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    原作者: Emedhome,鄭辛甜譯,肖鋒校對 文章來源: 《中華急診醫學雜志》編輯部 發布日期:2015-03-03

    Title: Spinal Cord Injury - Thoughts To Keep In Mind
    Author 作者:EMedHome.com
    翻譯:鄭辛甜 校對:肖鋒

    Spinal Cord Injury is bread and butter emergency medicine, but SCI does not present on a regular basis. Therefore, some pearls to keep in mind:
    • RSI is felt to be safe with in line stabilization acutely but succinylcholine is contraindicated from 72 hrs to 6 months post-injury because of life threatening hyperkalaemia. Acute denervation causes acetylcholine receptors to spread beyond the motor end plate of the neuromuscular junction, increasing receptor exposure to succinylcholine (1,2).
    • 在(頸椎)中線固定后進行RSI被認為是安全的,但是傷后72小時至6個月內要禁用琥珀酰膽堿,因為其可能會產生高血鉀而威脅患者生命。急性去神經會造成乙酰膽堿受體擴散超過神經肌肉接頭處的運動終板,增加琥珀酰膽堿對受體的作用。
    • C-spine movement should be minimized during laryngoscopy, especially flexion, which is thought to be more dangerous to the cord than extension (1).
    • 喉鏡檢查時應盡量避免頸椎活動,尤其是屈曲,它比拉伸對脊髓來說更危險。
    • Do not sit patients up with acute high-thoracic SCI as they will have better respiratory function lying flat. The diaphragm has a greater excursion in inspiration as it is pushed into the chest by abdominal contents; if sitting, the diaphragm is pulled down by abdominal contents impeding further excursion in inspiration (1).
    • 不要讓急性高位胸椎脊髓損傷的患者坐起,因為平躺能使他們的呼吸功能更好。(平臥時)膈肌在吸氣時活動范圍更大,因為它被腹部內容物推向胸腔;而如果患者坐起,膈肌被腹部內容物拉下,限制其在吸氣時的活動。
    • Patients must be ‘log rolled’ off the board, ideally within 30 min after arrival in hospital. The spinal board is a transport device only and its prolonged use is associated with pressure sores (1).
    • 患者必須要以“滾圓木”方式從板上挪下來,最好是在到達醫院后的30分鐘內。脊椎板只是轉運工具,且過長時間使用與褥瘡產生有關。
    • Neurogenic shock is common in T2-5 injuries, resulting in a decrease in SVR, decreased inotropism, and increased vagal tone. Intermittent atropine may be required, especially before vagally stimulating procedures (e.g. laryngoscopy or tracheal suctioning) (1-3).
    • 神經性休克常見于T2-5受傷,從而導致SVR降低,肌收縮力降低和迷走神經張力增加。可能需要間歇給予阿托品,尤其是在具有迷走神經刺激操作時(例如喉鏡或氣管吸痰)。
    • Early catheterization is essential to avoid bladder overdistension that may precipitate bradycardia. Consider supra pubic catheterization if priapism is present (1,3).
    • 為避免膀胱過度膨脹導致的心動過緩,早期導尿是必不可少的。如果陰莖異常勃起,可考慮恥骨弓上插管。
    References 參考文獻:
    (1) Bonner S, et al. Contin Educ Anaesth Crit Care Pain 2013;13: 224-231.
    (2) Dooney N, et al. Int J Crit Illn Inj Sci 2011; 1: 36-43.
    (3) Lo v, et al. J Neurosurg Sci 201357:281-92.