急診模板: Trauma

Mechanism:
Helmet (+), head injury (-), ILOC (-)
Active and passive ROM:
Gait: steady
Amnesia (-)
GCS: EVM
Suspected open or depressed skull fracture:
Sign of basilar skull fracture: raccoon eyes (-), Battle's sign (-), CSF otorrhea (-), CSF rhinorrhea (-)
More than 2 episodes of vomoting:
Retrograde amnesia to the event more than 30 minutes:
Dangerous mechanism:
Current medication: anticoagulant (-), antiplatelet (-)
Tetanus vaccine in recent 5 years: denied
Muscle power: R/L  /

Sensory deficit: nil
Allergy: nil
Last meal: 

PH:

PE:
No visible head wound
No obvious chest and abdominal injury
No focal neurological sign, no focal weakness

=============

• 急診創傷評估、處置

• 自介
• 病人名字、這裡是哪裡、你發生啥事

• Primary ABCDE
• A：airway＋C-spine restriction，呼吸通暢？
• 困難插管：影像輔助->cricothyrotomy（ER不做氣切！）
• C-spine 可問上下肢運動、感覺
• B：breathing & ventilation，呼吸、換氣足夠？
• 呼吸pattern、換氣功能（Ambu, BiPAP, Ventilator）、氧合狀態
• C：circulation & hemorrhagic control，休克？
• Tachycardia -> ↓BP -> shock, conscious change
• D：diability，意識清楚？
• AVPU（清聲痛否）、pupil size、light reflex
• E：exposure & environmental control +保暖
• Back & perineum + DRE/Anal tone
• 保暖：輸warm fluid＋烤燈

• 4大立即致命胸部外傷
• Tension pnx
• Open pnx
• Massive hemothorax
• Flail chest
• FAST
• Morrison pouch：肝腎
• hepatospleno：肝脾
• Pericardial
• Douglas pouch

• Secondary survey
• 全身各處再檢查（孔洞：鼻、耳、NG、陰道、尿道）
• AMPLE（之前吃藥過敏）
• A：allergy過敏
• Ｍ：medicine過敏
• Ｐ：past illness/ pregnancy 過去病史、懷孕
• Ｌ：last meal上一餐啥時吃、吃啥
• Ｅ：events/ environment related to injury 發生啥事、環境如何
• 完整PE、NE、Image

• 撞到頭
• Canadian CT Head Injury/ Trauma rule
• 在正常人使用，看ICH是否需ICU、neurointervention
• New Orleans/Charity Head Trauma/ Injury rule
• 應付刁民用
• 只要頭撞到幾乎都可用
• 看任何出血
• C-spine
• Canadian C-spine
• NEXUS Criteria for C-spine imaging
• 小兒撞到頭
• PECARN Pediatric Head Injury/Trauma Algorithm