1、Chapter 17Trauma in Children,第一页，共三十五页。,Trauma in Children,Trauma in Children儿童创伤,第二页，共三十五页。,Overview,Effective techniques to gain confidence有效增加信心的技巧Injuries based on mechanisms of injury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 e
2、quipment 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参与预防意外方案,3,Trauma in Children-,第三页，共三十五页。,Trauma in Children,Different from adults与成人不同Different patterns of injuries不同伤势模式Different responses to those injuries不同反响Special equipment required需要特别器材 Asses
3、sment 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,4,Trauma in Children-,第四页，共三十五页。,Communicating沟通,Family-centered care is critical.以家庭为中心Caregiver not always parent.照顾者未必是父母Involve caregivers as much as
4、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.,5,Trauma in Children-,第五页，共三十五页。,Assessing Mental Status捡查精神状态,Console
5、d 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,6,Trauma in Children-,第六页，共三十五页。,Assessing Mental Status,Initial level of consciousness最初清醒程度Preschool child:sleeping vs.unconscious 幼儿:疲倦vs人事不醒Most will not
6、 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 疑心缺氧、休克、头部受伤、癫痫,7,Trauma in Children-,第七页，共三十五页。,Communicating,Interaction strategies使用适龄的语言Appropriate language for developmental level适宜的语言Speak simply,slowly,clearly说话要慢及简溸Be
7、gentle and firm必需肯定Avoid“no questions防止说不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,8,Trauma in Children-,第八页，共三十五页。,Caregiver Consent照顾者同意,Critical care shouldnotbe delayed.切勿延医冶理Emergency care ne
8、eded如需进行急救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 如疑心儿童受虐待,通知警方,9,Trauma in Chi
9、ldren-,第九页，共三十五页。,Pediatric Equipment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,10,Trauma in Children-,Photo courtesy of Kyee Han,MD,第十页，共三十五页。,Mechanisms of Injury受伤机理,Falls高处下堕Usually land on head通常头先着地Serious
10、head injury unusual from 27 inches严重头部受伤并不常见于身长27吋Protective gear保护装备MVCs交通意外Seat-belt syndrome平安带综合症Liver,spleen,intestines,lumbar spine 肝、脾、小肠、腰椎Auto-pedestrian crashes路人被撞,11,Trauma in Children-,第十一页，共三十五页。,Mechanisms of Injury,Burns烧伤Airway obstruction气道受阻Foreign body异物Child abuse虐待儿童Suspect if
11、history does not match injury 受伤经过与伤势不吻合Story keeps changing经常改变说法,12,Trauma in Children-,第十二页，共三十五页。,Airway 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,13,Trauma in Children-,Courtesy of Bob
12、 Page,NREMT-P,第十三页，共三十五页。,Airway in Children,Opening airway张开气道Tongue is large;tissue soft舌大,组织软Jaw-thrust下颔上提法Oropharyngeal airway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,14,Trauma in Children-,
13、第十四页，共三十五页。,Breathing 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,15,Trauma in Children-
14、,第十五页，共三十五页。,20,15,10,Ventilation Rate换气次数,16,Trauma in Children-,10 per minute for adolescent如为中童,10次/分钟,20 per minue for 1 year如 1岁,20次/分钟,15 per minute for 1 year如 1岁,15次/分钟,第十六页，共三十五页。,Breathing Management呼吸处理,17,Effective BVM ventilation有效BVM换气intubation is elective.可考虑插喉,Trauma in Children-,第十
15、七页，共三十五页。,Endotracheal Intubation 气管内导管,Oral endotracheal intubation从口腔插入No blind nasotracheal intubation for 8 years 少于8岁不可施行鼻入插喉法Uncuffed tube无气袋式喉管Length-based tape system身长尺Same diameter as tip of childs little finger与小童尾指头直径相同Frequently reassess placement需经常捡查喉管位置,18,Trauma in Children-,第十八页，共三
16、十五页。,Circulation in Children儿童血循环,19,Persistent tachycardiais most reliable indicator of shock.最有效显示伤者休克的征状为持续的脉搏过快,Trauma in Children-,第十九页，共三十五页。,Circulation in Children,Early shock more difficult to determine.较难于休克初期预测 Persistent tachycardia持续的脉搏过快Rate 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 s
