創(chuàng)傷病人護理課件

第九章創(chuàng)傷病人的護理Chapter9

NursingCareofPatientsExperiencingTraumaYanyanWangE-mail:Amywy創(chuàng)傷病人護理LearningOutcomes:Definethewordtrauma.Definethetypesoftrauma.Discussthecauses,effects,andinitialmanagementoftrauma.Describecollaborativeinterventionsforpatientsexperiencingtrauma.Usethenursingprocessasaframeworkforprovidingindividualizedcaretopatientsexperiencingtrauma.創(chuàng)傷病人護理DefinitionandIntroductionTraumaisdefinedasinjurytohumantissuesandorgansresultingfromtheabnormaltransferofenergyfromtheenvironment.

[創(chuàng)傷：是由于外界環(huán)境中各種力量（能量）的異常傳遞而造成的機體組織或器官損傷。]創(chuàng)傷病人護理【概述】

創(chuàng)傷(trauma)有廣義和狹義之分，廣義的是指機械、物理、化學或生物等因素造成的氣傷；狹義的是指機械性致傷因素作用于機體所造成的組織結(jié)構(gòu)完整性破壞或功能障礙。臨床多見的是機械性致傷因素作用于機體所致的損傷，如工傷事故、交通事故等導致的卻軟組織破損、出血、臟器破裂、骨折、關節(jié)脫位等。創(chuàng)傷病人護理

Inthepast,thetermtraumahasbeenassociatedwiththewordaccident.Accident

meansthattheinjuryocurredwithoutintent,justaresultofrandomchance.Wenowknowthatconsiderablenumberofinjuriesarepreventableandnotofrandomchance.Intentionalandnonintentionaltraumaencompassesavarietyofinjuriesresultingfrommotorvehiclecrashes,pedestrianinjuries,gunshotwounds,falls,voilencetowardsothers,orself-inflictedviolence.

Theinjuries,disabilities,anddeathsresultingfromtheseactsconstituteamajorhealthcarechallenge.

創(chuàng)傷病人護理RoleofNurses

Traumausuallyoccurssuddenly,leavingthepatientandfamilywithlittletimetoprepareforitsconsequences.

Traumamayalterthepatient’spreviouswayoflife,potentiallyeffectingindependence,mobility,cognitivethinking,andappearance.

Nursesprovideavitallinkinboththephysicalandpsychosocialcarefortheinjuredpatientandfamily.Incaringforthepatientwhohasexperiencedtrauma,nursesmustconsidernotonlythe

initialphysicalinjury,butalsoitslong-termconsequences,includingrehabilitation.創(chuàng)傷病人護理由于創(chuàng)傷往往是突然發(fā)生的，患者和家屬沒有足夠時間來應對創(chuàng)傷帶來的各種不良后果。而護士對于患者及家屬身體的、心理社會的安撫照料發(fā)揮著重大作用。護士在護理創(chuàng)傷患者過程中不僅要考慮其最初的身體傷害，還要擬定后期康復等長遠護理計劃，因為創(chuàng)傷對于患者的影響可能不單涉及到生活方式的改變，還可能潛在地影響其獨立性，生活活動能力，認知能力以及外表形象。

創(chuàng)傷病人護理TypesofTrauma

Generally,traumacanbeclassifiedas:

minortraumamajortrauma創(chuàng)傷病人護理Minortrauma—causesinjurytoasinglepartorsystemofthebodyandisusuallytreatedinaphysician’sofficeorinthehospitalemergencydepartment.eg.afractureoftheclavicle,asmallsecond-degreeburn,andalaceration（撕裂傷）requiringsutures(縫合)

