国际创伤生命支持ITLS-02-伤势检查及处理Chapter2_Patient_assessment

Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJInternationalTraumaLifeSupportforPrehospitalCareProvidersSixthEditionPatriciaM.Hicks,MS,NREMTPRoyAlson,PhD,MD,FACEPDonnaHastings,EMT-PJohnEmoryCampbell,MD,FACEPandAlabamaChapter,AmericanCollegeofEmergencyPhysiciansChapter2AssessmentandInitialManagementoftheTraumaPatientCampbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJAssessmentandInitialManagementoftheTraumaPatient伤势检查及处理CourtesyofITLSOntarioCampbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJOverviewStepsofITLSPatientAssessment•ITLSPrimarySurvey初步检查•ITLSSecondarySurvey进一步检查•ITLSOngoingExam持续监察及检查InitialAssessmentrelatedto初步检查RapidTraumaSurveyorFocusedExam快速创伤检查/重点检查•InitialAssessmentinterruptions(暂停)Criticalconditionsandcriticalinterventions危急的伤势及处理2PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPatientAssessmentITLSPrimarySurvey初步检查•SceneSize-up现场处理•InitialAssessment初步检查•RapidTraumaSurveyorFocusedExam快速创伤检查/重点检查ITLSSecondarySurvey进一步检查ITLSOngoingExam持续监察及检查3PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyITLSPrimarySurvey初步检查•SceneSize-up现场处理•InitialAssessment初步检查•RapidTraumaSurveyorFocusedExam快速创伤检查/重点检查4PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJSceneSize-up现场处理5PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJSceneSize-up6PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJInitialAssessment7PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyInitialAssessment•Generalimpression伤者一般状况•Initiallevelofconsciousness清醒程度•Manualstabilizationofcervicalspine固定颈椎•ABCsPrioritizespatient优先处理•Determinesexistenceofimmediatelylife-threateningconditions如发现实时危害生命之伤势8PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyLessthan2minutes•InitialAssessmentandRapidTraumaSurvey快速创伤检查Delegateanyintervention.如以下情况出现Interruptsurveyonlyfor:,必需停止检查9PatientAssessment-Scenedanger现场环境不安全Airwayobstruction气道阻塞Cardiacarrest心跳停止Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyGeneralimpression评估伤者一般状况•Approximateage,sex,weight•Generalappearance外观•Positionofpatientbodyandsurroundings伤者及周围物品•Patientactivity•Obviousmajorinjuriesorbleeding明显伤势及出血Triagepatientsrapidly,ifnecessary.尽快分流伤者10PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyInitialLevelofConsciousness•Cervical-spinestabilizationAlertRespondstoVerbalstimuliRespondstoPainUnresponsive11PatientAssessment-固定颈椎Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyAirway:look,listen,feel气道:视、听、触•Direct:simplepositioningandsuctioningIfnotadequate,notquicklycorrectable如不畅通,亦无法短时间内解决•Interrupt:advancedairwaytechniques进行高级气道处理12PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyBreathing:look,listen,feel•Direct:high-flowoxygen如换气不足,给予高浓度氧气Ifnotadequate•Direct:assistedventilation辅助呼吸13PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJBreathingRates14PatientAssessment-NormalAbnormalAdult10–2010and24Child15–3015and35Infant25–5025and60Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJITLSPrimarySurveyCirculation:peripheralpulse血循环•Noperipheral,checkcarotid如无边周脉搏,检查颈动脉•Toofast,tooslow,quality太快,太慢,质量•Interrupt:cardiacarrestSkin皮肤•Color,temperature,condition颜色,温度,湿度Majorbleedingscan见血止血•Direct:bleedingcontrol15PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJMOIDecisionDangerousgeneralizedorunconsciousRapidTraumaSurvey快速创伤检查Dangerousfocused局部危急伤势•FocusedExam重点检伤Notsignificant初步检查正常InitialAssessmentnormal•FocusedExam重点检伤16PatientAssessment-明显危急伤者或人事不醒Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJPriorityPatientDangerousMOIHistory•Lossofconsciousness人事不醒•Difficultybreathing呼吸困难•Severepaininhead,neck,torso头,颈或上身十分痛楚High-riskgroup高危一族•Alteredmentalstatus神智不清•Difficultybreathing呼吸困难•Abnormalperfusion灌注不足•AbnormalInitialAssessment初步检查时发现异常17PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJRapidTraumaSurvey18PatientAssessment-Campbell,InternationalTraumaLifeSupport,6thEd.©2008PearsonEducation,Inc.,UpperSaddleRiver,NJRapidTraumaSurveyInspectHeadandNeck头及颈视诊MajorFacialInjuries,B