单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,About myself,Name:,费 健,Email:feijianhotmail,Mobile:137-0176-9798,About myselfName:费 健,1,开始了,大家要专心啊,开始了,2,一个例子四大问题,一个例子四大问题,3,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,急诊医士,）,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,4,Study Questions 1:Whats your first impression of this case?,Study Questions 1:Whats yo,5,Open or Closed Injuries?,Hollow or Solid Organs?,Single or Multiple?,Open or Closed Injuries?,6,病史询问,病患受伤之可能机转，如车祸之车体损伤严重度，是否用安全带，救援病患之时间从病患或家属快速取得,AMPLE,资料，但不可因为问病史而耽误急救处置。,病史询问 病患受伤之可能机转，如车祸之车体损伤严重度,7,病史询问,A:Allergy,过敏史,M:Medication,用药史,P:Past history,过去病史,L:Last meal,最后一次进食喝水时间及,LMP(,女性,)E:Event,外伤发生之经过史,病史询问A:Allergy 过敏史M:Med,8,Study Questions 2:Whats the key points of physical exam?,Study Questions 2:Whats th,9,His 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 arrival his vital signs are the same,with a temperature of 36,o,C.,His airway was patent.At the,10,His abdomen is markedly distended.His hands and feet are cold,his legs mottled.,His abdomen is markedly disten,11,理学检查,病患是否有休克症状,(tachycardiatachypneacold swealing),胸腹部是否有开放性伤口 胸腹部是否有挫伤,瘀血肿等 女性病患应注意是否怀孕,理学检查 病患是否有休克症状 (tac,12,Study Questions 3:What will you do next?,Study Questions 3:What will,13,-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,14,诊断工具,Laboratory Data Hb,Hct(serial measurement)Base line WBC Coagulation studies Baseline electrolyte,Liver and renal function tests Serum amylase Urinalysis,诊断工具 Laboratory Data Hb,H,15,Study Questions 4:Whats the final diagnosis?,Study Questions 4:Whats th,16,影像学检查：,X,线平片、,CT,、,B,超、,DSA,影像学检查：,17,外科学腹损pblppt课件,18,外科学腹损pblppt课件,19,外科学腹损pblppt课件,20,21,目的要求：,了解：腹部损伤的分类、病因和病理；,掌握：腹部损伤的临床表现；,熟练掌握：腹部闭合性损伤引起的脏器破裂、出血、穿孔的诊断及治疗原则。,目的要求：了解：腹部损伤的分类、病因和病理；,22,思考题,腹部闭合性损伤的诊断,腹腔诊断性穿刺的方法及意义,脾破裂的治疗方法,只剩两月就要,考试了,!,思考题腹部闭合性损伤的诊断 只剩两月就要,23,外科学腹损pblppt课件,24,New Eng J Med,Volume 356:1353-1360,March 29,2007,Number 13,NextCase 10-2007,A 55-Year-Old Man Impaled in a Rowing Accident,New Eng J Med,25,男,30,岁，由,5m,高处跌下,2,小时。腹痛，腹肌紧张，有压痛和反跳痛，肠鸣音弱。血压,104/70mmHg,，脉率,120,次,/,分，血红蛋白,80g/L,。,X,线检查：右侧第,9,、,10,肋骨骨折，右侧膈肌升高。最可能的诊断是（）。,A,肝破裂,B,胃破裂,C,脾破裂,D,横结肠破裂,E,胰腺断裂,男30岁，由5m高处跌下2小时。腹痛，腹肌紧张，有压痛和反跳,26,腹部闭合伤，确诊有无内脏伤最简便，最可靠的诊断方法为（）。,A,X,线照片,B,CT,C,白细胞计数,D,B,超,E,腹腔穿刺,。,腹部闭合伤，确诊有无内脏伤最简便，最可靠的诊断方法为（）,27,腹部闭合性损伤，以下都是不能早期确诊的原因除了（）。,A,实质脏器损伤但其被膜未破,B,同时合并其他部位的严重损伤,C,空腔脏器穿孔不大,D,腹腔穿刺抽出不凝固血液,E,后腹膜脏器的损伤,腹部闭合性损伤，以下都是不能早期确诊的原因除了（）。,28,A,腹膜炎出现早,B,腹膜炎严重，呈板状腹,C,腹膜炎出现较晚，但较重,D,腹膜炎出现较晚且较轻,E,无腹膜刺激征,结肠破裂（）。,胰腺损伤（）。,A腹膜炎出现早,29,经常有膈下游离气体的情况有（）。,A,胃、十二指肠溃疡穿孔,B,腹部手术后,2,周内,C,肠道外伤穿孔,D,阑尾穿孔,经常有膈下游离气体的情况有（）。,30,