創(chuàng)傷病人護理MajororMultipletrauma—involvesserioussingle-systeminjury(suchasthetraumaticamputation截肢ofaleg)ormultiple-systeminjuries.創(chuàng)傷病人護理Specifically,traumaisfurtherclassifiedaseither

bluntorpenetrating創(chuàng)傷病人護理BlunttraumaBlunttrauma—occurswhenthereisnocommunicationbetweenthedamagedtissuesandtheoutsideenvironment.Bluntforcesoftencausemultipleinjuriesthatmayaffectthehead,spinalcord,bones,thorax(胸腔)，andabdomen.Blunttraumaisfrequentlycausedbymotorvehiclecrashes,falls,assaults,andsportsactivities.創(chuàng)傷病人護理BlunttraumaItincludes:contusion(挫傷)sprain（扭傷）crushinjury（擠壓傷）concussion（震蕩傷）luxationandsemiluxation（關節(jié)脫位和半脫位）closedfracture（閉合性骨折）closedinternalinjury（閉合性內(nèi)臟損傷）

創(chuàng)傷病人護理Penetratingtrauma

Penetratingtrauma—occurswhen

aforeignobjectentersthebody,causingdamagetobodystructures.Structurescommonlyaffectedincludethebrain,lungs,heart,liver,spleen,theintestines,andthevascularsystem.Examplesofpenetratingtraumaare

gunshotorstabwounds(刺傷),impalement（穿刺）,andincisedinjury(切割傷).創(chuàng)傷病人護理OthertypesOthertypes：inhalationinjuriesfromgases,smoke,

steam,burnor

freezinginjuries

blastinjuries

fromexplosions創(chuàng)傷病人護理

ClassesofTrauma

Outcomestudiesshowacorrelationbetweensurvivalratesofmultipletraumavictimsandrapidresposetimesbypre-hospitalproviders,coupledwithappropriatedecisionmakingwithregardstotransportingvictims.

大量有關創(chuàng)傷的結(jié)局研究顯示，多發(fā)傷患者的存活率與院前急救者的快速反應及采取正確急救措施相關。創(chuàng)傷病人護理ClassesofTrauma

TraumapatientsareclassifiedasClass1,2or3basedonfactors,including：mechanismofinjuries,vehiclespeed,heightoffalls,locationofpenetratinginjuries.創(chuàng)傷病人護理Class3trauma

—theleastsevere,withoutlossofconsciousnessorsignificantinjury.Class1trauma

—themostsevere,involveslife-threateninginjurieslikelytorequiremedicalspecialistsorimmediatesurgicalintervention.SowhatisClass2trauma?創(chuàng)傷病人護理AnyhospitalemergencydepartmentshouldbecapableofcaringforClass3traumapatients,patientsmeetingClass1or2shouldbetransportedtoadesignatedtraumacenterwhenpossible.創(chuàng)傷病人護理【病理生理】（一）局部反應損傷后，局部血管通透性增加、血漿成分外滲，白細胞等趨化因子迅速集聚于傷處以吞噬和清除致病菌或異物，出現(xiàn)疼痛、發(fā)熱表現(xiàn)，其病理過程與一般炎癥相同，一般3～5日后逐漸消退。（二）全身反應損傷可引起神經(jīng)內(nèi)分泌活動增強，組織功能和代謝發(fā)生應激性改變。1、發(fā)熱：損傷釋放炎性介質(zhì)和細胞因子作用于下丘腦體溫調(diào)節(jié)中樞引起機體發(fā)熱。

創(chuàng)傷病人護理【病理生理】2、神經(jīng)內(nèi)分泌系統(tǒng)反應：疼痛、血容量不足，下丘腦-垂體-腎上腺皮質(zhì)軸、交感神經(jīng)—腎上腺髓質(zhì)軸分泌大量兒茶酚胺，以及腎素-血管緊張素—醛固酮系統(tǒng)被激活，代償性保證回心血量。3、代謝反應：基礎代謝率增高，分解代謝增強導致負氮平衡；表現(xiàn)體重下降，疲乏無力、反應遲鈍。水電解質(zhì)代謝紊亂，可致水鈉潴留。4、機體免疫力下降：嚴重損傷可致機體免疫防御能力下降（中性粒細胞、單核-巨噬細胞吞噬和殺菌能力減弱，淋巴細胞數(shù)量減少、功能降低等），易發(fā)生感染。創(chuàng)傷病人護理【病理生理】（三）損傷的修復１、修復的基本方式：

