懷孕創傷

不同懷孕時期子宮大小位置; 5. 生理變化消化系統– 胃排空時間延長，易造成吸入性肺炎; 6. 基本觀念懷孕創傷是兩個受傷病患。

對孕婦最適當的急救， 就是對胎兒最好的 ... SlideShareusescookiestoimprovefunctionalityandperformance,andtoprovideyouwithrelevantadvertising.Ifyoucontinuebrowsingthesite,youagreetotheuseofcookiesonthiswebsite.SeeourUserAgreementandPrivacyPolicy. SlideShareusescookiestoimprovefunctionalityandperformance,andtoprovideyouwithrelevantadvertising.Ifyoucontinuebrowsingthesite,youagreetotheuseofcookiesonthiswebsite.SeeourPrivacyPolicyandUserAgreementfordetails. Home Explore Login Signup Successfullyreportedthisslideshow. Activateyour30dayfreetrial tounlockunlimitedreading. 懷孕創傷 2 Share SunYai-Cheng • May.17,2012 • 2likes • 7,959views DownloadNow Download NextSlideShares Youarereadingapreview. Activateyour30dayfreetrial tocontinuereading. ContinueforFree UpcomingSlideShare Handinfections Loadingin…3 × Facebook Twitter LinkedIn Size(px) Starton ShowrelatedSlideSharesatend Share Email     Topclippedslide 1 1of23 懷孕創傷 May.17,2012 • 2likes • 7,959views 2 Share DownloadNow Download Downloadtoreadoffline SunYai-Cheng Follow EmergencyPhysicianatJen-AiHospitalDali Handinfections drpouriamoradi COVID-19(Coronavirusdisease2019),part2 SunYai-Cheng COVID-19(Coronavirusdisease2019)update SunYai-Cheng InitialCareoftheSeverelyInjuredPatient SunYai-Cheng ManagementofHeartFailureinED SunYai-Cheng 2018StrokeGuidelines SunYai-Cheng DAWNandDEFUSE3trial SunYai-Cheng ATLS10thEditionCompendiumofChange SunYai-Cheng TheEuropeanGuidelineonManagementofMajorBleedingandCoagulopathyFollo... 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–懷孕第二階段(secondtrimester)，子宮 開始壓迫下腔靜脈，減少靜脈回流，造 成產婦平躺時低血壓(supine hypotensionsyndrome)。

3. 生理變化 呼吸系統 –每分鐘換氣量增加 →PaCO2of30mmHg –懷孕第三階段 PaCO2:35-40mmHg →代表即將呼吸衰竭 4. 不同懷孕時期 子宮大小位置 5. 生理變化 消化系統 –胃排空時間延長，易造成吸入性肺炎 6. 基本觀念 懷孕創傷是兩個受傷病患。

對孕婦最適當的急救， 就是對胎兒最好的照護。

SaveTheMotherFirst!! SaveTheFetusIfPossible. 母親死亡是外傷造成胎兒死亡 最常見的原因。

母親休克之後存活 者，有80%胎兒死亡 7. 母親死亡是外傷造成胎兒 死亡最常見的原因 胎盤剝離是造成胎兒死亡 的第二常見原因 左圖，孕婦腹部撞擊方向盤， 導致胎盤剝離 8. 急診處置 孕婦評估 –同ATLS流程 –對母親最適當的急救，就是對胎兒最好 的照護。

