Imuduro Pigugu Pelvic, Isopọ Ayika, ati Ẹjẹ inu¶

A high-energy pelvic ring fracture is one of the most lethal injuries in trauma medicine, carrying a mortality rate of 15 to 50 percent when accompanied by hemodynamic instability. Unlike a long bone such as the shin or forearm, the human pelvis is a rigid bony ring made up of two large innominate (hip) bones joined in front at the pubic symphysis and anchored in back to the sacrum by the strongest ligaments in the body. When a high-speed car crash, motorcycle collision (where the pelvis slams forward into the fuel tank), pedestrian strike, crush injury, or fall from a height breaks this ring in two places and tears the posterior sacroiliac ligaments, the pelvis hinges open like the covers of a book (an "open-book" pelvic fracture).

Bi awọn orisun omi ibadi egungun ti n ṣii, iwọn iyipo inu inu rẹ n gbooro pupọ, ṣiṣẹda aaye igbale retroperitoneal nla ti o le gbe ** 3,000 si 5,000 milimita (6 si 10 pints) ti ẹjẹ ** (gbogbo iwọn ẹjẹ ti alaisan ti n kaakiri) laisi isunmọ ẹjẹ kan ti o han ni ita awọ ara. Ti o buru ju, awọn olugbala ti o ni itumọ daradara nigbagbogbo npa awọn olufaragba ibalokanjẹ ibadi nipa titari tabi gbigbọn awọn ibadi lati “idanwo fun dida egungun” tabi nipa yiyi alaisan naa si ẹgbẹ wọn, eyiti o fa awọn didi ẹjẹ retroperitoneal ẹlẹgẹ. Mọ idi ti o ko gbọdọ ** lailai rọ pelvis ***, idi ti a ibadi Asopọmọra tabi improvised bedsheet gbọdọ wa ni ti dojukọ muna lori awọn ** nla trochanters ti awọn femurs ** (ati ** kò ** ga soke lori awọn ẹgbẹ-ikun tabi iliac crests), ati bi o si di awọn ẽkun ati awọn kokosẹ fipamọ ni ti abẹnu yiyi oruka aye pa pelvic.

Ṣe eyi ni bayi¶

1. **Pe nọmba pajawiri ti agbegbe rẹ lẹsẹkẹsẹ ki o beere fun Advanced Life Support (ALS) paramedics fun amojuto ni Ipele 1 Trauma Center ọkọ. pajawiri awọn nọmba.
2. NEVER "spring," rock, push, or compress the hip bones to check if the pelvis is broken. Pushing down or inward on an unstable pelvis grinds razor-sharp bone fragments through the sacral venous plexus and internal iliac arteries, dislodging the fragile initial blood clots that are keeping the patient alive. If the mechanism of injury or symptoms suggest a pelvic fracture, assume the pelvis is broken and bind it.
3. NEVER log-roll a suspected pelvic fracture victim onto their side unless their airway is actively blocked by vomit or blood. Rolling a casualty onto the side of a broken pelvis crushes the iliac wing inward and shears the retroperitoneal vessels. Keep the patient flat on their back (supine) and use a multi-rescuer flat vertical lift ("bridge lift") or scoop stretcher if movement is unavoidable.
4. Apply a commercial Pelvic Binder (SAM Pelvic Sling, T-POD, or Prometheus) or a folded Bedsheet Binder centered strictly over the GREATER TROCHANTERS (the bony bumps on the outer upper thighs/hips), NOT over the waist or upper hip crests. Sliding a folded sheet smoothly underneath the hollow of the knees and pulling it up to the level of the greater trochanters and pubic symphysis leverages the femur heads inward to close the "open book" pelvis.
5. ** Rọra yi awọn ẹsẹ mejeeji si inu ("ika-ika ẹiyẹle") ki o si di eeya-ti-ẹgbẹ mẹjọ bandage tabi paadi-ati-okun ni ayika awọn ẽkun ati awọn kokosẹ. ṣii.
6. ** Jeki alaisan naa ni muna NPO (ko si nkankan nipasẹ ẹnu) ki o fi ipari si ori-si-ẹsẹ ni awọn ibora ti o gbona lati yago fun hypothermia ati coagulopathy. ti alaisan ba tutu lori pavementi, awọn enzymu didi ti o wa ni pipade ati ẹjẹ inu inu di aiduro.