完全修復：即缺損組織完全由原來性質(zhì)的組織細胞修。（愈后結(jié)構(gòu)功能與原組織相同）

不完全修復：是由成纖維細胞增生替代代替原來的組織，而形成瘢痕愈合。

創(chuàng)傷病人護理２、損傷的修復過程（三階段）：

（1）炎性反應階段：約3～5天。主要為血管和細胞反應、免疫應答、血液凝固和纖維蛋白溶解，傷口由血凝塊充填；而后，血漿纖維蛋白沉積構(gòu)成網(wǎng)架，封閉創(chuàng)口，為組織再生和修復奠定基礎。

（2）肉芽形成階段：成纖維細胞、內(nèi)皮細胞等經(jīng)增殖、分化、遷移，形成肉芽組織充填傷口，形成瘢痕愈合。

（3）組織塑形階段：膠原纖維交聯(lián)和強度的增加，多余的膠原纖維被降解和吸收，過度豐富的毛細血管網(wǎng)逐步消退，傷口黏蛋白和水分減少，傷部外觀和功能得到改善。

創(chuàng)傷病人護理３、損傷的愈合類型

（1）一期愈合：又稱原發(fā)愈合。傷口修復以原來的細胞為主，僅含少量纖維組織，傷口邊緣整齊、嚴密、呈線狀，組織結(jié)構(gòu)和功能修復良好。見于創(chuàng)傷輕、范圍小、無感染的傷口。

（2）二期愈合：又稱瘢痕愈合。傷口修復以纖維組織為主，需周圍上皮逐漸覆蓋或植皮后才能愈合。局部結(jié)構(gòu)和功能有不同程度的影響，多見于組織缺損較大、感染或異物存留的傷口。創(chuàng)傷病人護理4、影響損傷愈合的因素（1）局部因素：①細菌感染；②創(chuàng)口內(nèi)異物；③血運障礙；④特殊部位（如關節(jié)處）（2）全身性因素：①年齡（老年人）；②慢性疾?。喝缣悄虿?、結(jié)核、腫瘤等；③營養(yǎng)狀況：營養(yǎng)不良或肥胖；④藥物：抑制細胞增生藥(如皮質(zhì)類固醇)；⑤免疫功能低下。創(chuàng)傷病人護理ClinicalManifestationSymptom:

painfeverSystemicInflammatoryResponseSyndrome(SIRS)

創(chuàng)傷病人護理【臨床表現(xiàn)】（一）癥狀：

1、疼痛：

2、發(fā)熱：

3、全身炎癥反應綜合征(SIRS)：表現(xiàn)：①體溫>38OC或<36OC；②心率>90次／分鐘；③呼吸>20次／分鐘或過度通氣，PaC02<4.3kPa(32mmHg)；④血白細胞計數(shù)>12X109／L或<4X109／L或未成熟細胞>0.1％。

4、其他：可伴有食欲減退、倦怠和失眠等創(chuàng)傷病人護理ClinicalManifestationSigns:

P↑、R↑、BP↓woundandhemorrhage

tenderness(壓痛)andswelldysfunction

創(chuàng)傷病人護理【臨床表現(xiàn)】（二）體征1、生命體征改變(P↑、R↑、BP↓）2、創(chuàng)口和出血3、壓痛和腫脹

4、活動或功能障礙↓

↓

↓

創(chuàng)傷病人護理【輔助檢查】（一）實驗室檢查

1、血常規(guī)和紅細胞比容（失血、感染）。

2、尿常規(guī)、尿淀粉酶檢查（泌尿系和胰腺的損傷）。

3、血生化檢查：腎功能檢查—腎損傷；淀粉酶檢查—胰腺損傷；血電解質(zhì)檢測和血氣分析。創(chuàng)傷病人護理【輔助檢查】（二）影像學檢查

1、X線透視或攝片：可證實有無骨折、脫位、金屬異物存留和胸、腹腔內(nèi)游離氣體。

2、CT和MRI：主要用于顱腦損傷的檢查。MRI對脊髓、顱底、骨盆底部等處損傷的診斷具優(yōu)越性。

3、B超檢查：實質(zhì)性器官損傷和腔內(nèi)積液。

創(chuàng)傷病人護理【輔助檢查】（三）診斷性穿刺：內(nèi)臟器官破裂、出血。（四）置管灌洗檢查：診斷性穿刺不能明確診斷，可穿刺后置導管灌洗，抽取灌洗液作檢查（如腹腔灌洗）。（五）監(jiān)測中心靜脈壓可判斷血容量和心功能。創(chuàng)傷病人護理EffectsofTraumaticInjury

