1、International Trauma Life Supportfor Prehospital Care ProvidersSixth Edition Patricia M. Hicks, MS, NREMTPRoy Alson, PhD, MD, FACEPDonna Hastings, EMT-PJohn Emory Campbell, MD, FACEPand Alabama Chapter,American College of Emergency PhysiciansCampbell, International Trauma Life Support, 6th Ed. 2008

2、Pearson Education, Inc., Upper Saddle River, NJChapter 17Trauma in Children第一頁，共三十五頁。Campbell, International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJTrauma in ChildrenTrauma in Children兒童兒童(r tng)創傷創傷第二頁，共三十五頁。Campbell,International Trauma Life Support, 6th E

3、d. 2008 Pearson Education, Inc., Upper Saddle River, NJ3兒童創傷急救OverviewEffective techniques to gain confidence有效增加信心的技巧有效增加信心的技巧Injuries based on mechanisms of injury受傷機理受傷機理ITLS Primary and Secondary Surveys初步及進一步檢查初步及進一步檢查 Consent and the need for immediate transport家長同意及需實時運送家長同意及需實時運送Pediatric eq

4、uipment needs適合兒童之器材適合兒童之器材Various methods of SMR on child兒童脊椎固定兒童脊椎固定(gdng)方法方法EMS involvement in prevention programs參與預防意外計劃參與預防意外計劃第三頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ4兒童創傷急救Trauma in ChildrenDifferent from adults與成人不同與

5、成人不同 Different patterns of injuries不同傷勢模式 Different responses to those injuries不同反應 Special equipment required需要特別器材 Assessment equipment and treatment equipment檢查(jinch)及冶療用的器材 Difficult to assess and communicate 較難評估及溝通 Come with caregivers and other family members 與家人或照顧者同行第四頁，共三十五頁。Campbell,Inte

6、rnational Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ5兒童創傷急救Communicating溝通溝通(gutng)Family-centered care is critical.以家庭為中心以家庭為中心 Caregiver not always parent.照顧者未必是父母 Involve caregivers as much as possible in care.盡量讓照顧者參與 Give explanations and careful instructi

7、ons.必需詳加解釋及指示 Inclusion and respect will improve stabilization.包容及尊重可穩定(wndng)傷者 Keep caregivers in physical and verbal contact.與照顧者保持接觸Demonstrate competence and compassion.第五頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ6兒童創傷急救Asses

8、sing Mental Status撿查精神狀態撿查精神狀態Consoled or distracted可按撫或轉注意力可按撫或轉注意力 Most sensitive indicator of adequate perfusion 能準確反映組織灌注是否足夠 Caregivers best at detecting subtle changes 照顧者會較易分辯出傷者微小(wixio)改變第六頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle

9、 River, NJ兒童創傷急救Assessing Mental StatusInitial level of consciousness最初清醒程度最初清醒程度 Preschool child : sleeping vs. unconscious 幼兒:疲倦vs人事不醒 Most will not sleep through arrival of ambulance大部份沿途不會(b hu)睡覺 Ask caregivers to wake child著照顧者弄醒傷者 Suspect hypoxia, shock, head trauma, seizure 懷疑缺氧、休克、頭部受傷、癲癇7T

10、rauma in Children -第七頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ8兒童創傷急救CommunicatingInteraction strategies使用適齡的語言使用適齡的語言Appropriate language for developmental level合適的語言合適的語言 Speak simply, slowly, clearly說話要慢及簡溸 Be gentle and firm必

11、需肯定 Avoid “no” questions避免說”不” Get a favorite belonging 利用其喜愛的玩具/隨身(sushn)物品 Get on childs level 降下身段至與傷者視線平衡 Explain SMR necessity 解釋脊椎固定之需要 Allow caregiver to accompany child 讓照顧者與傷者同行第八頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ

12、9兒童創傷急救Caregiver Consent照顧照顧(zho g)者者”同意同意”Critical care shouldnotbe delayed.切勿延醫冶理切勿延醫冶理Emergency care needed如需進行急救如需進行急救Consent not available未能取得”同意” Transport before permission, document why, notify medical direction記錄,速送醫院,通知醫五Consent denied不同意Try to persuade, document actions, obtain signature

13、嘗試(chngsh)說服、記錄、簽署 Notify law enforcement and appropriate authorities 行使有關法例 Report suspected abuse 如懷疑兒童受虐待,通知警方第九頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ10兒童創傷急救Pediatric Equipment兒科兒科(r k)器材器材Length-based tape身長尺身長尺 Weight es