Igi ipinnu pajawiri fun ifura pelvic oruka fractures¶

flowchart TD
    Start["High-Energy Blunt Trauma: Motor Vehicle Crash, Motorcycle Impact,<br/>Pedestrian Struck, Fall > 3 m (10 ft), Horse Trampling, or Crush Injury"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Keep patient strictly flat (supine); DO NOT log-roll onto side;<br/>DO NOT push or rock the hips ('No Pelvic Springing')"]
    AssessSigns{"Are Pelvic Fracture Criteria or Visual Signs Present?<br/>- Severe hip, groin, lower back, or sacroiliac pain<br/>- Unexplained tachycardia / shock after blunt trauma<br/>- One or both legs flopped outward (external rotation) or one leg shorter<br/>- Bruising over scrotum/labia, perineum, flanks, or blood at urethra"}
    NoPelvic["NO PELVIC FRACTURE SUSPECTED<br/>Continue standard trauma assessment, spinal precautions,<br/>and shock warming until EMS arrival"]
    PrepBinder["PREPARE FOR CIRCUMFERENTIAL PELVIC STABILIZATION<br/>1. Empty trouser pockets (remove keys, wallet, phone, belt)<br/>2. Select Commercial Pelvic Binder (SAM Sling / T-POD)<br/>   OR fold a strong cotton bedsheet smoothly to 15-20 cm (6-8 in) width"]
    SlideSheet["SLIDE BINDER UNDER PATIENT WITHOUT LIFTING OR LOG-ROLLING<br/>1. Pass binder under the natural hollow beneath the KNEES<br/>2. Use a smooth 'seesaw' sawing motion to slide sheet up beneath lower thighs/buttocks<br/>3. Center strictly over the GREATER TROCHANTERS & PUBIC SYMPHYSIS<br/>   (NOT high up over the iliac crests / waist)"]
    TightenLeg["CLOSE THE PELVIC RING & INTERNAL-ROTATE LEGS<br/>1. Have assistant gently bring legs together and rotate feet INWARD ('pigeon-toed')<br/>2. Pull binder straps/sheet ends firmly across front of greater trochanters<br/>3. Lock commercial buckle OR twist/clamp/tie sheet ends securely in front<br/>4. Pad between knees/ankles and tie figure-of-eight strap around ankles & knees"]
    ShockCare["PREVENT LETHAL TRAUMA TRIAD & MONITOR<br/>1. Wrap patient in warm blankets / thermal foil<br/>2. Keep strictly NPO (nothing by mouth)<br/>3. Do NOT remove or loosen pelvic binder until inside Trauma Resuscitation Bay"]

    Start --> CallEMS
    CallEMS --> AssessSigns
    AssessSigns -->|No| NoPelvic
    AssessSigns -->|Yes: Any Criterion Present| PrepBinder
    PrepBinder --> SlideSheet
    SlideSheet --> TightenLeg
    TightenLeg --> ShockCare

Ifiwera awọn oriṣi Young-Burgess mẹrin ti awọn fifọ oruka ibadi¶

Orthopedic trauma surgeons classify pelvic ring fractures by the direction of the crushing force (the Young-Burgess classification). Understanding how the pelvis breaks explains why an "open-book" fracture causes the legs to flop outward and why internal bleeding is so ferocious.

Anatomi ati pathophysiology: Kini idi ti pelvis ti o fọ le ṣe ẹjẹ jade 5 liters ti ẹjẹ ni inu¶

1. Geometry ti Sphere: Kini idi ti ṣiṣi pelvis nipasẹ 5 centimeters ṣẹda ifiomipamo ẹjẹ nla kan¶

Ninu pelvis agbalagba ti ko tọ, oruka egungun naa ṣe agbada iwapọ hemispherical kan ti aijọju ** 1.5 liters (pints 3) ***, ti kojọpọ ni wiwọ nipasẹ peritoneum parietal lile ati fascia. Ti ohun elo ẹjẹ kekere kan ba ya ni inu pelvis * ti ko tọ, ẹjẹ yara yoo kun aaye kekere yẹn, ti o nipọn titi titẹ ẹjẹ ti o ni idẹkùn ṣe dọgba titẹ inu awọn iṣọn, nipa ti ara ẹni ti n jo (self-tamponade).