創(chuàng)傷后效應和結(jié)果創(chuàng)傷病人護理Deathisacommonresultofserioustraumaticinjury,andmaybeimmediate,early,orlate.Immediate.Becauseoftheseriousconsequencesoftrauma,itisimportanttorapidlyidentifythepatient’sinjuriesandinstituteappropriateinterventionsquickly.創(chuàng)傷病人護理HeadandNeckEffectsThoracicEffects

Hemorrhage

AbdominalEffectsNeurologicEffects

MultipleOrganDysfunctionSyndromes(MODS)創(chuàng)傷病人護理HeadandNeckEffects

創(chuàng)傷病人護理HeadandNeckEffects

—AirwayObstruction

Maintenanceoftheairwayandcervicalspine（頸椎）

arethehighestpriorityinthetraumapatient.

HeadandNeckEffects

創(chuàng)傷病人護理Assessment

Assessment

includes：①determiningairwaypatency.

②reassesstheeffectivenessoftheintervention.

③assesstheeffectivenessofbreathing.

HeadandNeckEffects

創(chuàng)傷病人護理DeterminingairwaypatencyIfthepatientisunresponsive,manualopeningoftheairwayusinga

jawthrustmaneuver（托下頜法)isnecessary

ThejawthrustmaneuverisrecommendedinpatientswithactualandpotentialC-spineinjury.

HeadandNeckEffects

創(chuàng)傷病人護理DeterminingairwaypatencyOncetheairwayisopened,thepractitionermustidentifyanypotentialobstructionfromthetongue,

looseteeth,foreignbodies,bleeding,secretions,vomitus,oredema.

Ifthepatientisresponsiveandcanvocalize,thatisagoodindicationthattheairwayisclear.

HeadandNeckEffects

創(chuàng)傷病人護理ReassesstheeffectivenessoftheinterventionForexample,ifyousuction(吸，抽吸)theairwaytoremovevomitus,youwouldreassesstheairwayaftersuctioningtodetermineifthatinterventionwassuccessfulorifyouhavetore-suctiontheairwayasecondtime.HeadandNeckEffects

創(chuàng)傷病人護理ReassesstheeffectivenessoftheinterventionInadditiontosuctioning,otherairwayadjunctsavailableinclude

oralornasalpharyngeal(鼻咽部)airways,

laryngeal（喉部）airway

and

endotrachealintubation(氣管內(nèi)插管).

Intubationisthepreferredmethodofairwaymanagement.創(chuàng)傷病人護理Assesstheeffectivenessofbreathing

Assessmentshouldincludeifthepatienthasspontaneousbreathing（自主呼吸）,goodriseandfallofthechest,determinationofskincolor,generalrateanddepthofrespirations,abdominaloraccessorymuscleuse,positionofthetrachea（氣管）,observationofchestwall（胸壁）integrity，presenceofjugularveindistension(頸靜脈怒張)

aswellasthepresenceofanysurfacetrauma.創(chuàng)傷病人護理Traumapatientsmayexhibitseveralaspectsofairwaymanagementthatareuniqueandrequirespecialpreparationandprecautions.

Let’sdiscusstogether.HeadandNeckEffects

創(chuàng)傷病人護理Closedheadinjury

Changesinhemodynamics,oxygenation,andventilationshouldbeminimizedinordertomaintainadequatecerebralperfusionpressure(腦灌注壓).ThegoalistomaintainaPaCO2of30-35mmHg.

