1、International Trauma Life Supportfor Prehospital Care ProvidersSixth Edition Patricia M.Hicks,MS,NREMTPRoy Alson,PhD,MD,FACEPDonna Hastings,EMT-PJohn Emory Campbell,MD,FACEPand Alabama Chapter,American College of Emergency PhysiciansCampbell,International Trauma Life Support,6th Ed.2008 Pearson Educ
2、ation,Inc.,Upper Saddle River,NJChapter 17Trauma in ChildrenCampbell,International Trauma Life Support,6th Ed.2008 Pearson Education,Inc.,Upper Saddle River,NJTrauma in ChildrenTrauma in Children儿童创伤儿童创伤急救3OverviewEffective techniques to gain confidence有效增加信心的技巧Injuries based on mechanisms of injury
3、受伤机理ITLS Primary and Secondary Surveys初步及进一步检查 Consent and the need for immediate transport家长同意及需实时运送Pediatric equipment needs适合儿童之器材Various methods of SMR on child儿童脊椎固定方法EMS involvement in prevention programs参与预防意外计划儿童创伤急救4Trauma in ChildrenDifferent from adults与成人不同 Different patterns of injuries
4、不同伤势模式 Different responses to those injuries不同反应 Special equipment required需要特别器材 Assessment equipment and treatment equipment检查及冶疗用的器材 Difficult to assess and communicate 较难评估及沟通 Come with caregivers and other family members 与家人或照顾者同行儿童创伤急救5Communicating沟通Family-centered care is critical.以家庭为中心 Car
5、egiver not always parent.照顾者未必是父母 Involve caregivers as much as possible in care.尽量让照顾者参与 Give explanations and careful instructions.必需详加解释及指示 Inclusion and respect will improve stabilization.包容及尊重可稳定伤者 Keep caregivers in physical and verbal contact.与照顾者保持接触Demonstrate competence and compassion.儿童创伤
6、急救6Assessing Mental Status捡查精神状态Consoled or distracted可按抚或转注意力 Most sensitive indicator of adequate perfusion 能准确反映组织灌注是否足够 Caregivers best at detecting subtle changes 照顾者会较易分辩出伤者微小改变儿童创伤急救Assessing Mental StatusInitial level of consciousness最初清醒程度 Preschool child:sleeping vs.unconscious 幼儿:疲倦vs人事不醒
7、 Most will not sleep through arrival of ambulance大部份沿途不会睡觉 Ask caregivers to wake child着照顾者弄醒伤者 Suspect hypoxia,shock,head trauma,seizure 怀疑缺氧、休克、头部受伤、癫痫7Trauma in Children-儿童创伤急救8CommunicatingInteraction strategies使用适龄的语言Appropriate language for developmental level合适的语言 Speak simply,slowly,clearly说
8、话要慢及简溸 Be gentle and firm必需肯定 Avoid“no”questions避免说”不”Get a favorite belonging 利用其喜爱的玩具/随身物品 Get on childs level 降下身段至与伤者视线平衡 Explain SMR necessity 解释脊椎固定之需要 Allow caregiver to accompany child 让照顾者与伤者同行儿童创伤急救9Caregiver Consent照顾者”同意”Critical care shouldnotbe delayed.切勿延医冶理Emergency care needed如需进行急救
9、 Consent not available未能取得”同意”Transport before permission,document why,notify medical direction记录,速送医院,通知医五 Consent denied不同意 Try to persuade,document actions,obtain signature 尝试说服、记录、签署 Notify law enforcement and appropriate authorities 行使有关法例 Report suspected abuse 如怀疑儿童受虐待,通知警方儿童创伤急救10Pediatric E
