nyenaceyg
Dołączył: 13 Gru 2010
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Skąd: England
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 Wysłany: Nie 23:46, 06 Mar 2011 Temat postu: 7 cases of heart, lung, Successful treatment of st |
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7 cases of heart, lung, Successful treatment of stab injury experience
Especially pay attention to or inclined toward the heart of the wound tract. The rapid emergence of the chest injury is difficult to correct the shock and (/ or) Beck triad,[link widoczny dla zalogowanych], and clinicians are generally not misdiagnosed, in the heart of the wound surface projection area or left upper quadrant, especially the treatment of patients immediately after injury, Even without hemorrhagic shock, cardiac tamponade, such as performance, but also should take into account the possibility of penetrating cardiac injuries. It has been reported in patients with pericardial and pleural cavity interlinked rip the heart out of the blood by pericardial drainage gap to the pleural cavity, delayed cardiac tamponade occurred at a time _2J. Another report, pericardial tamponade after cardiac trauma accounted for only 57% to 69%, showed the typical triad in only 35% to 40%, while a small number of delayed cardiac tamponade. Penetrating wound in the group 3 cases pericardial tamponade, 2 cases of hemorrhagic shock, this has obvious 5N precordial wound. 1 patient from Zuoye wound tract through the left front 5th intercostal lung, left lung directly to the left ventricle, blood loss of 2600ml, because preoperative accurately determine the wound tract, heart damage has been fully prepared and no delay in treatment Therefore, the surface wounds do not mind or do not appear before the district can not ignore when cardiac tamponade cardiac injury. To improve early diagnosis, we must note the following: ① the wound before the area does not mind who still need to carefully determine the direction of the wound, acts of depth. ② break the heart of a small number of injured is very small, blood clots can occur after falling off delayed cardiac tamponade, vital signs should be closely observed. ③ shock and blood loss, the wounded out of proportion by the anti-shock hard to correct, should be the appropriate indications for exploratory thoracotomy relaxed. In addition,[link widoczny dla zalogowanych], penetrating wounds in the heart of the process of diagnosis and rescue measures simultaneously. Relatively stable condition was feasible on the chest x-ray,[link widoczny dla zalogowanych], CT examination can be pericardiocentesis, echocardiography and so on. But if a clear history of trauma, in the critical state line can not be time-consuming laboratory examinations, and treatment should immediately take the necessary measures to promptly arrange surgery, is the key to saving _4]. 'The choice of incision depends on the location and the chest wound may hurt the heart of the site. Accessible to left anterior incision anterior LV and right ventricle, right lateral chest incision for the treatment of right atrium and the vena cava, if necessary, to increase cross-sectional sternum revealed. The selection of 6 cases of left lateral chest incision, thoracotomy fast, revealing good; one case of chest stab wounds were the right choice right anterolateral incision. After thoracic laceration should continue probe of lung pericardium, great vessels, to distinguish whether the loss of blood from the pulmonary laceration only. When they find both have heart damage lung laceration should first deal with the latter. Good exposure before pericardial incision surgical field, ready and adequate suction blood. The inner product of the rapid removal of pericardial blood pressure with your fingers rip the heart temporarily stop the bleeding, to accelerate blood transfusion, infusion rate,[link widoczny dla zalogowanych], along with the needle line invasive edge of both sides of the injury as sneaking under the myocardial arterial suture to prevent damage coronary vessels, small coronary artery branches can be ligated. Gap can be non-invasive atrial appendage clamp forceps or stay after the continuous suture rupture. Are as sparse pericardial suture and drainage in the phrenic nerve above the window. Accompanied by structural damage to the heart surgery patients was appropriate to take two,[link widoczny dla zalogowanych], in the heart of acute trauma, the key is repairing the heart surface wounds, bleeding to solve problems, structural damage heart no significant effect on hemodynamics, could be two surgical treatment. To meet the repair of cardiac injury should not rip no bleeding, should be comprehensive and systematic examination, to prevent the omission of other parts of the injury. It has been reported after repair of the heart that a lot of blood in the chest, once again see the intercostal thoracic vascular rupture J, attention should be paid. For the case of dying Do not give up treatment should be carried out quickly into the chest heart massage, but the heart of gap repair, quick to add volume, do everything possible to save the patient's life. [
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