Transcription of 外傷傷口處理 常見陷阱 - disaster.org.tw
1 - .. 1.. 2.. 3.. 4.. 5.. 1. (1).. / .. (2).. : .. : 30 . 10/min GCS 13. SBP 90mmHg 2.. 3. 4 . Apnea and bradycardia .. 4. Five stages 1. Inflammation 2. Epithelialization 3. Collagen synthesis 4. Contraction 5. Remodeling ~ 1 yr Wound Healing Primary healing ( ). No tissue loss Skin edges held in apposition to each other sutured wound Delayed primary healing Secondary healing( ). Tissue loss which results in skin edges being far apart granulation ulcer Reepithlialization ( ). 5.. : 8-12 ( : 24 . ). : 4 5 (3-7 ). : (22%. ). Suture Primary closure Delayed primary closure Secondary closure Reepithelialization 6.
2 ABCDE. (Hemostasis). (Irrigation and cleansing). (Debridement). (Suture). (Skin grafting).. A.. B.. C.. D.. 7. Irrigation & Cleansing All traumatic wounds are contaminated Irrigation of wound NS or water Cleansing of skin Povidone-iodine or Chlorhexidine . Irrigation . > 7 PSI. The best solution to infection is dilution 8. High Pressure Irrigation Devices The ideal pressure for routine wound irrigation is 5 8 psi - achieved through the use of a 20 to 30 cc syringe attached to an 18 or 19 gauge catheter sheath (top), or a commercially available device with splash shield - Cleansing.
3 : .. 9. Debridement Remove foreign matter and devitalized tissue Excessively contaminated wound or wound >. 8-12h can be converted to relatively clean, fresh wound by excising the entire wound .. A. (local). B. (nerve block). 10.. lidocaine . Lidocaine . : 3-5 mg/kg < 300 mg (15cc of 2%). epinephrine Lidocaine : 5-7 mg/kg . 11.. lidocaine . ? A. (27#). B.. C.. D. 1:10 bicarbonate Lidocaine . procaine, tetracaine, and benzocaine [ Lidocaine ]. cardiac lidocaine ( . 30 min). 1% aqueous diphenhydramine (Venan).. 12. nerve & tendon Radial Nerve 13. Ulnar Nerve Median Nerve 14.
4 Sensory Extensor Digitorum 15. Flexor Digitorum Superficialis Flexor Digitorum Profundus 16.. 3-9 .. - . 17.. : 60 . Dermalon, Ethicon, silk, nylon : 60 . Dexon, Vicryl, catgut 18. Foreign Bodies Inert (Nonreactive) FB. Glass fragments, metallic objects, needles, bullets, pencil leads, nails bullet can be left in place Glass should be removed symptomatic Pencil lead (graphite ) should be removed tatooing wood fragments Organic (Reactive) FB. Wood splinters (most common), thorns, bone, soil, stones, rubber Must be removed inflammation/infection .. 19.
5 4-8 h (> 8-12 h ).. ( ). / .. epinephrine . 20.. : A. %. B. 6 %. C. 20 %. D. 50 %. Mammalian Bites Dog bite Laceration If < 12h, suture after high-pressure irrigation 3-18 % . Cat bite Puncture Do not suture 28-80 %. 21.. S. aureus / strep. pyogenes . / Pasteurella 30% Eikenella corrodens Vibrio vulnificus Aeromonas hydrophila . tennis shoe Pseudomonas .. Clostridium perfringens ( ). 22. Necrotizing Fasciitis Flesh-eating bugs Group A streptococcus normal flora Vibrio vulnificus sea water Aeromonas hydrophila fresh water Clostridium perfringens soils, aquatic sediments and the intestinal tracts of animals Fight bite injuries =.
6 Clenched fist laceration . (MPJ) . Staph / Strep / Eikenella (30%). Boxer's Fracture 23. - Tetanus toxoid, TT. cc . 7-21 (3-56 ).. Tetanus Immune Globulin TIG TT .. TIG TT . Dose 250U . 125U . 75U . 24.. Life - . Limbs - . Function - . Cosmetics - . 25.
