重症颅脑损伤指南——日本资料.ppt

Guidelines for the management of Severe Head Injury,2nd edition 2014级急诊专业研究生 周生虎 Content 1、introduction 2、Recommended grade 3、Pre-hospital care 4、Imitial treatment to protect the brain 5、ICU management 1、introduction In 2000, the first guidelines were published Revised the Guidelines 7 times between 2003 and 2005 Target patients Closed head injuries in adults with a Glasgow Coma Scale（GCS）score of 8 or less after resuscitation GCS score after resuscitation is 9 or above but deteriorate to 8 or less after admission due to secondary brain damage Multiple head injuries and head injuries complicated by spinal cord injury were excluded from this edition 2、Recommended grade 1，…is desirable 2，…is often（performed） 3，…can be（performed） 4，…may be（performed） 5，… is undesirable 6，…may be regarded as a contraindication 3、Pre-hospital care The objective of pre-hospital care is to minimize secondary brain damage Securing the airway Correction of hypoxia Correction of hypotension Protection of the neck First aid for additional injuries Table 1 Japan Coma Scale (JCS)scores Table 2 Glasgow Coma Scale (GCS) scores easdale,Jennett; Lancet, 1974) 4-1 Initial Examination and Treatment of Injuries Primary assessment and resuscitation to secure stability of the general condition are as follows： 1.It is desirable to resuscitate immediately when abnormal physiologic parameters is detected 2.Resuscitation is often performed in the order of airway, respiration,and circulation 3.It is desirable to secure the airway by endotracheal intubation when GCS score is 8 or less,while protect the cervical spine 4.It is desirable to maintain sufficient oxygenation and ventilation 5.It is desirable to start treatment immediately if a life-threatening thoracic injury is detected 6.It is desirable to promptly perform chest and pelvic radiography and abdominal ultrasonography if there is abnormal respiration or circulation 7.If there are symptoms of shock, it is desirable to give initially rapid 1–2