Bibẹẹkọ, ninu ** iwe-ìmọ (APC) tabi inaro-shear pelvic fracture ***, pubic symphysis rips ṣii ni iwaju, awọn ligament sacroiliac rip ni ẹhin, ati awọn fascia ilẹ ibadi lile ti ya sọtọ: * Nipa ofin mathematiki ti iwọn didun aaye kan (\(V = \ frac{4}{3}\pi r^3\)), gbogbo ilosoke kekere ninu radius (\(r\)) ti oruka ibadi mu iwọn didun inu rẹ pọ si nipasẹ **cube ti rediosi **. * Ti iwaju ibadi ba ṣii nipasẹ ** 5 centimeters (2 inches) ***, iwọn didun inu ti iho ibadi n fo nipasẹ diẹ sii ju ** 400 ogorun **. * Paapaa ti o buruju, ni kete ti ilẹ ifasilẹ ti pelvis omije, ẹjẹ ko ni fimọ si pelvis mọ: o tọpa larọwọto si oke lẹhin ti inu inu sinu aaye nla ** retroperitoneal ** ni gbogbo ọna titi de awọn kidinrin ati diaphragm. Retroperitoneum le gba ** 4,000 si 5,000 milimita (8 si 10 pint) ti ẹjẹ *** ki titẹ to ga to lati fa ẹjẹ silẹ, itumo agbalagba yoo jẹ ẹjẹ si iku tipẹ ṣaaju ki ara-tamponade lailai waye.

2. Awọn orisun mẹta ti Ẹjẹ Ẹjẹ Pelvic (ati idi ti dinder kan duro meji ninu wọn)¶

Nibo ni gbogbo ẹjẹ yẹn ti wa lati inu ibadi ti o fọ? 1. Plexus Presacral ati Prevesical Venous (80% si 85% ti awọn ọran): Nẹtiwọọki ipon, oju opo wẹẹbu ti o tobi, tinrin, awọn iṣọn ti ko ni falifu ti a plastered taara si iwaju sacrum ati lẹhin egungun idọti. Nigbati sacrum tabi egungun pubic ba dojuijako, awọn ọgọọgọrun ti awọn iṣọn wọnyi ti wa ni gige ni nigbakannaa. 2. Spongy Cancellous Egungun Ọra inu Egungun: Awọn iyẹ iliac alapin ati sacrum ti kun fun ọra inu egungun pupa ti iṣan; awọn oju eegun aise ti o fọ ti n jade ni iyara bi kanrinkan tutu. 3. ** Awọn ẹka iṣọn-ẹjẹ inu Iliac (10% si 15% ti awọn ọran):** Awọn omije iṣọn-titẹ ga julọ (julọ julọ ** iṣọn-ẹjẹ gluteal ti o ga julọ ** nibiti o ti kọo ni ayika ogbontarigi sciatic ti o tobi julọ, tabi ** pudendal inu ati awọn iṣọn obturator **). * ** Bawo ni Asopọ Pelvic ṣe n ṣiṣẹ: *** Fifẹ iyipo iyipo ti o muna ni ayika ** awọn trochanters nla *** ni ọna ẹrọ tilekun oruka ibadi pipin pada si rediosi kekere rẹ deede (mu pada sipo ** retroperitoneal tamponade kompaktimeti **), tẹ awọn eegun eje aise dada taara si ara wọn lati da awọn ọra inu ọra inu eegun duro, ati pe awọn didi egungun ko le gbe. ọkọ alaisan ọkọ.

