医学孕妇创伤急救

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1、Chapter19TraumainPregnancyTraumainPregnancy孕妇创伤Overview概要Dualgoalsinmanagingpregnanttrauma需要处理两个或以上的病人Physiologicalchangesofpregnancy孕妇生理改变Responsetohypovolemia对血溶积减少的反应Typesofinjuriesmostcommonlyassociated常见伤势Initialassessmentandmanagement初步检查及处理Traumapre

2、ventioninpregnancy预防孕妇创伤3TraumainPregnancy-TraumainPregnancy孕妇创伤Uniquechallenges挑战Vulnerabilityofpregnanttraumapatient孕妇于创伤时之弱点Potentialinjuriestounbornchild对胎儿的伤害Dualroles双重角色Providecaretomother照顾母体Providecaretofetus照顾胎儿4TraumainPregnancy-TraumainPregnanc

3、yLeadingcauseofmorbidityandmortality为孕妇发病率及死亡率的主要原因6–7%ofpregnanciesexperiencesometrauma6-7%孕妇曾遇上创创1in12injuredexperiencesignificanttrauma1-2%遭遇严重创伤Majorcauses主要原因Motor-vehiclecollisions交通意外Falls高处堕下Abuseanddomesticviolence虐待及家庭暴力Penetratinginjuries穿刺性创伤Bu

4、rns烧伤5TraumainPregnancy-PregnantPatientIncreasedriskfortrauma创伤的风险增加Faintingspells,hyperventilation,excessfatiguecommonlyassociatedwithearlypregnancy孕妇初期较易头晕,呼吸过速,易疲倦Balanceandcoordinationaffectedbychangesthroughoutpregnancy怀孕过程可影响其平衡力及身体协调6TraumainPregnan

5、cy-FetalDevelopment7TraumainPregnancy-ViabilityAssessment8TraumainPregnancy-阴道出血肚脐耻骨联合流产可被见宫高PhysiologicChanges9TraumainPregnancy-肠蠕动血色素心输出量血量血压心率血含二氧化碳量PhysiologicChanges孕妇生理的改变Respiratorysystem呼吸系统Diaphragmelevatedduetouterinesize日渐长大的子宫令横隔膜上升Decreasedth

6、oracicvolume肺容量下降Relativealkalosis血液相对为碱性Predisposedtohyperventilation较易出现呼吸过速10TraumainPregnancy-VitalSignsinPregnancy孕妇生命表征的改变Donotmistakenormalvitalsignsforsignsofshock.切勿把正常的生命表征当作休克Normalpulse:10–15beatsfaster正常脉搏:快10-15次Bloodpressure:10–15mmHglower血压

7、:低10=15mmHg30–35%bloodlossbeforesignificantbloodpressurechange失血量达30-35%才出现休克Bealerttoallsignsofshock.注意出现休克征状FrequentITLSOngoingExams反复ITLS”复检”捡查11TraumainPregnancy-ResponsetoHypovolemia血溶积减少的反应Vasoconstrictionandtachycardia血管收缩及心跳过速Reductionofuterinebloo

8、dflowby20–30%子宫血流量减少20-30%Fetalheartrateandbloodflowdecreases胎儿心跳速率及血流量下降Fetusbecomeshypoxemic胎儿出现血氧过低High-flowoxygenisessential.给予高浓度的氧气Maternalshockhas80%fetalmortalityrate孕妇出现休克,胎儿死亡率可达80%12TraumainPregnan