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急診創傷個案討論

急診創傷個案討論. 新光醫院 急診科 張志華 醫師. 2005 / 09 / 22. ATLS: 初級評估與處置. ATLS: 5 Steps. Preparation Triage Primary survey (ABCDE) + Resuscitation Adjuncts to primary survey Secondary survey Adjuncts to secondary survey Continued monitoring and reevaluation Definite care / Transfer. Primary Survey.

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急診創傷個案討論

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  1. 急診創傷個案討論 新光醫院 急診科 張志華醫師 2005 / 09 / 22

  2. ATLS: 初級評估與處置

  3. ATLS: 5 Steps • Preparation • Triage • Primary survey (ABCDE) + Resuscitation • Adjuncts to primary survey • Secondary survey • Adjuncts to secondary survey • Continued monitoring and reevaluation • Definite care / Transfer

  4. Primary Survey 考題！ • Airway + C-spine protection • Breathing + R/O tension pneumothorax • Circulation + stop bleeding • Disability (GCS) + pupils + MP x 4 • Exposure + Environmental control

  5. Adjuncts to Primary Survey • NG/OG, Foley • X-rays: Chest, pelvis, c-spine • DPL or FAST • Monitoring: ECG, BP, SpO2, ABG, ETCO2

  6. Secondary Survey Does not begin until • Primary survey (ABCDE) is completed • Normalization of vital signs after resuscitation

  7. Secondary Survey • Complete History • AMPLE • Complete PE • Head to toes • Finger to holes

  8. Secondary Survey • History: • Allergies • Medication • Past illness / pregnancy • Last meal • Events / environment

  9. Adjuncts to Secondary Survey Specialized diagnostic tests • CT scans • Contrast x-rays • Extremity x-rays • Endoscopy and ultrasonography

  10. Reevaluation • Reevaluation constantly (start with ABCDE) • To discover new findings • To discover deterioration • Continuous monitoring • Vital signs, EKG • U/O • ABG, SpO2 • ETCO2

  11. Definite Care and Transfer • Decision during the primary survey and resuscitation • D2D communication • Transfer after life-saving resuscitation

  12. 謝謝聆聽

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