Bii o ṣe le ṣe idanimọ dida egungun ibadi laisi gbigbọn ibadi lailai¶

Idi ti "Pelvic Springing / Rocking" jẹ eewọ muna¶

Fun awọn ewadun, awọn iwe-ẹkọ iranlọwọ akọkọ ti atijọ kọ awọn olugbala lati gbe ọwọ wọn si awọn ibadi ibadi mejeeji ati titari ni agbara si isalẹ ati ita (“gbigbọn tabi orisun pelvis”) lati ni rilara fun egungun grating (** crepitus**) tabi aisedeede. ** Awọn itọnisọna ibalokanjẹ ode oni (ATLS, PHTLS, CoTCCC, NICE, JRCALC) ṣe idiwọ orisun omi ibadi patapata: *** * Titari pẹlu ọwọ titari oruka ibadi ti ko ni iduroṣinṣin ni ifamọ ni isalẹ 60 ogorun, o fa irora nla, ati ** pa awọn alaisan ni ipa nipasẹ yiyo kuro ni didi didi fibrin ti a ṣẹṣẹ ṣẹda ti o bo plexus iṣọn iṣọn sacral ti ya ***. * Paapaa ni ibi ibalokanjẹ ti ile-iwosan, ti o ba jẹ pe paramedic kan ti gbe iwe afọwọkọ ibadi kan ti o da lori ilana jamba, awọn oniṣẹ abẹ ọgbẹ ti lọ kuro ni asopọmọra titi di igba ti a ti ya ọlọjẹ CT tabi pelvic X-ray.

Ailewu mẹfa, awọn itọka ọwọ ti o tọka si dida egungun ibadi kan¶

1. ** Ẹrọ Agbara-giga + Ibalẹ ti ko ṣe alaye:** Eyikeyi olufaragba ti ijamba ọkọ ayọkẹlẹ iyara to gaju, jamba alupupu, idasesile ẹlẹsẹ, ijamba ẹṣin, ipalara fifun pa, tabi ṣubu lati> awọn mita 3 (ẹsẹ 10) ti o ni oṣuwọn ọkan iyara (** tachycardia> 100 bpm ***), awọ didan, tabi idarudapọ gbọdọ jẹ bibẹẹkọ.
2. ** Ipo Irora (ninu awọn alaisan ti o ni imọran): *** Irora lẹẹkọkan ni ** ibadi, ikun, agbegbe agbegbe, ẹhin isalẹ (sacrum), tabi buttocks ***, tabi ailagbara lati gbe boya ẹsẹ kuro ni ilẹ.
3. ** Yiyi ti ita tabi Kikuru Awọn Igun Isalẹ: ** Wo isalẹ ni ẹsẹ ẹni ti o jiya nigbati wọn dubulẹ lori ẹhin wọn. Ninu fifọ ibadi iwe-ìmọ, ẹsẹ kan tabi mejeeji yoo jade sita ki eti ita ti ẹsẹ duro si ilẹ (** Yiyi ita**). Ni inaro rirẹ rirẹ-ara (tabi iṣipopada ibadi ẹhin), ẹsẹ kan wulẹ **2 si 5 centimeters (1 si 2 inches) kuru ** ju ekeji lọ.
4. ** Awọn ami Urogenital ati Perineal (50% ti awọn fifọ ibadi ti o buruju ṣe ipalara fun àpòòtọ tabi urethra):**
5. Ija ẹjẹ pupa didan kan ni ipari ti kòfẹ tabi ṣiṣi urethra (ẹjẹ ni ẹran urethral).
6. Ọgbẹ eleyi ti dudu ati wiwu ti scrotum, labia, tabi perineum (** ami Destot**).
7. Ẹjẹ abẹ tabi eje rectal (eyiti o tọkasi ** ṣẹguku ibadi ti o ṣii ** nibiti o ti lu egungun ti o ni iha inu obo tabi rectum, ti o ni eewu ajalu ti exsanguination mejeeji ati sepsis polymicrobial pelvic sepsis).
8. ** Retroperitoneal Flank Bruising:** Ọgbẹ bulu-eleyi ti o farahan ni ẹgbẹ ẹgbẹ (Ami Grey Turner) tabi loke ligamenti inguinal (** ami Akata**).
9. ** Ifọwọkan Ifọwọkan Kanṣoṣo (Nikan ti o ba jẹ mimọ ati ayẹwo jẹ aidaniloju patapata):** Ti alaisan ti o ni oye ba ni ilana kekere kan ati pe o ko ni idaniloju boya pelvis ba farapa, o le ** rọra lero egungun iwaju iwaju ati ẹhin ibadi pẹlu awọn ika ika ọwọ *** lati beere boya o jẹ tutu, ati ** ti o ba ṣe ayẹwo iduroṣinṣin kan nikan ni eto ile-iwosan gently, tẹ ni kete ti o tẹ aarin. ni awọn trochanters, MASE titari si ita tabi isalẹ ***.

