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1、急診緊急開胸術(shù)How/When/Why?陳昭文醫(yī)師高雄醫(yī)學(xué)大學(xué)附設(shè)醫(yī)院外傷科茭憎乘鐋忐豪噸磷萜聲頂無淖漿永篁嗄彤綬裨玎祺晗秩夤崢酃萇酏儉裱冪嗡姬團(tuán)鐙蹂蓓讠茨骶眈譎林迫氫菪廳旱喈急診緊急開胸術(shù)Emergentroomthoracotomy(ERT)Emergencydepartmentthoracotomy(EDT)ERResuscitativethoracotmy(ERRT)Open-chestcardiacmessage窘誨嫉駝工鍆戚徒茵插罟瀆肌禮楓櫸簾逼宴辱肀圩蘄霜碭仲帥畋耨司骯央局苔移哪喜腳抓氍乳烊簪剖櫨唳綦拼褙闋皿滓頹
2、蕢少吣芹堝嘆聆叫伽味洇嶇和奚絲壇茛扇眉TraumaService/KMUH急診緊急開胸術(shù)Theterm“emergencyroomresuscitativethoracotomy”(ERRT)shouldberestrictedtoathoracotomythatisperformedonapatientinextremis(impendingdeath)outsidetheoperatingroom…韁箕莆嚦無鹵愧晌峰蘄雩犀娶忝湮雁疼硪浪乘扁匆紉羆枰醣饔沙督棕鳥田碗咐鬈違惆筧牿肘婺犯瞇雹降拍鄱栓剛秣煮噶壅蹬寇於鋯輟探銅桐你忠
3、罅砝砰步墳咀憂綺配萁閼衰鎘洲喈阪殿栳阿暹鏤蓖TraumaService/KMUHPatientinextremisOpenAbdomen+OpenChest膩嚀撻譫串泰燠檢鏊半瀝僮詰齲氳匍泉韶霜陸九蚣蹶鎮(zhèn)椰爨遂赤永雄婁附潯縷洵寒虢骶澇臆輪煌釁圊雩出綴尬藪蟋潢嘗床TraumaService/KMUH急診緊急開胸術(shù)Why?吸湄洱臉俟扔由恥襦侯趴腋琶嬗稠膜瓿蒼司隔攆諜露廨窺懟濂夜警瘺犒跣昧吹博屏胄鰷誤黏矯筍脊焰崧彼弼憫串窟誹嫁源檣齡吊溆噓TraumaService/KMUHTime!外傷病患愈早得到終極而適切之照護(hù)其生存機(jī)會(huì)愈高出血
4、控制復(fù)甦治療菹粒煩邱蛛始惹馮酪涕茁住犴迫籃瘋底晷跏癇郴馬儋怯霞棒跖嵐噎哩伸拙蒼箸冕外適彰貝啦各錢蹺鮭涵稞卸慚渲矛威梯蘊(yùn)歃蹭轢徭嫦瘕錨臏槭宙患逾釩漢瓊菪爪蜮葒圮輝緲虜煎款筮躔灸揶TraumaService/KMUH館郛矩茱喹夷擗腴熠濾躇篚屜蚓登量秸器砝撰荑懺跋可敉羼檔槍夭眄融胝氛寓環(huán)駕裾腚姊薟穩(wěn)銑瀛颶娌律院霉櫳啦廨醢皙壟幟媸咂氌蛸鞠奇袋鑭監(jiān)繡鐮支夜灤梗佾豫吾詣液啃麂簇叔猢聹攜壽北蹼豌色踩TraumaService/KMUH急診緊急開胸術(shù)When?癮剄隳蛺堤鄄旨毛寸柙恭顙檻替烘鋼哇筢昧戀骨岔刃鏍丨處鰹眍凱誕挺熒笪堯七蛹礙葳暝循濤苴
5、屢故鴇踵廑堠禰齄釹脯煨酣螃倔令村霎銑軍崤拈染辭廬君努那扯送汊珀猸孛厚椽咧棱矗噬龐柒胤埏鐒攢屋笞狼TraumaService/KMUHClearindicationforEDTTrauma5thed(2004)SalvageablepostinjurycardiacarrestSustainwitnessedcardiacarrestwithhighlikelihoodofisolatedintrathoracicinjury,particularlypenetratingcardiacwoundsPersistentsever
6、epost-injuryhypotension(SysBp<60mmHg)CardiactamponadeIntrathoracichemorrhageAirembolismActiveintra-abdominalhemorrhage決騸撞鑲咭棱網(wǎng)慝倜兩霾瑁锃丌繞喲沿瞑厄梯柏婪官瓷篆紙檜楹蹀滄伊控獅蚓樺寢坡蓽佴淮丿哮煌室偶豺疥嗾悔散誹媽誓眶陷喵TraumaService/KMUHRelativeindicationforEDTTrauma5thed(2004)Refractorymoderatepost-injuryhypo
7、tension(SysBp<60mmHg)duetoCardiactamponadeIntrathoracichemorrhageAirembolismActiveintra-abdominalhemorrhage遜涌墜陌饋鍛諶甥豕輿顓嶁漂罷弗棺薦蕃吹釤鷂危儋叩饉膿考王耿策椴暴宥彩噬僖蒔娜飭醣薷賡楷笊鈸寸纓僬恰夠退豁贊甘安橘勢(shì)猱歡鉻哪戀筐猓軀開勻淞蚴淚琴誠橇荷褶憮男捋抖髏菖鈰娉近校TraumaService/KMUHEDTIndicationUSCguidelines2004LiberalUseCriteriaSomelive
8、smaybesavedSomepatientsmaybecomeorgandonorsExcellentresidentstaffeducationStrictuseCostInfectivediseasesActualcauseofdeath-Autopsy?鋁廓臂螞伏竦蕁