HeadandNeckEffects

創(chuàng)傷病人護理ClosedheadinjuryButintubationcancauseamarkedincreasein

intracranialpressure(ICP,顱內(nèi)壓),andalsolidocaineadministered3-5minutespriortointubationcanblunt（使減弱）anincreaseinICPthatissecondarytolaryngealstimulation（喉部刺激）.Betablockers（普萘洛爾、阿替洛爾）

canbegiven2-3minutespriortointubationtoattenuatethe

sympathetic(交感神經(jīng)的)response

inanormotensivepatient.HeadandNeckEffects

創(chuàng)傷病人護理Maxillofacialtrauma

頜面部創(chuàng)傷

Significantdistortionofnormalanatomyinfacialtraumaandrespiratorycompromise(呼吸道損害)isnotuncommon.Asurgicalairway

maybetheonlyalternative.HeadandNeckEffects

創(chuàng)傷病人護理Directairwaytrauma

Penetratingtraumatotheneckisassociatedwithahighdegreeofmorbidityandmortality.

Airwayinvolvementincludesdyspnea,cyanosis,subcutaneousemphysema,hoarseness.HeadandNeckEffects

dyspnea[disp‘ni:?]呼吸困難，cyanosis[,sai?’n?usis]發(fā)紺，emphysema[,emfi‘si:m?]皮下氣腫，hoarseness嘶啞創(chuàng)傷病人護理DirectairwaytraumaOrotrachealintubationisthetechniqueofchoice.Thekeyisearlyidentificationoftheneedforintubationbeforethepatienthasnoairwayatall.HeadandNeckEffects

Orotracheal[?r?tr?t?i:l

]intubation口腔氣管插管創(chuàng)傷病人護理Cervicalspineinjury

Approximately3%-6%ofmajortraumavictimshaveclinicallysignificantC-spineinjuries.Oralintubationwithmanualin-lineaxialheadandneckstabilization(MIAS，頭頸部的軸向固定)isasafemethod.

HeadandNeckEffects

Cervicalspine頸椎，

axial[‘?ks??l]軸向的

創(chuàng)傷病人護理Burns

Burnpatientswithairwaycompromiserequire

aggressivemanagement(緊急處理).

Upperairwayedemaassociatedwithinhalationcanprogressduringthepostburnphase.So

securinganairway

soonerthanlateristhegoal.HeadandNeckEffects

吸入性燒傷患者需要緊急處理。燒傷后期上呼吸道水腫導致呼吸不暢會越來越重，因此應盡早采取措施保護氣道。創(chuàng)傷病人護理ThoracicEffects

Thoracic[θ??‘r?s?k]胸的創(chuàng)傷病人護理Tensionpneumothorax

Apneumothoraxresultswhenairentersthepotentialspacebetweentheparietalandvisceralpleura.Airpresentinthepleuralspacewilleventuallycollapsethelungs.Atensionpneumothorax

islife-threateningandrequiresimmediateintervention.ThoracicEffects

pneumothorax[,nju:m?‘θ?:r?ks]高壓性氣胸，張力性氣胸，parietal[p?’raiit?l]腔壁的，visceral[‘vis?r?l]內(nèi)臟的，pleura[’plur?]胸膜，thorax

[‘θ??r?ks]胸廓，胸膛創(chuàng)傷病人護理TensionpneumothoraxOninspirationairentersthepleuralspace（胸膜腔）,doesnotescapeonexpiration,andincreasestheintrapleural(胸膜內(nèi)的)pressure.