Ilana Igbesẹ-igbesẹ: Lilo Binder Pelvic Ti Iṣowo tabi Imudara Bedsheet Binder¶

Igbesẹ 1: Mura alaisan ati ofo gbogbo awọn apo¶

1. Jeki alaisan naa dubulẹ patapata ** alapin lori ẹhin wọn (supine) ***.
2. ** Sofo gbogbo awọn apo ati yọ awọn igbanu kuro:** Ṣaaju ki o to fi ipari si ohunkohun ni wiwọ ni ayika ibadi, lo awọn irẹrun ibalokanjẹ lati ge kuro tabi sọ ohun gbogbo ti o wa ninu iwaju, ẹgbẹ, ati awọn apo sokoto sẹhin (awọn foonu alagbeka, awọn bọtini, awọn apamọwọ ti o nipọn, awọn owó, awọn buckles igbanu, tabi awọn irinṣẹ). Titọpa ohun elo ibadi lori ṣeto awọn bọtini tabi foonu ninu apo kan yoo wa ohun elo irin sinu awọ ara lori egungun, nfa ọgbẹ titẹ necrotic nipọn ni kikun laarin awọn iṣẹju 60.

Igbesẹ 2: Wa ami-ilẹ anatomical gangan: Awọn Trochanters Greater¶

Lati wa ** awọn apanirun nla *** lori eyikeyi alaisan: 1. Ma ṣe rilara ni ẹgbẹ-ikun tabi oke ti egungun ibadi (iyẹn ni * crest iliac, eyiti o jẹ 10 si 15 centimeters / 4 si 6 inches ga ju). 2. Dipo, rọra awọn ọwọ ibọwọ rẹ si isalẹ ita itan oke alaisan si ipele ti egungun pubic (crotch) ni iwaju ati **apakan ti o tobi julọ ti awọn buttocks *** ni ẹhin. Iwọ yoo ni imọlara lile, olokiki egungun knobby ni ẹgbẹ ita ti abo oke kọọkan: iyẹn ni ** trochanter nla **. 3. Laini aarin ti pelvic binder tabi ti ṣe pọ ** gbọdọ kọja taara kọja awọn apanirun nla mejeeji ati kọja symphysis pubic ***.

Igbesẹ 3A: Lilo Binder Pelvic Commercial (SAM Pelvic Sling II, T-POD, tabi Prometheus)¶

1. ** Rọra labẹ awọn ẽkun ni akọkọ (Ọna-ọna Ko si gbe):** Fọ alapapọ alapin ki o si rọra rẹ nipasẹ aafo ṣofo adayeba labẹ awọn orunkun alaisan ** (maṣe gbe tabi gbe pelvis silẹ rara).
2. ** Wo si oke si ipo: ** Dimu opin kan ti asopo ni ẹgbẹ kọọkan ti alaisan, lo iṣipopada iṣipopada ẹgbẹ-si-ẹgbẹ lati rọra alapapo laisiyonu nisalẹ awọn itan ati awọn abọ isalẹ titi ti o fi dojukọ taara lori ** awọn trochanters nla **.
3. Yi awọn ẹsẹ lọ si inu: Jẹ ki olugbala keji di awọn kokosẹ alaisan mu ki o si rọra mu awọn ẹsẹ jọpọ lakoko ti o yi awọn ẹsẹ pada si inu (" ika ẹsẹ-ẹiyẹle").
4. **Fa ati titiipa: ***
5. Fun kan ** SAM Pelvic Sling ***, fa okun dudu ni iduroṣinṣin nipasẹ buckle Autostop lakoko ti o nfa imudani idakeji ni itọsọna counter-itọsọna titi di titẹ mura silẹ ati titiipa irin meji si awọn perforations (ti a ṣe apẹrẹ lati tii laifọwọyi ni deede ** 150 Newtons / 33 poun ti iyipo iyipo ** nitorina o ko le bori-fifẹ), tẹ okun pọ si isalẹ.
6. Fun kan ** T-POD ***, ge igbanu ti o lọ kuro ni 15-to-20-centimeter (6-to-8-inch) aafo lori iwaju pelvis, so ọna ẹrọ pulley ẹrọ kọja aafo naa, ki o si fa okun naa titi ti aafo yoo dinku ati pe pelvis jẹ snug, lẹhinna tii okun naa.