10、quipment儿科器材Length-based tape身长尺 Weight estimate大约体重 Fluid and medication doses precalculated 输液及药物剂量 Common equipment size estimates 常用器材尺码Photo courtesy of Kyee Han,MD儿童创伤急救11Mechanisms of Injury受伤机理Falls高处下堕 Usually land on head通常头先着地 Serious head injury unusual from 27 inches严重头部受伤并不常见于身长27吋 Pro
11、tective gear保护装备MVCs交通意外 Seat-belt syndrome安全带综合症 Liver,spleen,intestines,lumbar spine 肝、脾、小肠、腰椎Auto-pedestrian crashes路人被撞儿童创伤急救12Mechanisms of InjuryBurns烧伤Airway obstruction气道受阻 Foreign body异物Child abuse虐待儿童 Suspect if history does not match injury 受伤经过与伤势不吻合 Story keeps changing经常改变说法儿童创伤急救13Air
12、way in Children儿童气道Signs of obstruction呼吸受阻征状 Apnea无呼吸 Stridor吸气时有喘鸣声“Gurgling”respiration有杂声的呼吸Contribute to obstruction诱因 Hyperextension过度舒张 Hyperflexion过度屈曲Courtesy of Bob Page,NREMT-P儿童创伤急救14Airway in ChildrenOpening airway张开气道 Tongue is large;tissue soft舌大,组织软 Jaw-thrust下颔上提法 Oropharyngeal airw
13、ay口咽气道 Nasopharyngeal airways鼻咽气道 Too small to work predictably 因鼻孔太少未必有效 Neonate obligate nose breather 新生婴儿用鼻孔呼吸 Clear nose with bulb syringe用球状泵吸走分泌儿童创伤急救15Breathing in Children儿童呼吸Work of breathing呼吸方法 Retractions,flaring,grunting 肋间收缩、鼻翼扩张、咕噜声 Persistent grunting requires ventilatio n持续咕噜声需要施行助
14、呼吸Respiratory rate呼吸次数 Fast,then periods of apnea or very slow 先后短暂停止或转慢Minor blunt neck trauma can be critical.轻微头部挫伤可引起严重伤势16儿童创伤急救20,15,10Ventilation Rate换气次数10 per minute for adolescent10 per minute for adolescent如为中童如为中童,10,10次次/分钟分钟 20 per minue for 1 year20 per minue for 1 year如如 11 year15 pe
15、r minute for 1 year如如 1 1岁岁,15,15次次/分钟分钟17儿童创伤急救Breathing Management呼吸处理Effective BVM ventilationEffective BVM ventilation有效有效BVMBVM换气换气intubation is elective.intubation is elective.可考虑插喉可考虑插喉儿童创伤急救18Endotracheal Intubation 气管内导管Oral endotracheal intubation从口腔插入 No blind nasotracheal intubation for
16、130 usually shock in all ages except neonates脉搏130多为休克,新生婴儿除外 Prolonged capillary refill and cool extremities微血管回流时闭迟及肢体冰冷 Level of consciousness清醒程度 Circulation can be poor even if child is awake 血循环衰竭的儿童仍可完全清醒 Low blood pressure is sign of late shock.血压低是休克的后期征状 BP 80 mmHg in child;70 mmHg in youn
17、g infant儿童创伤急救21Shock in ChildrenStrong compensatory mechanisms生理的补尝机制较强 Appear surprisingly good in early shock 早期休克可有效发挥“Crash”when deteriorate但情况会急转直下 Be prepared必需有心理准备 Fluid administration 20 mL/kg in each bolus输液补充每次20 mL/kg Consider intraosseous infusion骨髓输液法 Frequent Ongoing Exams持续检查 儿童创伤急救
18、22Pediatric Trauma Center 儿童创伤中心Criteria条件 Obstructed airway气道阻塞 Need for airway intervention处理气道 Respiratory distress呼吸困难 Shock休克 Altered mental status意识紊乱 Dilated pupil曈孔扩大 Glasgow Coma Scale score 13 Pediatric Trauma Score 10 feet高处堕下 Motor-vehicle collision MVC with fatalities车祸中有人死亡 Ejection fr
