外科學腹損pbl課件

1、About myselfName: 費 健Email: feijianhotmailMobile:137-0176-9798About myselfName: 費 健開始了大家要專心啊開始了一個例子四大問題 一個例子四大問題 A 22 year old man was driving drunk and without his seatbelt fastened when he was involved in a single-vehicle automobile accident. When attended by EMT（abbr. emergency medical technician

2、 急診醫(yī)士） personnel, no information was available about the time of the accident. He was found agitated and complaining of abdominal pain. A 22 year old man was driving Study Questions 1:Whats your first impression of this case? Study Questions 1:Whats yoOpen or Closed Injuries ?Hollow or Solid Organs

3、?Single or Multiple ?Open or Closed Injuries ?病史詢問 病患受傷之可能機轉，如車禍之車體損傷嚴重度，是否用安全帶，救援病患之時間從病患或家屬快速取得AMPLE資料，但不可因為問病史而耽誤急救處置。 病史詢問 病患受傷之可能機轉，如車禍之車體損傷嚴重度病史詢問A : Allergy 過敏史M : Medication 用藥史P : Past history 過去病史L : Last meal 最后一次進食喝水時間及 LMP ( 女性 )E : Event 外傷發(fā)生之經過史病史詢問A : Allergy 過敏史M : MedStudy Question

4、s 2:Whats the key points of physical exam? Study Questions 2:Whats thHis airway was patent. At the scene, he was breathing at 20 per minute with a blood pressure of 90/60 and a pulse of 130. He was placed in a hard cervical collar and on a back board and transported to your emergency room. Upon arri

5、val his vital signs are the same, with a temperature of 36oC. His airway was patent. At theHis abdomen is markedly distended. His hands and feet are cold, his legs mottled. His abdomen is markedly disten理學檢查 病患是否有休克癥狀 ( tachycardiatachypneacold swealing ) 胸腹部是否有開放性傷口 胸腹部是否有挫傷瘀血腫等 女性病患應注意是否懷孕理學檢查 病患是

6、否有休克癥狀 ( tacStudy Questions 3:What will you do next? Study Questions 3:What will-A nasogastric tube reveals green liquid.-A urinary catheter reveals dark yellow urine. -His hemoglobin is 7. -His abdominal lavage（灌洗）reveals gross blood. -A nasogastric tube reveals gr診斷工具 Laboratory Data Hb,Hct ( seri

7、al measurement ) Base line WBC Coagulation studies Baseline electrolyte Liver and renal function tests Serum amylase Urinalysis診斷工具 Laboratory Data Hb,HStudy Questions 4:Whats the final diagnosis? Study Questions 4:Whats th影像學檢查： X線平片、CT、 B超、DSA影像學檢查：外科學腹損pbl課件外科學腹損pbl課件外科學腹損pbl課件 目的要求：了解：腹部損傷的分類、病因

8、和病理；掌握：腹部損傷的臨床表現；熟練掌握：腹部閉合性損傷引起的臟器破裂、出血、穿孔的診斷及治療原則。 目的要求：了解：腹部損傷的分類、病因和病理；思考題腹部閉合性損傷的診斷腹腔診斷性穿刺的方法及意義脾破裂的治療方法 只剩兩月就要 考試了! 思考題腹部閉合性損傷的診斷 只剩兩月就要外科學腹損pbl課件New Eng J MedVolume 356:1353-1360March 29, 2007Number 13NextCase 10-2007 A 55-Year-Old Man Impaled in a Rowing AccidentNew Eng J Med男30歲，由5m高處跌下2小時。腹

9、痛，腹肌緊張，有壓痛和反跳痛，腸鳴音弱。血壓104/70mmHg，脈率120次/分，血紅蛋白80g/L。X線檢查：右側第9、10肋骨骨折，右側膈肌升高。最可能的診斷是（ ）。A肝破裂B胃破裂C脾破裂D橫結腸破裂E胰腺斷裂男30歲，由5m高處跌下2小時。腹痛，腹肌緊張，有壓痛和反跳腹部閉合傷，確診有無內臟傷最簡便，最可靠的診斷方法為（ ）。AX線照片BCTC白細胞計數DB超E腹腔穿刺。 腹部閉合傷，確診有無內臟傷最簡便，最可靠的診斷方法為（ ）腹部閉合性損傷，以下都是不能早期確診的原因除了（ ）。A實質臟器損傷但其被膜未破B同時合并其他部位的嚴重損傷C空腔臟器穿孔不大D腹腔穿刺抽出不凝固血液E后腹膜臟器的損傷腹部閉合性損傷，以下都是不能早期確診的原因