頭頸部外傷 與 脊椎外傷 - taccn.org.t · 1 頭頸部外傷 與 脊椎外傷 陽大附醫...
Transcript of 頭頸部外傷 與 脊椎外傷 - taccn.org.t · 1 頭頸部外傷 與 脊椎外傷 陽大附醫...
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TACCN & FAST TNTP
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e-mail:
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Head 4
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Head 5
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Head 6
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Vintracranial vault=Vbrain+Vblood +VCSF
http://images.google.com.hk/imgres?imgurl=http://www.geocities.com/drweightloss/neurosurgery/monrokellie.jpg&imgrefurl=http://www.geocities.com/drweightloss/neurosurgery/neurosurgery.html&h=478&w=650&sz=105&tbnid=ObTwXgbySvoJ:&tbnh=99&tbnw=135&start=2&prev=/images%3Fq%3Dmonro%2Bdoctrine%26hl%3Dzh-TW%26lr%3D%26sa%3DN
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Head 8
50160 mmHg
PaO2PaCO2
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GCS score
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(Glasgow coma scale)
G.C.S. 13-15 80%
G.C.S. 9-12 10%
G.C.S. 3-8 10%
15-24 y/o
77%
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. . . . .
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EDH
SDH
ICH
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Head 15
(CSF)
(CSF/hemotympanum)
1. (Air in sulci)
2. (Air and fluid/levels in
sinuses)
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Head 16
(periorbital ecchymoses)
Battles sign (retroauricular)
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Skull Bone Fracture
http://www.business-presentations.co.uk/images/skulfrac.jpg
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concussion
(Diffuse Axon Injury)
(diffuse brain injury)
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Head 22
(Lucid interval)
0.5%()
CT
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Head 24
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Head 25
SDH
30%()
5mm
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Head 26
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SDH
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Head 28
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Head 29
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Head 30
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Contusion hemorrhage
Mottled
Speckled
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20-30%
1224
CT
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Pneumoencephalus ()
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Traumatic SAH & IVH
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Head 39
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Glasgow Coma Scale
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GCS 14-15
3%CT
CT
CT
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Canadian CT Head Rules
1. High Risk (for neurological intervention) GCS < 15 at two hours after injury. Suspected open or depressed skull
fracture. Any sign of basal skull fracture. Vomiting 2 or more episodes. Age > 65. 2. Medium Risk (for brain injury on CT) Amnesia before impact > 30 minutes Dangerous Mechanism.
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Head CT Indications from
Other Studies 1. Drug or alcohol or
inappropriate mental status*
2. Physical findings of trauma above clavicle
3. Seizure
4. Coagulopathy.
5. Focal neurologic deficit
6. Graze wound from high velocity missile
7. Any vomiting*
8. Persistent deficit of short-term memory
9. Persistent anterograde amnesia
10. GCS 60 (by ACEP)
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GCS 9-13
10-20%
CT
12-24CT
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GCS 3-8
ABCDEs
CT(CT)
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Mannitol
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1g/Kgrepeat! (? CC )
Lasix
Anti-convulsants
Barbiturate
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(Ringers lactate or normal saline)
PaCO2 35 mmHg
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ICP
: 20 mmHg
: > 40 mmHg
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9. Cushing
10.
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1CT
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1 mannitolglycerol
2dormicum atracurin
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PaCO2:30~35mmHg,
PaO2100mmHg
3Valsalva maneuvers
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436~37
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30
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1.GCS
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5.
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Head 58
(SOP)
1ICU! 2 3on Foley, NG (or OG) 4 5!
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1/2
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Head 60
2/2
(?)
30
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GCS =3
(oculocephalic, corneal, Dolls eyes and no gag reflex)
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Head 62
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Head 63
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Head 64
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Head 65
(I)
CT
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(II)
,
CPP> 70mmHg
(MAP 80 mmHg, SBP:140~160mmHg)
PaCO2 30mmHg
CT
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Neck Collar
!
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Head 70
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Head 71
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Head 72
X-ray , CT , MRI
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Head 74
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Head 75
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Head 76
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,
(Bradycardia)
(Warm extremities)
atropine (?)
Vasopressors ( Dopamine ! )
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l- Halo-Vest
l8 Methylprednisolone 30mg/kg 24 5.4mg/kg/hr
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86
!! !!
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Question
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TACCN & FAST TNTP
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Thanks!
TACCN & FAST TNTP