14、timate大約體重 Fluid and medication doses precalculated 輸液及藥物(yow)劑量 Common equipment size estimates 常用器材尺碼Photo courtesy of Kyee Han, MD第十頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ11兒童創傷急救Mechanisms of Injury受傷受傷(shu shng)機理機理Falls高處

15、高處(o ch)下墮下墮 Usually land on head通常頭先著地 Serious head injury unusual from 27 inches嚴重頭部受傷并不常見于身長27吋 Protective gear保護裝備MVCs交通意外交通意外 Seat-belt syndrome安全帶綜合癥 Liver, spleen, intestines, lumbar spine 肝、脾、小腸、腰椎Auto-pedestrian crashes路人被撞路人被撞第十一頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2

16、008 Pearson Education, Inc., Upper Saddle River, NJ12兒童創傷急救Mechanisms of InjuryBurns燒傷燒傷Airway obstruction氣道受阻氣道受阻 Foreign body異物Child abuse虐待兒童虐待兒童 Suspect if history does not match injury 受傷經過與傷勢不吻合 Story keeps changing經常改變(gibin)說法第十二頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 200

17、8 Pearson Education, Inc., Upper Saddle River, NJ13兒童創傷急救Airway in Children兒童兒童(r tng)氣道氣道Signs of obstruction呼吸受阻征狀呼吸受阻征狀 Apnea無呼吸 Stridor吸氣(x q)時有喘鳴聲 “Gurgling” respiration有雜聲的呼吸Contribute to obstruction誘因誘因 Hyperextension過度舒張 Hyperflexion過度屈曲Courtesy of Bob Page, NREMT-P第十三頁，共三十五頁。Campbell,Intern

18、ational Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ14兒童創傷急救Airway in ChildrenOpening airway張開氣道張開氣道 Tongue is large; tissue soft舌大,組織軟 Jaw-thrust下頷上提法(t f) Oropharyngeal airway口咽氣道 Nasopharyngeal airways鼻咽氣道 Too small to work predictably 因鼻孔太少未必有效 Neonate obliga

19、te nose breather 新生嬰兒用鼻孔呼吸 Clear nose with bulb syringe用球狀泵吸走分泌第十四頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ15兒童創傷急救Breathing in Children兒童兒童(r tng)呼吸呼吸Work of breathing呼吸方法呼吸方法 Retractions, flaring, grunting 肋間收縮、鼻翼擴張、咕嚕(gl)聲 Per

20、sistent grunting requires ventilatio n持續咕嚕聲需要施行助呼吸Respiratory rate呼吸次數呼吸次數 Fast, then periods of apnea or very slow 先后短暫停止或轉慢Minor blunt neck trauma can be critical.輕微頭部挫傷可引起嚴重傷勢輕微頭部挫傷可引起嚴重傷勢第十五頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle Riv

21、er, NJ16兒童創傷急救20, 15, 10Ventilation Rate換氣換氣(hun q)次數次數10 per minute for adolescent如為中童如為中童, 10次次/分鐘分鐘 20 per minue for 1 year如如1 year如如 1歲歲, 15次次/分鐘分鐘第十六頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ17兒童創傷急救Breathing Management呼吸呼吸(h

22、x)處理處理Effective BVM ventilation有效有效BVM換氣換氣(hun q)intubation is elective.可考慮插喉可考慮插喉第十七頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ18兒童創傷急救Endotracheal Intubation 氣管氣管(qgun)內導管內導管Oral endotracheal intubation從口腔插入從口腔插入 No blind nasotra

23、cheal intubation for 130 usually shock in all ages except neonates脈搏130多為休克,新生嬰兒除外 Prolonged capillary refill and cool extremities微血管回流時閉遲及肢體冰冷 Level of consciousness清醒程度Circulation can be poor even if child is awake 血循環衰竭的兒童仍可完全(wnqun)清醒 Low blood pressure is sign of late shock.血壓低是休克的后期征狀 BP 80 mm

24、Hg in child; 70 mmHg in young infant第二十頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ21兒童創傷急救Shock in ChildrenStrong compensatory mechanisms生理的補嘗機制較強生理的補嘗機制較強 Appear surprisingly good in early shock 早期休克可有效(yuxio)發揮 “Crash” when deter

