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:
Allergy: nil
Last meal:
PH:
PE:
No visible head wound
No obvious chest and abdominal injury
No focal neurological sign, no focal weakness
=============
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
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