19、om an automobile in a MVC 车祸中弹离车厢 In MVC,significant intrusion into compartment 车祸中受困于车厢中 Hit by a car as a pedestrian or bicyclist行人被撞 Fractures in more than one extremity多边一条肢体骨抑 Significant injury to more than one organ system多过一个器官受伤儿童创伤急救24Pediatric Trauma CenterRecommended建议送院 Burns烧伤 Near-dro
20、wning遇溺 Head injuries with loss of consciousness 人事不醒的头部受伤Notify hospital as early as possible.尽早知会医院儿童创伤急救25Life-Threatening Injuries 危害生命伤势Head injury头部受伤 Most common cause of death最常见死亡原因 Level of consciousness change best indicator 清醒程度之改变为最有效的征状 Pupil assessment important检查瞳孔儿童创伤急救Life-Threaten
21、ing Injuries High-flow oxygen高浓度氧气 Hyperventilate only with cerebral herniation syndrome 加快换气只适用于出现脑疝征状 Fluid administration titrated to systolic BP 控制输液速度至可维持基本收缩压 Preschool child:80 mmHg;older child:90 mmHg 幼儿:80 mmHg,小童:90 mmHg Be prepared to prevent aspiration 预防气道吸入异物26Trauma in Children-儿童创伤急救
22、27Life-Threatening InjuriesChest injury胸部创伤 Respiratory distress common最常见的征状为呼吸困难 Pneumothorax or tension pneumothorax气胸或张力性气胸 Difficult to assess较难分别 Needle thoracostomy can be life-saving剌胸膜腔穿刺 Pulmonary contusion胸部挫伤 Rare injuries较少发生伤势 Rib fractures,flail chest,aortic rupture,pericardial tampon
23、ade 肋骨折、槤架胸、主动脉撕裂、心胞膜填塞儿童创伤急救28Life-Threatening InjuriesAbdominal injury腹部创创 Liver and/or spleen rupture肝、脾撕裂 Second leading cause of traumatic death 伤第二致死伤势 Bleeding often contained within organ 出血通常局限于器官之内 Difficult to diagnose难以诊断 Severe injury with minimal signs 严重伤势可只有轻微征状 Suspect with any abno
24、rmal abdominal assessment 若有任何异常腹部征状当作严重伤势处理 Be prepared to prevent aspiration.预防气道吸入异物儿童创伤急救29Life-Threatening InjuriesSpinal injury脊椎创伤 Uncommon before adolescence青少年以下较少发生 9 years usually lower cervical-spine injuries头椎下受伤 Higher incidence of SCIWORAspinal-cord injury without radiographic abnorma
25、lity 可无X-光片异常儿童创伤急救Life-Threatening Injuries SMR脊椎固定脊椎固定 Pad under torsoPad under torsofor neutral position 于天然屈曲位下放置较垫 May have to secure without cervical collar 可不使用颈圈固定颈椎 Do not restrict chest movement 切勿紧束胸部30Trauma in Children-31儿童创伤急救Child Restraint Seats儿童汽车安全椅Child in car seat Serious injury
26、严重受伤 Remove from car seat 移离安全椅 Apply SMR脊椎固定 No apparent injury无明显严重受伤 Secure and transport in car seat稳固后原椅运走儿童创伤急救32Child Neglect and Abuse 疏忽照顾及虐待A leading cause of death in U.S.Be alert to signs注意征状 Transport if suspected 如有怀疑,送院冶理 Know local laws 行使法例儿童创伤急救33Summary总结Good trauma care for children有效儿童创伤处理 Proper equipment良好装备 Interact with frightened caregivers与受惊照顾者沟通 Know normal vital signs for various ages认识不同年龄的生命表征正常读数 Reference chart Be familiar with common injuries in children熟悉常见儿童创伤伤势 Be active in prevention programs积极参与预防意外计划34儿童创伤急救Discussion