25、iorate但情況會急轉直下 Be prepared必需有心理準備 Fluid administration 20 mL/kg in each bolus輸液補充每次20 mL/kg Consider intraosseous infusion骨髓輸液法 Frequent Ongoing Exams持續檢查 第二十一頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ22兒童創傷急救Pediatric Trauma Cent

26、er 兒童兒童(r tng)創傷中心創傷中心Criteria條件條件 Obstructed airway氣道阻塞 Need for airway intervention處理氣道 Respiratory distress呼吸困難(h x kn nn) Shock休克 Altered mental status意識紊亂 Dilated pupil曈孔擴大 Glasgow Coma Scale score 13 Pediatric Trauma Score 10 feet高處墮下 Motor-vehicle collision MVC with fatalities車禍中有人死亡 Ejection

27、 from an automobile in a MVC 車禍中彈離車廂 In MVC, significant intrusion into compartment 車禍中受困于車廂中 Hit by a car as a pedestrian or bicyclist行人被撞 Fractures in more than one extremity多邊一條肢體骨抑 Significant injury to more than one organ system多過一個器官受傷第二十三頁，共三十五頁。Campbell,International Trauma Life Support, 6th

28、 Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ24兒童創傷急救Pediatric Trauma CenterRecommended建議送院建議送院 Burns燒傷(shoshng) Near-drowning遇溺 Head injuries with loss of consciousness 人事不醒的頭部受傷Notify hospital as early as possible.盡早知會醫院盡早知會醫院第二十四頁，共三十五頁。Campbell,International Trauma Life Support, 6th

29、Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ25兒童創傷急救Life-Threatening Injuries 危害危害(wihi)生命傷勢生命傷勢Head injury頭部受傷頭部受傷 Most common cause of death最常見死亡原因 Level of consciousness change best indicator 清醒程度(chngd)之改變為最有效的征狀 Pupil assessment important檢查瞳孔第二十五頁，共三十五頁。Campbell,International Trauma

30、 Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ兒童創傷急救Life-Threatening Injuries High-flow oxygen高濃度氧氣 Hyperventilate only with cerebral herniation syndrome 加快換氣只適用于出現(chxin)腦疝征狀 Fluid administration titrated to systolic BP 控制輸液速度至可維持基本收縮壓 Preschool child: 80 mmHg; older ch

31、ild: 90 mmHg 幼兒: 80 mmHg,小童: 90 mmHg Be prepared to prevent aspiration 預防氣道吸入異物26Trauma in Children -第二十六頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ27兒童創傷急救Life-Threatening InjuriesChest injury胸部創傷胸部創傷 Respiratory distress common最常

32、見的征狀為呼吸困難 Pneumothorax or tension pneumothorax氣胸或張力性氣胸 Difficult to assess較難分別 Needle thoracostomy can be life-saving剌胸膜腔穿刺 Pulmonary contusion胸部挫傷 Rare injuries較少發生(fshng)傷勢 Rib fractures, flail chest, aortic rupture, pericardial tamponade 肋骨折、槤架胸、主動脈撕裂、心胞膜填塞第二十七頁，共三十五頁。Campbell,International Traum

33、a Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ28兒童創傷急救Life-Threatening InjuriesAbdominal injury腹部創創腹部創創 Liver and/or spleen rupture肝、脾撕裂 Second leading cause of traumatic death 傷第二致死傷勢 Bleeding often contained within organ 出血通常局限于器官之內 Difficult to diagnose難以診斷 Severe in

34、jury with minimal signs 嚴重傷勢可只有輕微征狀 Suspect with any abnormal abdominal assessment 若有任何異常腹部征狀當作(dn zu)嚴重傷勢處理 Be prepared to prevent aspiration. 預防氣道吸入異物第二十八頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, NJ29兒童創傷急救Life-Threatening Injurie

35、sSpinal injury脊椎創傷脊椎創傷 Uncommon before adolescence青少年以下(yxi)較少發生 9 years usually lower cervical-spine injuries頭椎下受傷 Higher incidence of SCIWORAspinal-cord injury without radiographic abnormality 可無X-光片異常第二十九頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upp

36、er Saddle River, NJ兒童創傷急救Life-Threatening Injuries SMR脊椎固定脊椎固定 Pad under torsofor neutral position 于天然屈曲位下放置(fngzh)較墊 May have to secure without cervical collar 可不使用頸圈固定頸椎 Do not restrict chest movement 切勿緊束胸部30Trauma in Children -第三十頁，共三十五頁。Campbell,International Trauma Life Support, 6th Ed. 2008 Pearson Education, Inc., Upper Saddle River, N