Chapter19TraumainPregnancyTraumainPregnancy

孕婦創(chuàng)傷

Overview概要Dualgoalsinmanagingpregnanttrauma需要處理兩個或以上的病人Physiologicalchangesofpregnancy孕婦生理改變Responsetohypovolemia對血溶積減少的反響Typesofinjuriesmostcommonlyassociated常見傷勢Initialassessmentandmanagement初步檢查及處理Traumapreventioninpregnancy預(yù)防孕婦創(chuàng)傷3TraumainPregnancy-TraumainPregnancy孕婦創(chuàng)傷Uniquechallenges挑戰(zhàn)Vulnerabilityofpregnanttraumapatient 孕婦于創(chuàng)傷時之弱點Potentialinjuriestounbornchild

對胎兒的傷害Dualroles雙重角色Providecaretomother照顧母體Providecaretofetus 照顧胎兒4TraumainPregnancy-TraumainPregnancyLeadingcauseofmorbidityandmortality為孕婦發(fā)病率及死亡率的主要原因6–7%ofpregnanciesexperiencesometrauma6-7%孕婦曾遇上創(chuàng)創(chuàng)1in12injuredexperiencesignificanttrauma1-2%遭遇嚴(yán)重創(chuàng)傷Majorcauses主要原因Motor-vehiclecollisions交通意外Falls高處墮下Abuseanddomesticviolence虐待及家庭暴力Penetratinginjuries穿刺性創(chuàng)傷Burns燒傷5TraumainPregnancy-PregnantPatientIncreasedriskfortrauma創(chuàng)傷的風(fēng)險增加Faintingspells,hyperventilation,excessfatiguecommonlyassociatedwithearlypregnancy

孕婦初期較易頭暈,呼吸過速,易疲倦Balanceandcoordinationaffectedbychangesthroughoutpregnancy

懷孕過程可影響其平衡力及身體協(xié)調(diào)6TraumainPregnancy-FetalDevelopment7TraumainPregnancy-ViabilityAssessment8TraumainPregnancy-陰道出血肚臍恥骨聯(lián)合流產(chǎn)可被見PhysiologicChanges9TraumainPregnancy-腸蠕動血色素心輸出量血量血壓心率血含二氧化碳量PhysiologicChanges

孕婦生理的改變10TraumainPregnancy-VitalSignsinPregnancy

孕婦生命表征的改變Donotmistakenormalvitalsignsforsignsofshock.切勿把正常的生命表征當(dāng)作休克Normalpulse:10–15beatsfaster正常脈搏:快10-15次Bloodpressure:10–15mmHglower血壓:低10=15mmHg30–35%bloodlossbeforesignificantbloodpressurechange失血量達30-35%才出現(xiàn)休克Bealerttoallsignsofshock.注意出現(xiàn)休克征狀FrequentITLSOngoingExams反復(fù)ITLS〞復(fù)檢〞撿查11TraumainPregnancy-ResponsetoHypovolemia

血溶積減少的反響12TraumainPregnancy-TraumainPregnancyITLSPrimaryandSecondarySurveys初步檢查及進一步檢查OptimizematernalandfetaloutcomeHigh-flowoxygenrapidlyadministered盡快給予高濃度氧Fetalhypoxiaoccursbeforematernalhypoxia胎兒會比母體早缺氧Fluidadministrationmustbeprompt必需正確輸液Fluidvolumeneededisgreater輸液量較多FrequentOngoingExams反復(fù)ITLS〞復(fù)檢〞撿查Mortalityoffetusrelatedtomaternaltreatment胎兒死亡率與母體處理有關(guān)13TraumainPregnancy-SupineHypotension仰臥血壓低Venousreturndecreases30%insupinepositionwith20-weekorlargeruterus.下腔靜脈于仰臥時受壓引致心臟血液回流受阻,通常20周以后出現(xiàn)Acutehypotension急性血壓低Syncope昏厥Fetalbradycardia胎兒心跳過慢14TraumainPregnancy-SupineHypotension15TraumainPregnancy-SupineHypotensionTransportpositionBetterstabilized

withvacuumbackboardMorecomfortable

thanstandardbackboard固定于真空脊板較比一般脊板舒適16TraumainPregnancy-EvaluationofUterineSize17TraumainPregnancy-18Relativelyminorabdominaltrauma

cancausefetaldeath.Maternaldeathismostcommoncauseoffetaldeath.

胎兒死亡的原因最主要是母體死亡TraumainPregnancy-PregnantTraumaArrest

孕婦創(chuàng)傷性心跳停上Treatedsameasforothervictims急救法與普通傷者相同Defibrillationsettingsaresame相同去顫法電量Drugdosagesaresame相同藥物劑量Fluidvolumeneededincreases需要較大量靜脈輸液4litersnormalsalinerapidinfusionduringtransport

送院時輸液4公升Ifmotherunsalvageable:如孕婦不能挽救ContinueCPR繼續(xù)

CPRNotifyhospitalofpossiblecesareansection

通知院方:準(zhǔn)備接生/剖腹接生19TraumainPregnancy-TypesofTrauma創(chuàng)傷種類Motor-vehiclecollisions交通意外Penetratinginjuries穿刺性創(chuàng)傷

Domesticviolence家庭暴力Falls高處墮下Burns燒傷20TraumainPregnancy-Motor-VehicleCollisions撞車21TraumainPregnancy-Motor-VehicleCollisionsMaternaldeath母體死亡HeadinjuryMostcommon頭部受傷為最常見Uncontrolledhemorrhage不能制止的內(nèi)出血Secondmostcommon

第二常見Assesspelvis檢查盆骨

Fetalinjury胎兒受傷22TraumainPregnancy-AbdominalTrauma腹部創(chuàng)傷23TraumainPregnancy-PenetratingInjuries

穿透性創(chuàng)傷24TraumainPregnancy-DomesticViolence

家庭暴力10%experienceabuseduringpregnancy10%孕婦曾于懐孕期受虐待Proximalandmidlineinjuries近端及中線部位受傷Faceandneckmostcommon

面部及頸為最常見

Lowbirthweight出生體重較輕Abusedbyspouseorboyfriend:70–85%(U.S被配偶或男友虐待:70-85%25TraumainPregnancy-Falls高處墮下Injuryfromfalls高處墮下受傷Increasewithprogressionofpregnancy受傷時機隨著懷孕期增加Centerofgravityaltered中心改變Proportionatetoforceandbodypartimpacted與受力及身體撞擊點有直接關(guān)系Pelvicinjuries盆骨受傷Placentalseparation胎盆別離Fetalfractures胎兒骨折26TraumainPregnancy-Burns燒傷FluidvolumeneededincreasesMortalityandmorbidity死亡率及發(fā)生率Maternalmortalitysameasnon-pregnant死亡率與非孕婦相同F(xiàn)etalmortalityincreaseswith>20%BSA燒傷面積>20%會増加胎兒死亡時機27TraumainPregnancy-TraumaPrevention預(yù)防28TraumainPregnancy-Summary總結(jié)TraumainPregnancy孕婦創(chuàng)傷Knowledgeofphysiologicalchanges生理上的改變Hypotensionandhemorrhageeasilyoverlooked血壓低及出血容易被無視Rapidevaluationan