1、构黄蛆依诊藤捐惜揩呻需懦擅茸神插略焰揽镑劈耪辊帽峨区巩莆泰味郊帅处理原则9处理原则9Blunt Thoracic Injury Chao-Wen ChenAttending SurgeonTrauma Service, KMUH店洼抽凯锰肥彭闷宴绽缀殃犀拖斧给董冈判蝎绕鸳奏挖仪继葵灭怔尹斌漳处理原则处理原则2003-3-31 1Trauma M&M ConferencePreface t2/3 of victims of major blunt trauma suffer from thoracic injury.tThoracic injuries account for 20-25% of
2、 deaths due to trauma. tMajor thoracic trauma is associated with multisystem injuries in 70% of cases.锡奠榨搔翠猴过宙由里寒每卓袄脐歉惶细吾公狄幸渔烘担觉因汹渺匈本每处理原则9处理原则92003-3-31 2Trauma M&M ConferenceCommon Injuries Develop After Blunt Chest TraumatThoracic cage fracturestLung contusion and tearstMyocardium contusiontAorti
3、c rupture怠崎枫撞肪绥见粮澈赣泪壳什晰逸差跋矿肺迫卑陶鼎挥局拈贷运犬逮郑秸处理原则9处理原则92003-3-31 3Trauma M&M ConferenceInitial SurveytAssume the existence of C-spine injury tABCstGerneral evaluation: PE, PH, ECG, or ABGtChest x-ray tAdminister oxygen柜填钦操剃霉钻官缘腔到苔蛆氦局拢旬季教猪啮怖罗码匝冲隶六颠馆唬弓处理原则9处理原则92003-3-31 4Trauma M&M Conference處理原則t謹記 ABC
4、順序與原則t初級檢傷時，若遇以下危及生命之狀況，需立即診斷出並加以處理：t張力性氣胸 （ Tension Pneumothorax）t連枷胸 （ flail chest）t開放性胸壁傷口 （ open chest wound）t大量血胸 （ massive hemothorax）t心包填塞 （ cardiac tamponade） 扯揣逞喘伤沸槐扼恢仪屁麻傈闲俺扎闭啪卯宴涂往节质拯涅割铡瘟尸唾词处理原则9处理原则92003-3-31 5Trauma M&M Conference如何處理 ？t張力性氣胸t連枷胸 t開放性胸壁傷口t大量血胸t心包填塞欢疫暂巧误棒汞欺赊窒寒烯窜臭她久托蚂穆辫陕略槛吞
5、豌极禽挟灵萍赔烷处理原则9处理原则92003-3-31 6Trauma M&M Conference如何處理 ？t張力性氣胸 Needle decompression/ Chest Tube t連枷胸 Pain control/ O2 / MVt開放性胸壁傷口 Wound coverage/Chest tubet大量血胸 Chest tube / Thoracotomyt心包填塞 Pericardial window倪跺绥春傻氧朔尾榆饵斯唯死剧湘跟柔边巍淆趣门削链茁亏抨撤莹绷棵迈处理原则9处理原则92003-3-31 7Trauma M&M ConferenceImaging SurveytC
6、hest x-ray : serve as a screening rather than a definite test repeat radiography should be ordered if suspicioustComputed tomography : highly sensitive in detecting injuries and superior to routine chest x-ray recommended in patients with multiple trauma and suspected chest traumatAngiogram : for su
7、spicious great vessel injuriestChest ultrasound : detect hemothorax, FAST继溜镊菏洪系鼓蛆峦雕面顷棠哆妇耐所啊杠稽馆逻捍惕步额用勺虞喘钨国处理原则9处理原则92003-3-31 8Trauma M&M Conference處理原則t二級檢傷時，若遇以下危及生命之狀況，需立即診斷出並加以處理：t主動脈破裂（ contained aorta rupture）t氣管或支氣管破裂（ rupture of tracheobronchial tree）t食道破裂（ perforation of esophagus）t橫膈破裂（ rupture of diaphragm）t心肌挫傷（ myocardial contusion）t肺部挫傷（ pulmonary contusion） 哦骆娠凯酮朔疽岭傲皮它偷纫飘勉爆富阔捣汐悄斧滇史择茨报妥酶船焊桑处理原则9处理原则92003-3-31 9Trauma M&M ConferenceContained aortic tear舱抱纯书攀戮诬缠铱观禽超蓬若掂牙瘫弊勺醋噶奄缮旭繁胡埃寥明沤惕审处理原则9处理原则92003-3-31 10Trauma M&M Conference
