严重创伤病人的麻醉.pptVIP

严重创伤病人的麻醉;几个概念;Why should we learn trauma anesthesia?;In 1993, approximately 90,000 individuals in the U.S died of accidental injuries , for a rate of 34.9 deaths per 100, 000 population, the second lowest accidental death rate on record;In the same year there were an estimated 18,200,000 disabling accidental injuries, or about 2,080 injuries every hour, and the 90,000 accidental deaths amounted to 1 every 6 minutes---and these numbers excluded the rising level of intentional injuries caused by attempted or successful suicides and homicides; ;Potential roles of the anesthesiologist in this area;Pain relief physician Prohospital care physician Critical care transport physician or director Disaster planning consultant;病情评估;病情评估;Scoring system;ASA分级;GCS（Glasgow coma score);Eye opening;Verbal reponses;Motor response;创伤机制;2021/3/12;严重创伤病人的病情特点;严重创伤病人的麻醉处理特点;术前准备;原则;程序（sequence of management of trauma patients);Primary survey(ascertain “ABCDEs”) Breathing (give supplemental oxygen) Determine whether ventilation is adequate Inspect chest to exclude open pneumothorax Auscultate for bilateral breath sounds Provide assisted ventilation for ventilatory failure Circulation (establish venous access) Check peripheral pulses, capillary refill, and blood pressure Obtain electrocardiogram Grade shock according to vital signs Correct hypovolemia and obtain blood samples;Primary survey(ascertain “ABCDEs”) Disability (determine neurologic status) Evaluate central function A: alert V: responds to vocal stimulus P: responds to painful stimulus U: unresponsive Evaluate pupil response to light Expose patient for complete examination Resuscitation phase Secondary survey Definitive care phase;气管插管术; 插管时应注意以下问题 ;2021/3/12;插管时应注意以下问题;插管时应注意以下问题;插管时应注意以下问题;休克复苏——液体通道;休克复苏——液体通道;休克复苏——液体选择;休克复苏——液体选择;休克复苏——液体选择;休克复苏——液体选择;复苏初始，麻醉医师的输液方案建立在对病人生命体征正确判断的基础上 失血量≤30%，输入3倍的晶体量 失血量30%或出血继续，应输胶体和血，另外再加1～3倍的晶体液（根据临床表现和监测判断），这部分病人同时需要纯氧通气以增加氧向组织中的释放，直至血红蛋白恢复 失血量≥40%，立即输入浓缩红细胞，再加胶体和晶体液 初期复苏完成后，应结合监测