Thispressurecollapsestheinjuredlung,shiftsthemediastinalcontents，compressingtheheart,greatvessels,tracheaandeventuallytheuninjuredlung.Inturn,thiscausesthefollowingsignsandsymptoms:Severerespiratorydistress;Hypotension;Jugularveindistension;Trachealdeviation(氣管偏移)towardtheuninjuredside;Cyanosis.ThoracicEffects

mediastinal[,mi:di?s'tin?l]縱隔的,trachea(氣管),Cyanosis[,sai?'n?usis](發(fā)紺).創(chuàng)傷病人護理TensionpneumothoraxTheimmediateshort-termlife-savinginterventionisaneedlethoracostomy:insertingalargeboreovertheneedlecatheterintothesecondintercostalspace（第二肋間）

atthemid-clavicular（鎖骨的)line(MCL,鎖骨中線).ThoracicEffects

needlethoracostomy[,θ?:r?‘k?st?mi,,θ?u-](胸腔穿刺造口術)，intercostal(肋間的)

創(chuàng)傷病人護理Flailchest連枷胸

Flailchest

isthefractureoftowormoreribsintwoormoreseparatelocations,leadingtoanunstablethoracicwall（胸壁）

segment.

Paradoxicalmovement（反常運動）

ofthechestwallisseenwiththeareasinkingintothechestcavity(胸腔)withinspirationandprotrusion（突出）withexpiration.Theareamustbesupportedquicklytore-establishthethoracicbellowseffect.（塌陷區(qū)域需要修復以重建胸廓的呼吸運動）ThoracicEffects

protrusion[pr?‘tru??n]突出創(chuàng)傷病人護理Hemorrhage

Hemorrhage[‘hem?r?d?]出血

創(chuàng)傷病人護理Hemorrhage

Whenthepatienthassufferedaninjurythatcausesexternalhemorrhage,suchassevering(切割，分離)ofanartery,thebleedingmustbecontrolledimmediately.Thismaybedonebyapplyingdirectpressureoverthewound

and

applyingpressureoverarterialpressurepoints.Oncethesourceofinternalhemorrhagehasbeenrecognized,interventionsareinitiated,including

operativecontrolofbleedingandcontinualassessmentofthepatient.Hemorrhagemayresultinhypovolemicshock(低血容量性休克).

Hemorrhage

創(chuàng)傷病人護理HemorrhageInternalhemorrhage

mayresultfromeitherbluntorpenetratingtraumaticinjury.Discoveringthecause

and

location

oftheinjury,aswellastheextentofrelatedbloodloss,arethemostimportantconcerns.Hemorrhage

創(chuàng)傷病人護理HemorrhageSeveralpotentialspacesinthebodycanaccommodatelargeamountsofbloodthatmayaccumulate(calledthirdspacing)followinginjury.Forexample,bleedingintothepleuralspacemayoccurwithchesttrauma(hemothorax,血胸)，andbleedingintotheabdominalcavitymayoccurwithabdominaltrauma.Apelvic

fracturemaycausemassivehemorrhageintheretroperitonealregion.Hemorrhage

pelvic[‘pelvik]骨盆的，retroperitoneal['retr?u,perit?'ni:?l]腹膜后的創(chuàng)傷病人護理AbdominalEffects

創(chuàng)傷病人護理AbdominalEffectsTheabdomencontainsboth

solidorgans

(liver,spleen,andpancreas)andholloworgans

(stomachandintestines):

Directtraumatotheabdomencanlacerate(撕碎)andcompressthesolidorgansandcause

burstinjuriestotheholloworgans.Bloodvesselsmaybetornandorgansmaybedisplacedfromtheirbloodsupply,producing

life-threateninghemorrhage.

AbdominalEffects

創(chuàng)傷病人護理AbdominalEffectsDamagetothemesentericvessels(腸系膜血管)supplyingthebowelcanresultinbowelischemiaandinfarction(梗塞).Injurytothestomach,pancreas,andsmallbowelmayallowdigestiveenzymes

toleakoutintotheabdominalcavity.Ruptureofthelargebowelresultsinescapeoffeces,whichcauses

peritonitis.AbdominalEffects

mesenteric[,mes?n‘terik]腸系膜，infarction[in’fɑ:k??n]梗塞，enzymes[‘enzaims]酶abdominalcavity腹腔，Rupture破裂，使破裂，peritonitis[,perit?'naitis]腹膜炎創(chuàng)傷病人護理NeurologicEffects創(chuàng)傷病人護理NeurologicEffects

Injuriestothespinalcord(脊髓)，resultinginlossof

neurologicfunction,aredevastatingoutcomesoftrauma,buttheyaremuchlesscommonthanheadinjuries.

