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Definition of shock
Inadequate tissue perfusion and oxygenation
Basic cardiac pathophysiology
Preload = Right atrial pressure – Mean systemic venous pressure
1. Venous volume that serves as reservoir
2. Venous volume that contributes to MSVP
Myocardiac contractility
Preload determines fiber length according to Starling law
Afterload : resistance to the forward flow of blood
출처 : 해피캠퍼스
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Epidemiology
.Injuries due to motor vehicles are the most common cause of death in children of all ages
.Blunt mechanisms of injury and children’s unique physical characteristics result in multisystem injury
.The condition of the majority of injured children will not deteriorate during treatment, and most injured children have no hemodynamic abnormalities. Nevertheless, the condition of some
children with multisystem injuries will rapidly deteriorate, and serious complications will develop
Unique characteristics of Pediatrics
출처 : 해피캠퍼스
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Patient identification
Chief complaint
Present Illness
환자 사진
Physical Exam
Lab/ECG
Initial assessment
Image findings
Plan
Neck injury
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Patient identification
O O O(F/64)
Vital sign: BP 119/73mmHg HR 100회/분 RR 16회/분 BT 37.2℃
Chief complaint
좌측 목 열상
내원시각: 2021-02-21 03:11
Onset time: 2021-02-21 02:30
<중 략>
Plan
환자 혈관, 기도, 식도 손상의 징후가 보이지 않아 우선 봉합 후 필요시 내시경, 후두경, 수술적 탐색고려.
입원 후 경과관찰 위해 이비인후과 협진 하였으나 이비인후과 당직의사 연락 되지 않아 타원 transfer(의정부성모)
출처 : 해피캠퍼스
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1. Anatomy
2. Physiology
3. Evidence-Based Treatment Guidelines
4. Primary Survey and Resuscitation
5. Secondary Survey
6. Diagnostic Procedures
7. Medical Thera pies for Brain Injury
8. Surgical Management
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Anatomy
Meningeal arteries
Lie between the dura and the internal surface of the skull in the epidural space. Overlying skull fractures can lacerate these arteries and causean epidural hematoma
The most commonly injured meningeal vessel is the middle meningeal artery, which is located over the temporal fossa. An expanding hematoma from arterial injury in this location can lead to rapid deterioration and death
Physiology
Intracranial Pressure
Elevation of intracranial pressure (ICP) can reduce cerebral perfusion and cause or exacerbate ischemia
The normal ICP for patients in the resting state is approximately 10 mm Hg. Pressures greater than 22 mm Hg, particularly if sustained and refractory to treatment, are associated with poor outcomes
출처 : 해피캠퍼스
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* Trimodal distribution
1st peak
병원 도착 전 사망
두부 파열 / 주요 장기손상
2nd peak
병원 도착 수분~수시간내 사망
두부/흉부/복부 장기손상
3rd peak
사고 수일 이후 사망
패혈증 / 다발장기부전
* ATLS
– Primary survey
– Airway maintenance with restriction of cervical spine motion
– Breathing and ventilation
– Circulation with hemorrhage control
출처 : 해피캠퍼스