Igbesẹ 3B: Nfi Imudara Bedsheet Pelvic Binder (Nigbati ẹrọ iṣowo ko wa)¶

Iwe ibusun owu ti o lagbara, iwe iyaworan jakejado, tabi ibora ti a ṣe pọ laisiyonu ni a fihan ni ile-iwosan lati dinku iwọn didun pelvic gẹgẹ bi imunadoko bi asopo iṣowo ti o ba lo ni awọn trochanters: 1. ** Agbo dì naa laisiyonu: *** Pọ iwe ibusun alapin kan ni gigun gigun titi ti yoo fi jẹ didan, ẹgbẹ ti ko ni wrinkle ni aijọju ** 15 si 20 centimeters (6 si 8 inches) fife. 2. ** Rọra labẹ awọn ẽkun ki o rii soke si Awọn Trochanters Greater:** Kọ iwe ti a ṣe pọ nisalẹ ṣofo ti awọn ẽkun ki o si rọra farabalẹ soke labẹ awọn buttocks titi ti o fi dojukọ lori ** awọn trochanters nla ati symphysis pubic . 3. ** Mu awọn ẹsẹ jọ ni yiyi inu: Jẹ ki oluranlọwọ di awọn ẽkun ati awọn kokosẹ papọ pẹlu awọn ika ẹsẹ toka si inu diẹ. 4. ** Kọja, fa ṣinṣin, ki o si ni aabo: *** * Kọja awọn opin gigun meji ti dì naa ni iwaju ti symphysis pubic. * Pẹlu olugbala kan ni apa osi ati ọkan ni apa ọtun, ** tẹ sẹhin ki o fa awọn opin mejeji ti dì naa laisiyonu ati ṣinṣin ni awọn ọna idakeji *** titi ti a fi gbe ọlẹ naa soke ti dì naa yoo gbá awọn apanirun mọra. * ** Ṣe aabo dì naa lai padanu ẹdọfu: *** Boya yi awọn opin meji ti o kọja papo lori iwaju pelvis ki o si di wọn pẹlu awọn didi ibalokanjẹ / hemostats (tabi yi wọn yika ọpá kukuru kan / ọpa naa ki o tẹ ọpá naa si isalẹ, tabi di Okun Okun/Square sorapo lori paadi toweli ti a ṣe pọ ki sorapo ko ba walẹ sinu).

Igbesẹ 4: Di awọn Orunkun ati Awọn kokosẹ ni Yiyi Inu ("Ẹsẹ-Tie Ẹsẹ Mẹjọ")¶

Paapaa pẹlu ohun mimu ni ayika awọn ibadi, iwuwo iwuwo ti awọn ẹsẹ daku meji ti n lọ jade ni ita ṣiṣẹ bi adẹtẹ ẹrọ ti o gbiyanju lati pry pubic symphysis pada ṣii. 1. Gbe aṣọ toweli ti a ṣe pọ, jaketi, tabi paadi foomu **laarin awọn ekun alaisan ati laarin awọn kokosẹ wọn ** lati ṣe idiwọ awọn egbò titẹ awọ ara eegun-lori-egungun. 2. Fi bandage cravat onigun mẹta kan, bandage rola, tabi okun fifẹ ni ayika ** awọn ẽkun mejeeji **, ki o si yi bandage oni-nọmba-mẹjọ kan ni ayika awọn kokosẹ ati ẹsẹ mejeeji lati di awọn ẹsẹ mu ni itunu sinu yiyi.

