脊柱损伤的早期评估与急诊处理资料.ppt

1、 The fundamental tenet of trauma care is careful, comprehensive, and timely initial evaluation, in conjunction with decisive urgent preliminary treatment, before definitive management。The initial appraisal of spinal injuries carries particular importance because of the potential for catastrophic and

2、 permanent neurologic impairment.Many issues surrounding the initial care of the spine-injured patient are ethically unsuitable for testing in a randomized format.Spinal column and spinal cord injuries are typically associated with high-energy mechanisms, such as motor vehicle accidents and the inhe

3、rently risky pursuits of youth.A second peak is seen in older age, resulting from lower-energy injuries in persons prone to fragility fractures or those with a preexisting ankylosed spine.It is imperative that both the physician and the patient be aware that concomitant injuries may potentially dist

4、ract from the presence of a spinal injury. Closed head injuries and facial trauma should heighten clinical suspicion because they imply that the cervical spine was likely subjected to a great deal of force.the identification of a single spinal fracture should prompt the physician to rule out other s

5、pinal injuries: a recent evaluation of 492 patients with CT-identified cervicalspine injuries revealed noncontiguous spinal injuries in 19% of cases.The protection of the injured spine and spinal cord begins at the accident scene. In as many as 25% of patients, poor immobilization and improper handl

6、ing have been implicated in causing further neurologic injury after the initial accident。Current recommendations for patient immobilization during transport consist of a rigid cervical collar, lateral supports, and tape and body straps to secure the patient to a backboard to protect the entire spine

7、.The initial evaluation and resuscitation of the injured patient adheres to the Advanced Trauma Life Support protocols, with assessment of the airway (A), breathing (B), and circulation (C)A- airway and in-line immobilization.B BreathingC circulation and control bleedingD disabilityE exposure and en

8、vironmentManaging the airway is of paramount importance in trauma patients, and it must be done while maintaining the cervical spine in a stable position.Those who sustain a spinal cord injury at or above C3 frequently experience acute respiratory arrest at the scene, requiring urgent intubation and

9、 ventilation.While individuals with lower cervical spinal cord injury may still be able to breathe, impaired diaphragmatic and intercostal muscle function can lead to delayed but potentially rapid ventilatory failure.Anticipation is of key importance. If pulmonary function monitoring (eg, vital capacity, arterial blood gases) suggests that the patient is developing ventilatory failure, then preemptive intubation under controlled settings is preferable to waiting until the patient is in extremis.