澳纽麻醉专科考题 1--Case Discussion1 ---ANZCA Exam question
本帖最后由 shenxiu2 于 2009-12-10 20:58 编辑A 72 year old male has been brought to your emergency room after being removed from a motor vehicle, which has been involved in a high speed collision. He is moaning, his eyes are closed and he withdraws to pain.
On transfer to the CT scanner his left pupil dilates.
Describe your management. 本帖最后由 shenxiu2 于 2009-12-11 09:41 编辑
**** Hidden Message ***** 马上叫“help”，同时检查生命征，如、颈动脉搏动、呼吸，如果心脏骤停了，马上行心肺复苏，压过来后送重症病房继续抢救，如果没停，也赶紧送重症病房，路上时刻注意以上生命征。 老年车祸男子，呻吟，闭眼，疼痛逃避反应，左侧瞳孔散大
注意呼吸血压情况，必要时气管插管，带呼吸囊和生命体征监护再到CT室检查 本帖最后由 shenxiu2 于 2009-12-17 14:28 编辑
1# shenxiu2
一些应付考试的技巧:
In exams, you will need to demonstrate that you understand the significance of the "unilateral pupil dilatation "---whichis increased ICP . And then all the managements will aim at decreasing ICP ----resuscitation, intubation , sedation , paralysis, urgent craniotomy to decompress the cranium . 回复 1# shenxiu2
回复一下，看看何题。 CT确定脑出血部位，注意呼吸循环，降颅内压，急诊手术 A 72 year old male has been brought to your emergency room after being removed from a motor vehicle, which has been involved in a high speed collision. He is moaning, his eyes are closed and he withdraws to pain.
On transfer to the CT scanner his left pupil dilates.
1."He is moaning, his eyes are closed and he withdraws to pain. " .This means that this patientmaybe in subconciouness state.Though no record given, before his transfer to the CT room, his two pupil maybe in similar size.And "On transfer to the CT scanner his left pupil dilates", that means his condition developed very fast and ICP increased rapidly.
2. This is a quite urgent case. Mannital, laxis should be given immediately. At the same time tracheal intubation is very necessary in order to control the respiratory because potential respiratary depression or aspiration induced the increase of CO2 and hypoxia could be fatal.
3. Monitor his vital signs carefully and life support should be prepared. Be prepare for surgery. Informe the relatives anesthesia and operation related risks including aspiration, transfusion related risks.
4. Transfer to OR, and take craniotomy. Intubated with moderate hyperventilation
Consult nerologist
Check for possible lung contusion and blunt abdominal trauma
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