–孕婦儘可能保持左側躺的姿勢。

右髖部墊高、長背板左傾15-30度 9. 用雙手將子宮推向左側 10. 用長背板支持骨盆和胸部 將病人往左外側傾斜30° 11. 急診處置 胎兒評估 –胎兒評估始於胎心音監測 –創傷產婦，胎兒監測最少應監測四小時 –正常胎心音FHB：120-160bpm –FHB↓→缺氧 可能原因：母親低血壓、低體溫、呼吸窘迫、胎盤剝離… –孕婦死亡五分鐘內進行剖腹產 胎兒有良好的預後（70%存活率） –若無胎心音，不必要進行剖腹產 大部分在一週內會自行產出 12. FHB uterinecontractions Fetaltocodynamometry.Normaldecelerations. 13. FHB uterinecontractions Fetaltocodynamometry.Abnormalorlatedecelerations. 14. 胎兒初級評估：是 胎心音 子宮大小＞24周 否 不管胎兒胎心音穩定若胎兒＞24周 急救母親監測四小時 穩定 母親次級評估 緊急超音波檢查 若胎兒＞24周 母親初級評估穩定胎心音不穩定 考慮緊急剖腹產 急救母親 不穩定 不穩定有胎心音若胎兒＞24周 考慮緊急剖腹產 母親心跳停止 停止急救 無胎心音 孕婦創傷急救流程 15. 何時要做放射影像檢查？ 當臨床狀況必須實施診斷性放射影像 檢查時，就不應該因考慮胎兒輻射傷 害而延誤檢查 風險評估：診斷性放射檢查對母親的 好處，遠超過對胎兒造成的傷害 放射傷害對胎兒的致畸胎性 (teratogenesis)在懷孕第10-17週達 到最大，小於5rad的輻射量對 胎兒並無顯著的影響 16. 懷孕時期，小於5rad的累積輻射暴露劑量 對胎兒的影響可以忽視，是可被接受的 影像檢查輻射暴露劑量 Cervicalspine<1.0rad Chest(twoviews)0.05rad Anteroposteriorpelvis<1.0rad Hip0.2rad HeadCT<1.0rad ChestCT<1.0rad AbdomenandL-spineCT3.5rad 17. 摘要 ATLS流程同非懷孕者 先急救母親，再評估胎兒 孕婦可能保持左側躺的姿勢、左傾15- 30度可改善母親和胎兒的循環 必要的放射影像檢查勿因胎兒而延誤 懷孕大於20-24周，胎心音監測 至少四到六小時 18. 急診專科醫師 甄審考題 19. 關於正常懷孕的生理變化，下列敘 述何者錯誤？ A.白血球數目增加，血紅素濃度減少 B.全身血量增加，心臟輸出增加 C.收縮壓及舒張壓皆降低，但舒張壓降低較 多 D.呼吸速度變快，潮氣容積增加 E.較大的失血量才會出現週邊灌流不足（休 克）的徵象 【99急專】 20. 治療懷孕的外傷病人時，下列敘述 何者正確？ A.一般治療的優先順序（priority）與未懷孕 者是不同的 B.先治療孕婦的傷勢再對胎兒做早期評估 C.面對孕婦與胎兒若兩者均存活則先治療哪 一位以當時狀況而定 D.Ｘ光檢查在懷孕初期不可使用 E.需待孕婦傷勢穩定後再會診婦產科 【96急專】 21. 25歲女性，現懷孕28週，因下樓梯摔 倒，撞傷右腰部至急診，病人生命跡象 正常且穩定，無腹痛、宮縮、破水或陰 道出血。

接下來何者處理最適當？ A.安排超音波檢查，無異常則出院回家觀察 B.安排腹部電腦斷層 C.出院回家觀察，給予衛教，安排門診追蹤 D.住院觀察至少48小時 E.體外tocodynamometricmonitoring至少4 小時 【99急專】 22. 35歲婦人懷孕24週、體重65公斤，於人行道遭腳踏車 擦撞腹部，被救護車送來急診時，體溫36.7℃，呼吸23 次/分鐘，心率110次/分鐘，血壓120/80mmHg。

病人 主訴劇烈下腹痛並感覺有宮縮。

理學檢查發現下腹壓痛但 無反彈痛合併陰道少量出血，以下關於此孕婦敘述何者錯 誤？ A.孕婦不知自己的血型，但已知孕婦丈夫的血型為typeORh（- ），因此不論驗出產婦的血型為何，都不需要給予Rh0D immuneglobulin B.外傷引起胎兒最常見的死因為母親死亡，第二常見為胎盤前置 C.安胎藥可能會影響到初步創傷評估 D.雖然此孕婦的血壓仍在正常範圍，但其出血量仍有可能超過 1500ml E.若母親在急診處置後仍不幸心跳停止，可考慮緊急剖腹生產 【99急專】 23. 參考資料 AdvancedTraumaLifeSupport®, 8thEd,2008,p259-268 Tintinalli'sEmergencyMedicine: AComprehensiveStudyGuide, 7thEd,2010,p1687-1692 Rosen'sEmergencyMedicine, 7thEd,2010,p252-261 2likes × KevinLi Jun.06,2021 WillemJooste Apr.20,2015 EmergencyMedicineRegistrar at ERConsulting Views × Totalviews 7,959 OnSlideShare 0 FromEmbeds 0 NumberofEmbeds 3,904 Youhavenowunlockedunlimitedaccessto20M+documents! × UnlimitedReading Learnfasterandsmarterfromtopexperts UnlimitedDownloading Downloadtotakeyourlearningsofflineandonthego YoualsogetfreeaccesstoScribd! Instantaccesstomillionsofebooks,audiobooks,magazines,podcastsandmore. Readandlistenofflinewithanydevice. FreeaccesstopremiumserviceslikeTuneln,Mubiandmore. DiscoverMoreOnScribd × ShareClipboard × Facebook Twitter LinkedIn Link Publicclipboardsfeaturingthisslide × Nopublicclipboardsfoundforthisslide Selectanotherclipboard × Lookslikeyou’veclippedthisslidetoalready. Createaclipboard Youjustclippedyourfirstslide! Clippingisahandywaytocollectimportantslidesyouwanttogobacktolater.Nowcustomizethenameofaclipboardtostoreyourclips. Name* Description Visibility OtherscanseemyClipboard Cancel Save SharethisSlideShare SpecialOffertoSlideShareReaders × TheSlideSharefamilyjustgotbigger.Younowhaveunlimited*accesstobooks,audiobooks,magazines,andmorefromScribd. Activateyourfree60daytrial Cancelanytime.