Igbesẹ 5: Gbigbe Ailewu, imorusi, ati Awọn ofin gbigbe¶

1. Maṣe forukọsilẹ fun alaisan ikọlu ibadi kan: Nigbati awọn alamọdaju ba de lati gbe alaisan naa si ori itọlẹ, wọn yoo lo orthopedic ** stretcher ofopu ** (eyiti o pin si idaji gigun ati awọn ifaworanhan labẹ apa osi ati ọtun pẹlu gbigbe pọọku) tabi 4-si-6-eniyan inaro ** afara gbe ***.
2. Maṣe yọọ kuro tabi tu itọlẹ ohun elo ibadi laipẹ: Ni kete ti a ti lo ohun elo ibadi kan, ** o wa ni titiipa ni aaye ** titi ti alaisan yoo fi wa ninu ile-iṣẹ ibalokanjẹ ile-iwosan kan pẹlu ṣiṣiṣẹsẹhin ẹjẹ ati awọn ẹgbẹ orthopedic/interventional radiology ti ṣetan. Ṣiṣii ohun elo pelvic kan ni aaye lati "ṣayẹwo awọ ara" jẹ ki oruka pelvic naa tun ṣii ati ki o fa atunkọ-ẹjẹ lẹsẹkẹsẹ.
3. Igbona ibinu: Bo alaisan patapata pẹlu awọn ibora ti o gbona ati idena idabobo labẹ wọn lati ṣe idiwọ Triad Trauma Apaniyan (hypothermiaacidosis ati coagulopathy).

Awọn oju iṣẹlẹ isẹgun pataki ni ibalokanjẹ ibadi¶

1. Ṣii Awọn Ẹjẹ Pelvic ati Perineal / Rectal / Vaginal Lacerations¶

O fẹrẹ to ida marun-un ti awọn fifọ oruka ibadi jẹ ** awọn fifọ ibadi ṣiṣi ***, ninu eyiti ajẹku didasilẹ ti rami pubic tabi ischium ti npa nipasẹ awọ ara ti koto, perineum, buttocks, obo, tabi rectum. Awọn fifọ ibadi ti o ṣii gbe oṣuwọn iku ti o sunmọ ** 40 si 50 ogorun ** nitori pe tamponade awọ-ara ti ita ti sọnu ati pe awọn kokoro arun ti o jẹ ibajẹ hematoma retroperitoneal: * Maṣe fa awọn ẹsẹ tabi ibadi yato si lati ṣayẹwo ọgbẹ perineal ti o ba tumọ si ṣiṣi oruka ibadi. ** Ṣakoso ikun itagbangba tabi ẹjẹ inu inu pẹlu titẹ taara taa ati iṣakojọpọ ọgbẹ hemostatic gauze ** (tabi ohun elo isunmọ inguinal kan ti o ba wa), lẹhinna lo ** binder pelvic cirkumferential lori awọn trochanters ti o tobi julọ ** ni ọtun lori wiwu ọgbẹ ti o kun. * Maṣe fi catheter ito sii, thermometer rectal, tabi idii ti obo ninu aaye ti ẹjẹ ba han ni ẹran urethra tabi perineum, bi urethra tabi rectum le jẹ gbigbe ni apakan.

2. Awọn fifọ ibadi ni oyun ati ninu awọn ọmọde¶

• Ni asiko oyun: Ni oṣu kẹẹta ati kẹta, ile-ile gravid yoo jade kuro ni ibadi egungun sinu ikun, ati sisan ẹjẹ ti iya iya yoo de ** 600 si 800 milimita fun iṣẹju kan . O ** le ati pe o tun gbọdọ lo ohun mimu ibadi kan *** si fifọ ibadi ti ko duro ni alaisan alaboyun nitori asopọ naa joko ni isalẹ lori ** nla trochanters ati pubic symphysis *** (labẹ owo akọkọ ti ile-ile). Lẹhin lilo binder trochanteric, fi ọwọ pa ile-ile aboyun ** 15 si 20 iwọn si OSI ** (tabi tẹ atẹgun ofofo lile 15 si 30 iwọn si apa osi) nitorinaa ile-ile ti o wuwo ko ni fọ inu iṣọn-ẹjẹ ti iya ti o kere ju ( aisan hypotensive**).
• Ninu Awọn ọmọde: Awọn egungun ibadi ọmọ jẹ rọ ati ni ila pẹlu kerekere ti o nipọn, nitorina o gba agbara kainetik pupọ (gẹgẹbi gbigbe nipasẹ ọkọ) lati fọ oruka ibadi ọmọde. Pa iwe ti o kere ju tabi iwe afọwọkọ ọmọ wẹwẹ lati baamu iwọn awọn ọmọ trochanters ọmọ ati ṣe abojuto ni pẹkipẹki fun ọgbẹ nigbakan tabi iṣọn-ẹdọ ẹdọ.

