1、Chapter 17Trauma in Children,第一页，共三十五页。,Trauma in Children,Trauma in Children儿童(r tng)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Pedi
2、atric equipment needs适合儿童之器材Various methods of SMR on child儿童脊椎固定(gdng)方法EMS involvement in prevention programs参与预防意外计划,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不同反应Special equipment require
3、d需要特别器材 Assessment equipment and treatment equipment检查(jinch)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(gutng),Family-centered care is critical.以家庭为中心Caregiver not always parent.照顾者未必是父母Inv
4、olve 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(wndng)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。,Ass
5、essing 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(wixio)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:sleepin
6、g vs.unconscious 幼儿:疲倦vs人事不醒Most will not sleep through arrival of ambulance大部份沿途不会(b hu)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,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
7、level合适的语言Speak simply,slowly,clearly说话要慢及简溸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(sushn)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(zho
8、g)者”同意”,Critical care shouldnotbe delayed.切勿延医冶理Emergency care needed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(chngsh)说服、记录、签署Notify law enforcement and appropr
9、iate authorities 行使有关法例Report suspected abuse 如怀疑儿童受虐待,通知警方,9,Trauma in Children-,第九页，共三十五页。,Pediatric Equipment儿科(r k)器材,Length-based tape身长尺Weight estimate大约体重Fluid and medication doses precalculated 输液及药物(yow)剂量Common equipment size estimates 常用器材尺码,10,Trauma in Children-,Photo courtesy of Kyee H
10、an,MD,第十页，共三十五页。,Mechanisms of Injury受伤(shu shng)机理,Falls高处(o ch)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Protective 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,11,Trauma in Children-,第
11、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 history does not match injury 受伤经过与伤势不吻合Story keeps changing经常改变(gibin)说法,12,Trauma in Children-,第十二页，共三十五页。,Airway in Children儿童(r tng)气道,Signs of obstruction呼吸受阻征状Apnea无呼吸Stridor吸气(x q)时有喘鸣声“Gurgli
12、ng”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 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(t f)Oropharyngeal airway口咽气道Nasopharyngeal airways鼻咽气道Too small to w
13、ork 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-,第十四页，共三十五页。,Breathing in Children儿童(r tng)呼吸,Work of breathing呼吸方法Retractions,flaring,grunting 肋间收缩、鼻翼扩张、咕噜(gl)声 Persistent grunting requires ventilatio n持续咕噜声需要施行助呼吸Respirato
14、ry 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-,第十五页，共三十五页。,20,15,10,Ventilation Rate换气(hun q)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 fo
15、r 1 year如 1岁,15次/分钟,第十六页，共三十五页。,Breathing Management呼吸(hx)处理,17,Effective BVM ventilation有效BVM换气(hun q)intubation is elective.可考虑插喉,Trauma in Children-,第十七页，共三十五页。,Endotracheal Intubation 气管(qgun)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
16、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(zhjng)相同Frequently reassess placement需经常捡查喉管位置,18,Trauma in Children-,第十八页，共三十五页。,Circulation in Children儿童(r tng)血循环,19,Persistent tachycardiais most reliable indicator of shock.最有效(yuxio)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Pr