创伤病人的术前评估

Breathing & Ventilation
C
Circulation & Hemorrhage Control
D
Disability & Neurological Function
E
Fra Baidu bibliotek
Exposure & Environment
Airway: LEMON law
L
Look externally
E
Evaluation(3-3-2 rule)
lethal triad of hypothermia Coagulopathy
acidosis
Anesthesia Management
Preparation
1. Drugs a. Anesthetics, Narcotics, Muscle relaxants b. Vasoactive agents c. Others：Fluid, Blood product, etc.
3. 进一步评估和处理
a. 实验室检查 b. 咨询
创伤病人的病情评估
快速复习病史
初步检查（Primary survey） 进一步检查（Secondary survey ）
时间就是生命：黄金1小时，白金10分钟
RAPID OVERVIEW
Review the history, Laboratory tests & Radiologic Examination
M
Mallampatti Score
O
Obstruction
N
Neck mobility
LEMON - Look
Evaluate the pt.
Obesity（肥胖） Micrognathia（小颌症），High arched palate（高腭穹） Presence of facial hair（大胡子） Dentures（假牙，或缺齿） Large teeth（门齿过长）, Prominent Upper Incisors Large tongue（巨舌症） Short or thick neck（脖子粗短） Neck trauma（颈部外伤，包括放疗） Big breast
创伤缩短预期寿命
40
30
20 36
10 16 12
0 Trauma
Cancer
Cardio vascular
Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003
治疗费用增加
400
300
200 334
100
0 Trauma
创伤病人的术前评估
Trauma
年龄< 45岁人群的首要死亡原因 目前位居第四位的死亡原因，预计到2020年，将成为第二位的
死亡原因
2001年美国有145000人死于创伤，位于心脏（700000）, 恶 性肿瘤（554000），脑血管病变（164000）之后
使人类的预期寿命缩短，致残率增加 造成严重的社会－经济问题
PRIMARY SURVEY
( Evaluation and Concurrent Resuscitation ) 1. Airway with spine control 2. Breathing & Ventilation 3. Circulation & Hemorrhage control ( Fluid Therapy) 4. Disability ( Neurologic Function Evaluation ) 5. Exposure & Environment
2. Equipments a. Airway management b. Hemodynamics ( PAC, CCO, SVV & TEE ) c. Rapid Infusion System d. Heat Preservation
Monitoring
1. ECG, SpO2, Non invasive or Invasive Bp, EtCO2 2. Hemodynamics ( PAC, CCO, SVV & TEE ) 3. Body Temperature 4. Urine Output 5. Laboratory Tests
面、下颔或颈部创伤 鼻咽、鼻窦、口腔或上呼吸道出血 颅脑损伤、中毒或镇痛药导致意识障碍 胃内容物或异物误吸
LEMON – Neck Mobility
Neck Mobility
trauma collar rheumatoid arthritis degenerative arthritis history of surgery
Grade 2
No difficulty
Grade 3
Moderate difficulty
Grade 4
Severe difficulty
LEMON - Obstruction
presence of any condition that could cause an obstructed airway
88 Cancer
51 Cardio vascular
Claire Merrick et. al. Prehospital Trauma Life Support, Mosby, 2003
创伤病人的处理程序
1. 挽救生命
a. 判断危及病人生命的损伤 b. 正确的复苏措施
2. 维持病人的生命体征
a. 详细的体格检查 b. 持续的复苏
LEMON – Evaluate 3-3-2
Evaluate 3-3-2
Evaluate the anatomy
颏颈间距 > 3指 下颌骨长度 > 3指 门齿间距 > 2指
LEMON – Mallampati score
Mallampati Score
Grade 1
No difficulty
a. ABG & Electrolyte, Hct ( Hb) b. Coagulation Function Test c. Blood Glucose, Lactate, etc
SICU
Primary survey: A-B-C-D-E
A
Airway & C-spine Protection
B