Careofthepatientwithaneurologicinjuryisdiscussedinlaterunit.AbdominalEffects

創(chuàng)傷病人護理MultipleOrganDysfunctionSyndromes

(MODS)

創(chuàng)傷病人護理MODSMultipleorgandysfunctionsyndrome(MODS)isacommoncomplicationofsevereinjuryandafrequentcauseofdeathinintensiveunits.Itisaprogressiveimpairmentoftwoormoreorgansystems.

MultipleOrganDysfunctionSyndromes(MODS)

創(chuàng)傷病人護理MODSThisistheresultofanuncontrolledinflammatoryresponsetosevereinjuryorillness.PatientsatriskforMODSarethosewithadisturbanceinhomeostasisresultingfromoneoracombinationofthefollowingconditions:

infectioninjuryinflammationischemiaimmuneresponseintoxicationofsubstancesiatrogenic(醫(yī)源性的)factors.

MultipleOrganDysfunctionSyndromes(MODS)

homeostasis[,h?umi?u‘steisis]平衡，內(nèi)穩(wěn)態(tài)，iatrogenic[ai,?tr?u'd?enik]醫(yī)源性的創(chuàng)傷病人護理MODSTheprimarysystemsinvolvedinMODSaretherespiratory,renal,hepatic,hematologic,cardiovascular,gastrointestinal,andneurological.

Supportivetherapydependsontheidentificationofcorrectablecauses.Itmaybeoneoracombinationofseveraltherapies.Surgicalintervention,antibioticadministration,corticosteroidadministration（糖皮質(zhì)激素的使用）,orcorrectioncoagulopathies(糾正凝血障礙)aresometherapiesusedforthiscondition.MODSfollowinginjuriesproducesmorethanhalfofthelatemortalityfollowingtrauma.MultipleOrganDysfunctionSyndromes(MODS)

Hematologic血液學的，antibiotic[,?ntibai‘?tik]抗生素，corticosteroid[,k?:tik?u’stε?r?id]糖皮質(zhì)激素coagulopathy[k?u,?ɡju'l?p?θi]凝血障礙創(chuàng)傷病人護理InterdisciplinaryCare

Pre-hospitalCare

EmergencyDepartmentCareMedications

EmergencySurgery

創(chuàng)傷病人護理Pre-hospitalCare創(chuàng)傷病人護理Pre-hospitalCareThemajorfunctionsofpre-hospitalcareinclude：

injuryidentificationcriticalinterventionrapidtransport.創(chuàng)傷病人護理Injuryidentification創(chuàng)傷病人護理Injuryidentification

Emergencycareofthepatientexperiencingtraumaisbasedonrapidassessmenttoidentifyinjuriesandbegin

appropriateinterventions.Pre-hospitalCare創(chuàng)傷病人護理InjuryidentificationInjuriesthatindicatetheneedfortraumacentercareincludethefollowing:

◆Penetratinginjuriestotheabdomen,pelvis,chest,neckorhead◆Spinalcordinjurieswithdeficit◆Crushing(粉碎性的)injuriestotheabdomen,chestorhead◆Majorburns◆InjuriesleadingtoairwaycompromiseorobstructionPre-hospitalCare創(chuàng)傷病人護理InjuryidentificationManymethodshelphealthcareprovidersdeterminetheseriousnessofthepatient’sinjuriesandthepotentialforsurvival.ScoringsystemssuchastheChampionRevisedTraumaScoringSystemcanbehelpful(Table1).

Aprimarytraumaassessmentfollowsanalphabetmnemonic:Pre-hospitalCare創(chuàng)傷病人護理Injuryidentification

◆Aisairwayassessment

(withC-spineimmobilization頸椎制動)todetermineiftheairwayispatent(通暢的),maintainable（可維持的）,ornonmaintainable.◆Bisbreathingevaluationforspontaneousrespirations(自主呼吸)orventilatoryimpedance（通氣阻力）suchasbyribfracturesoracollapsedlung.◆Ciscirculatoryassessment

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