tailieunhanh - KEY QUESTIONS IN SURGICAL CRITICAL CARE - PART 10

Tiểu Kiểm tra khảo sát - Yêu cầu đặt nội khí quản nếu cần thiết duy trì trong dòng cố định. - Họng xả gây kích thích với phế vị Canon đường hàng không, ngừng tim. - Chấn thương cột sống cổ tử cung giảm dòng chảy giao cảm. - Bệnh nhân hạ huyết áp Có Thể Cả hai và bradycardic | Examination Primary survey - Intubation if necessary requires maintenance of in-line immobilisation. - Pharyngeal stimulation with airway can cause vagal discharge and cardiac arrest. - Cervical spine injuries reduce sympathetic outflow. - Patients may be both hypotensive and bradycardic not a feature of hypovolaemia therefore suspect spinal cord injury . - Aggressive fluid resuscitation can induce pulmonary oedema. Secondary survey - Logroll - look for bruising palpate for a step tenderness. - Repeated neurological examination to determine neurological damage and its progression resolution. - Systematic examination for fractures as patient may not feel pain. - In tetraplegic patients respiratory failure may be due to intercostal paralysis partial phrenic nerve palsy impaired ability to cough or a ventilation-perfusion mismatch. - In paraplegic patients respiratory failure may be due to variable intercostal nerve paralysis or associated chest injuries. - May develop as a late feature due to ascending oedema in the cervical cord. - Abdomen may be flaccid with absence of sensation features of peritonism may be absent . - Priapism may develop. Imaging X-rays - Cervical spine AP lateral including C7 T1 swimmers view or pull arms down to visualise open mouth view of odontoid peg. AP and lateral view of other tender areas of spine. Image the entire spine if a spinal fracture is present. CT scan shows bony injury magnetic resonance imaging MRI scan shows soft tissue involvement. Other Systems and Multisystem Failure Vivas Key Questions in Surgical Critical Care 211 Other Systems and Multisystem Failure If neurological damage Insert a urinary catheter. Note reduced BP and bradycardia due to neurogenic shock. Exclude hypotension due to haemorrhage elsewhere. Invasive monitoring is required. Give methylprednisolone intravenous 30mg kg over 15 minutes then kg hr for next 23 hours. Needs to be given within 8 hours. Discuss with local spinal injuries unit. Pressure area .