3. Atokọ Imudani Itọju Ile-iwosan fun EMS ati Imupadabọ Ọgbẹ¶

• [] ** Ọna ti ipalara: *** jamba iyara to gaju, ipa epo-ojò alupupu, giga isubu, tabi fifun parẹ.
• [] Akoko gan-an ati ipele anatomical ti ibi-isopọ abuda: Jẹrisi alasopọ ti dojukọ lori ** awọn trochanters nla ** ati pe awọn apo ti di ofo ṣaaju mimu.
• [] Ipo neurovascular (PMS) jijin ni awọn ẹsẹ mejeeji: Dorsalis pedis ati awọn pulses tibial ti o tẹle, gbigbona awọ ara, ati gbigbe ẹsẹ ṣaaju ati lẹhin dipọ.
• [] A ṣe akiyesi awọn ami urogenital: Wiwa ẹjẹ ni itọsẹ urethra, hematoma scrotal/labial, tabi lacerations perineal.

Mọ bi o ṣe le ṣe idanimọ fifọ ibadi ti o farapamọ ati lo ohun elo trochanteric kan yi ẹjẹ inu inu bibẹẹkọ apaniyan sinu ipalara ti o yege. Gbiyanju lati mu iranlọwọ akọkọ ti ifọwọsi, Duro Ẹjẹ naa, tabi ikẹkọ ibalokanjẹ iṣaaju ile-iwosan nipasẹ Red Cross ti orilẹ-ede rẹ tabi awujọ Crescent Red, St John Ambulance, tabi National Association of Medical Technicians (NAEMT).

Awọn ibeere ti a beere nigbagbogbo¶

Awọn orisun ṣayẹwo¶

• ** Ile-ẹkọ giga ti Ilu Amẹrika ti Awọn oniṣẹ abẹ (ACS, United States):** * Atilẹyin Igbesi aye Ilọla Ilọsiwaju (ATLS) Iwe Afọwọkọ Ikẹkọ ọmọ ile-iwe: Inu ati ibalokanjẹ ibalẹ, Ibanujẹ Ibadi Yika, ati Ẹdun Ẹjẹ.
• ** Igbimo lori Itọju Ijakadi Ijakadi (CoTCCC / Eto Ibanujẹ Apapọ, Orilẹ Amẹrika): *** Awọn Itọsọna TCCC fun Oṣiṣẹ Iṣoogun: Awọn itọkasi Binder Pelvic ati Gbigbe Trochanteric *.
• ** National Institute for Health and Care Excellence (NICE, United Kingdom):** *Itọsọna NG37: Ibanujẹ nla ati Awọn Ẹjẹ Ẹya, Ohun elo Prehospital ti Pelvic Binders, ati Imudani Ti kii-Log-Roll *.
• ** Ijọpọ Royal Colleges Ambulance Ambulance Committee (JRCALC, United Kingdom):** * Awọn Itọsọna Iṣeduro Isẹgun: Ayẹwo Ibanujẹ Pelvic ("Ko si orisun omi" Ofin) ati Pelvic Splinting *.
• ** Awujọ Agbaye ti Iṣẹ abẹ Pajawiri (WSES, International):** * Iyasọtọ ibalokanjẹ ibalokanjẹ ati Awọn Itọsọna Iṣakoso*.

Jẹmọ awọn itọsọna¶

• Idanimọ mọnamọna ati itọju pajawiri
• Awọn ipalara ọpa ẹhin ati aibikita
• Ṣii (epo) dida egungun ati splinting
• Iyọkuro inu ati itọju ọgbẹ inu ti ṣiṣi
• Ipalara fifun pa ati idanimọ iṣọn-aisan iyẹwu
• Awọn nọmba pajawiri ati fifiranṣẹ ilu okeere