腹部创伤的急诊(英文版).ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Management of Acute Abdominal Trauma,Outline,Introduction,Diagnosis,Treatment,Conclusion,Introduction,Incidence in cats is unknown,Introduction,Many causes to acute abdominal injury,Some are easy to diagnose and some can be very challenging,Principal causes,Blunt trauma(automobile or fall),penetrating injury(gunshot wound or bite wound)are most common types presented,Diagnosis,Physical examination findings,Diagnostic studies,Experience with trauma cases,Theses help to determine which patient can be managed conservatively and which must be rapidly taken to surgical therapy,Diagnosis,Blunt abdominal trauma cases are challenging diagnostic problems because the clinical manifestations may be delayed for hours or even days in some cases.,Diagnosis,Physical examination is the most informative,Increasing abdominal size is an important clue for intra-abdominal hemorrhage,Palpate the abdomen for rigidity and pain,Many blunt injuries can cause internal bleeding and laceration of the liver and spleen,Examination,Severe Ventral Bruising,Examination,Penetrating Wound,Examination,Pale mucous membranes,Weak pulse,Profound hypovolemic shock,Patient Triage,Often must begin stabilization therapy prior to complete diagnosis or during diagnostic procedures depending on severity of the condition,IV Fluids,Oxygen,Blood Transfusion,Diagnostic,4 Quadrant Abdominocentesis,Fluid obtained is tested for:,HCT,Total solids,Cytology Blood Urea Nitrogen,Lipase,Amylase,and Bilirubin,Diagnostic,4 Quadrants,HCT,Blood Urea Nitrogen,Rupture of the Urinary system,Kidney,Ureter,Bladder,Bilirubin,Fluid almost black in color,Cytology,Radiology,Radiology,Contrast media leakage,Radiology,Abdominal fluid=loss of detail,Ultrasound,Free fluid easy to detect.Creates a space between organs,Management,Abdominal compression bandage,Treatment,Rapid volume expansion,Intravenous fluid(crystalloids)given up to 60-90ml/kg in the first hour,Abdominal compression,Blood pressure evaluation,Frequent girth evaluation,PCV/TP evaluated every 15-30 minutes,Treatment,If the hemorrhage is not self-limiting transfusion and exploratory surgery may be indicated.,A good rule of thumb if the packed cell volume drops rapidly below 25%=transfusion required,In a severely anemic animals blood should be administered as rapidly as possible using a pressure bag or an in-line syringe attached to a three-way stopcock.,Auto-transfusion is a rapid source of available blood until a donor can be located,Surgery?,Can it wait?,Usually,Better to stabilize the patient rather than rapidly explore if possible,Rarely must be done immediately,Uncontrollable hemorrhage primary need,Aorta can be compressed for up to 20 minutes to define location,Surgery,Blunt Trauma only if indicated,Peritonitis(bile,urine,gallbladder,septic),Often laceration of liver and spleen heal with surgery,Penetrating wound,Always,Conclusion,1.Trauma frequently affects multiple organ systems.,2.An organized,systematic approach should be undertaken for each patient,3.An aggressive diagnostic and therapeutic approach is taken towards each of the involved systems,4.Over treatment of some complications can be just as hazardous as under treatment.,5.Constant monitoring and reassessment of the patients status are mandatory.,Questions?,。