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【创伤外科】第1期（含ppt）。第2期ing：创伤首诊与处理（此处仅有翻译，精彩请见原帖） [精华]

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图片上的文字说明
The whole view of trauma bay 1
1号创伤室全景
the red line: everybody stands behind the red line except the trauma team doing assessment and the resuscitation.
红色警戒线：创伤组对患者做评估和复苏时，其他人员一律站在红色警戒线以外。
central line kits and pressure transfusion set up.
中心通路套装和输液加压器
FAST machine: with this machine, you can detect cardiac tamponade, any blood/fluid at right upper quadrant (liver laceration), left upper quadrant (spleen laceration), pelvis in 1 minute.
创伤专用超声机：有了这个机器，可以迅速判断是否有急性心包填塞，腹腔积液以及肾盂的损伤。
bare hugger: to warm cold patient, treat hypothermia.
裸抱机：温暖体温过低患者
IV fluids warmer: always resuscitate trauma patients with warm lactated Ringer's (LR)
静脉输液加温保温箱：常规用加温后的乳酸林格氏液进行复苏。
Portable X-ray machine:
便携式x线机
intubation kit:
气管插管套装
sterile gloves
无菌手套
triage nurse: she pages us when there is a trauma coming in.
分诊护士：创伤患者来了后由她来发出呼叫信号。
warmer to keep the warm blanket
毛毯加温保温箱
Computers for X-ray reading.
X线读片机
OR next door. all the operating rooms should be on the first floor, next to emergency room and trauma bay.
隔壁就是手术室：所有的手术室要求在一楼，紧邻急诊室和创伤室。

2007-01-19 16:13

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• 【规培笔记128】—工作报告偶遇，颅脑MR，您能看出几处异常？据说工作中很罕见！

tongdour

普外科

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认领问答部分(九)(3)至(十)(2)

(3)BO:
looks like he is not septic. major problems are
1. head injury which neurosureon should have some input. he probably can't protect his airway.

2. resp. failure. does he have ARDS? How long has he been on Vent. he failed extubation once already, and can't be wean off vent. you probably want to think about tracheostomy. interesting enough, it is easier to wean off after tracheostomy.

3. wound: looks like needs aggressive dressing change and debridement PRN.

4. Rehab is a big issue for him too.
看起来不像是脓毒症，主要的问题是：
1、脑部外伤，应该请神经外科医师会诊。可能没法很好地保护气道。
2、呼衰。病人是不是存在ARDS？他上呼吸机已经多久了？他曾经撤过呼吸机，但现在又无法撤机。你们应该考虑下做气管切开。很有意思，做了气管切开后反而更容易撤机。
3、外伤：看起来需要更好的包扎和随时清创。
4、机能恢复对他也是个大问题。
(4)BO:
i have too limited information to figure out why he is vent dependent. do you have CXR, CT of the chest, blood gas, ventilator setting in details, like what mode, rate, how much peep and pressure support? how's his phosphorous level?
我现在也说不上他为什么无法撤呼吸机。你们做了胸片、胸部CT、血气分析吗？呼吸机的设置参数具体如何？比如模式、频率、PEEP用了多大？血磷水平？
－－－－－－－－－－－－－－－－－（十）－－－－－－－－－－－－－－－－－－－－－
(1)BO：
even before patient's arrival, we have emergent blood release, type O packed RBC, at least 4 units ready at trauma bay. if the patient needs blood, he will get it in 0 seconds since it is already there. we treat patients first, no money issue is involved at that time. all the blood was donated by volunteers and collected by Red Cross. our blood bank gets blood from Red Cross.
在病人到达以前，我们在创伤急救室就已经准备好了急救血液，是O型血的浓缩RBC，至少4个单位。如果病人需要用血，会立刻得到输血。我们处理病人是放在第一位的，这不涉及到钱的问题。我们这所有的血都是志愿者捐献的，并由红十字会负责采集。我们的血库从红十字会取血。
(2)BO：
damage control surgery was orignally advocated by trauma surgeons since trauma patients sometimes are very unstable and more time in the OR will just make the patient worse, like the lethal triads i discussed before in a post about damage control surgery. this idea has been adopted by my general surgeons for other situation. for severe trauma injury, as you mentioned, damage control works quite well. we do it almost every day. we always have some trauma patients with an open abdomen in the ICU, waiting for wash-out, second look, completion of the surgery....

i have some disussion about damage control in "trauma case #1" too which was a gun shot wound to the abd, IVC injury.

Damage control surgery is an idea. because pt is not stable enough for you to complete the surgery in one stage, we need minimize OR time as short as possible to avoid lethal triads (hypothermia, acidosis, coagulopathy) and we can come back to finish the operation.

i recommended some books before in the past discussions.
损伤控制性手术最初由创伤外科医师所倡导，因为有时候创伤病人生命体征非常不稳定，在手术室待的时间越长病人的状况反而越差，正像我在以前关于损伤控制手术的贴子里提到的致命三联征。这种意见也被我们普外科医师所接受并用于其他情况。对于严重创伤，正如你提到的，损伤控制性手术效果非常好。我们几乎每天都这样处理。我们在ICU总有一些开放性腹部外伤的病人等着冲洗创口、二期手术继续处理。
我在“创伤病例1”的讲座中将会有一位腹部*击伤伴下腔静脉损伤的病人会讨论到损伤控制性手术。
损伤控制性手术是一种观念。因为病人病情非常不稳，你没法一期完成手术，我们需要尽量缩短在手术室处理的时间以避免致命三联征(低体温、酸中毒、凝血障碍)，而且我们可以再次进行二期手术。
我在以前的贴子中曾经推荐过几本书。

2007-01-20 12:58