• 脉搏逐渐增快 pulse + • 快速输液后，血压仍逐渐下降 Bp • Hb、RBC、HCT持续下降 • 胸穿无法抽出血液，胸片胸腔阴影渐大
pleural shadow + • 胸引量连续3小时大于200ml/hr
创伤性窒息Traumatic Asphyxia
胸部挤压综合征 Chest Squeeze Syndrome Cyanosis of the upper extremities, neck, and head
• Petechiae in the conjunctiva • Jugular venous distention, facial edema • Associated injuries include:
Pulmonary contusion mocardial contusion, rib fractures, hemo/pneumothorax
decrease venous return • Hypotension • Respiratory distress
Decompression!
血胸 Hemothorax
1. Concepts
• 小量血胸： <500ml • 中等量血胸：500--1000ml • 大量血胸： >1000ml
2 Pathophysiology
• Massive hemothorax • Cardiac and vascular injuries, with temponade • Large open wounds • Tracheobronchial、esophageal injury • Thoracoabdominal injury • Foreign body
心脏损伤 Cardiac injury
1 钝性伤 Blunt cardiac injury 诊断方法：临床、实验室、辅助检查 治疗原则：保守治疗
2 穿透伤 Penetrating card原则：手术治疗
return • Hypoxia, hypercapnia
hypotention, respiratory and circulatory failure
Tension Pneumothorax
Life-threatenting
• Complete lung collapsing • Tracheal deviation • Mediastinal shifting,
pnemo-thorax, flail chest, cardiac tamponade • shock treatment • drainage
手术探查指征
Indications for Exploration（thoracotomy）
• Cardiac arrest(resuscitative kthoracotomy)
• 呼吸困难 dyspnea • 反常呼吸运动 paradoxical respiratory motion • 咯血 hemoptysis • 脏器出血 visceral hemorrhage • 休克 shock
Principles of Treatment
轻伤 minor injury
• 固定 immobilization • 镇痛 pain control • 引流 drainage • 清创缝合 debridement and suture • 抗感染治疗 antibiotic therapy
Rib Fracture
Predominant locations (4th-7th)
Single Multiple Multiple fractures of single rib Multiple breaks of multiple ribs
Fail Chest
Paradoxcial motion the chest wall Flail chest--mediastinal flutter Respiratory failure: Ineffective air movement Pulmonary contusion Pain
• 临床表现 Clinical manifestation • 诊断方法 Diagnostic methods • 处理原则 Treatment principles
Open Pneumothorax
Sucking chest wound • Mediastinal flutter • Decreased venous
气胸 Pneumothorax
定义及分类
Definition & Classification
• 闭合性气胸 closed • 开放性气胸 open (纵隔扑动) • 张力性气胸 tension
Closed Pneumothorax
• 病理生理 Pathophysiology
➢ 少量气胸（肺压缩15%） ➢ 中等量气胸（15-60%） ➢ 大量气胸（>60%）
• 伤侧肺受压，影响呼吸功能 • 失血性休克 • 形成凝固性血胸或纤维胸
血胸 Hemothorax
处理原则 Principles of treatment
• 保守治疗 Non-surgical treatment
• 手术治疗 operation 进行性血胸
Progressive Hemothorax
重伤 Critical Trauma
ATLS (advanced trauma life support)
• Initial evaluation（triage, polytrauma） • airway patency • pneumo-thorax, massive hemothorax, open
Chest Trauma
Thoracic Trauma
分类 Classification：
• 钝性伤和穿透伤 Blunt & Penetrating injury
• 开放性和闭合性损伤 Open & Closed injury
临床表现 Clinical Manifestations
• 胸痛 chest pain