星期五, 12月 29, 2006
星期四, 12月 28, 2006
星期三, 12月 27, 2006
星期二, 12月 26, 2006
星期一, 12月 25, 2006
星期日, 12月 24, 2006
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星期四, 12月 21, 2006
星期三, 12月 20, 2006
星期二, 12月 19, 2006
星期一, 12月 18, 2006
星期四, 12月 14, 2006
星期三, 12月 13, 2006
星期二, 12月 12, 2006
外傷後造成胎兒死亡的原因
第一名: maternal death
第二名: abruptio placentae
胎盤早期剝離的發生率
1-5 % of minor injuries VS. 40-50% of major injuries
胎盤早期剝離的典型症狀: painful vaginal bleeding in the 3rd trimester
1) abdominal pain
2) vaginal bleeding
3) tetanic uterine contractions
第二名: abruptio placentae
胎盤早期剝離的發生率
1-5 % of minor injuries VS. 40-50% of major injuries
胎盤早期剝離的典型症狀: painful vaginal bleeding in the 3rd trimester
1) abdominal pain
2) vaginal bleeding
3) tetanic uterine contractions
懷孕時為何不宜將靜脈導管放置在鼠蹊部及下肢?
Placement of intravenous lines in the groin and lower extremity should be avoided if possible
because of inferior vena cava compression by the uterus
and
to avoid pooling in engorged or injured pelvic veins.
because of inferior vena cava compression by the uterus
and
to avoid pooling in engorged or injured pelvic veins.
何謂 supine hypotension syndrome?
發生在懷孕第 18~20 週
因為日漸擴大的子宮在躺臥時 supine position 壓迫下腔靜脈 inferior vena cava 進而造成回心靜脈血量 venous return 以及心輸出量 cardia output 下降，進而造成低血壓 hypotension
因此，在進行搬運超過 20 週的懷孕婦女時，應注意保持左傾 30 度，或直接將子宮推向左側，
使用 PAST (pneumatic anti-shock trousers) 時，勿將 abdominal compartment 充氣
因為日漸擴大的子宮在躺臥時 supine position 壓迫下腔靜脈 inferior vena cava 進而造成回心靜脈血量 venous return 以及心輸出量 cardia output 下降，進而造成低血壓 hypotension
因此，在進行搬運超過 20 週的懷孕婦女時，應注意保持左傾 30 度，或直接將子宮推向左側，
使用 PAST (pneumatic anti-shock trousers) 時，勿將 abdominal compartment 充氣
NHTSA 建議孕婦繫安全帶的方法
lap belt:
as low as possible under the gravid uterus
across both the anterior superior iliac spines and symphysis pubis
shoulder harness:
snugly between the breasts
off to the side of the uterus
as low as possible under the gravid uterus
across both the anterior superior iliac spines and symphysis pubis
shoulder harness:
snugly between the breasts
off to the side of the uterus
Shock and Fluid Resuscitation
| from The Merck Manual Medical Library: Professional Edition Critical Care Medicine: Shock and Fluid Resuscitation: If the above link does not work properly, please copy and paste the following URL to the address bar in your web browser window. |
neurogenic shock
-- The presence of shock in a pt with a head injury necessitates a search for another cause of shock. (Isolated intracranial injuries do not cause shock)
-- mechanism: loss of sympathetic tone
shock without tachycardia
shock without cutaneous vasoconstriction
shock without a narrowed pulse pressure
-- management: initially same as hypovolemia
Failure to restore organ perfusion with fluid resuscitation suggests
either continuing hemorrhage or neurogenic shock.
(CVP monitoring may be helpful in managing this sometimes complex problem.)
-- mechanism: loss of sympathetic tone
shock without tachycardia
shock without cutaneous vasoconstriction
shock without a narrowed pulse pressure
-- management: initially same as hypovolemia
Failure to restore organ perfusion with fluid resuscitation suggests
either continuing hemorrhage or neurogenic shock.
(CVP monitoring may be helpful in managing this sometimes complex problem.)
tension pneumothorax
-- a true surgical emergency (without waiting for x-ray confirmation)
-- mechanism: one-way valve → ↑ intrapleural pressure → lung collapse →
mediastinal shift → venous return ↓ → cardiac output ↓
-- S/S: hypotension associated with
absent breath sound, tracheal shift, jugular vein engorgement, hypoxia
-- needle thoracostomy:
2nd intercostal space at midclavicular line or
5th intercostal space at midaxillary line
-- mechanism: one-way valve → ↑ intrapleural pressure → lung collapse →
mediastinal shift → venous return ↓ → cardiac output ↓
-- S/S: hypotension associated with
absent breath sound, tracheal shift, jugular vein engorgement, hypoxia
-- needle thoracostomy:
2nd intercostal space at midclavicular line or
5th intercostal space at midaxillary line
cardiac tamponade 和 tension pneumothorax 有何共通之處？
Ans: 都需要戳一針 (one for pericardial sac; one for pleural space)
星期三, 12月 06, 2006
星期一, 12月 04, 2006
星期五, 12月 01, 2006
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