIWORA

spinal-cordinjurywithoutradiographicabnormality可無(wú)X-光片異常第二十九頁(yè)，共三十五頁(yè)。29精選pptLife-ThreateningInjuriesSMR脊椎固定Padundertorsoforneutralposition

于天然屈曲位下放置(fàngzhì)較墊Mayhavetosecurewithoutcervicalcollar

可不使用頸圈固定頸椎Donotrestrictchestmovement

切勿緊束胸部30TraumainChildren-第三十頁(yè)，共三