สำนักงานสาธารณสุขจังหวัดราชบุรี (สสจ.ราชบุรี) - Ratchaburi ...
????????????? ????? Trauma ???????? 4 ?????? 17 ??????? 2563 ? ?????????????????????????????? 9.00-16.00 ? ?????????????? 1 ??????????????????????????????????? ???????????????????????????????????? 4 ????? 2563 ?????????????????????????Trauma ????????????????????????????????????????????????????? ????. ??? ??? ??? ?????? Trauma care ????????????????????????????????????????????????????????? ??????????????????????????????????????????????????? ???????????????????????????????????? ?????? ????? STAFF ??????????????????????????????? ????????????:????????????????????? 2 ????????????????????? ????????????: ??????????????????????? 3?????????????? 3 ?????????????????? 3.1 ?????????????????????????????????????????????? ?? ???????? 2563 ?????????????????????????????????????????????? ??????? ?? 62 – ?? 63 ????????????????? 10545 ??? ????????? 186 ??? ???????????? 21.94 ????????????? ???????????????????? 128 ??? ????????? ?????????????? 27 ??? ??????????????? 31 ??? ??????????????????????????????????????? ???????????? ?????????? ???????????????????????????????? : ?????? ??. ????????????????????????????????????????? ??? ??? ?????????????????????????????? ??.????????????????? ???.???? ?????????????? 3 ?????????????????????????????????????? ????????????: ???????3.2 ?????????????????????????????????? ???????????????????????????????????????? ??? ??????????????????????????????????? ?? .????? A S M1 ????????????????????????? 60 ??????????????????? 80 ?????????????? ???????? 59.49 ??????: ???????????? ??.??????????????????case ?????????????????????????????????????? ???????? 60 ???? ??????????????????????????????????????????????????????? ??????????????.??????? ??????????????????? ??????????????????????????? ???????????????????????????????????????????: ??????? 3.3 ????? ??????? ????????????????? ??.????????? 1. ??.????? ??? ??.?????????? ????????????????????????? ???????????????????? ????????? ??.????????????????????????????????????????? ??.??????? ?????? : ???????? ?????????????????????2. ?????????????????? ??.??????? ????? ??.??????? ???????????????????????????????? ???????????????? ?????????????????????? 3. ??????? Thai refer ????? ??.????????????????????????????????????????? ??????: ?????????????????????????????? ??.??????? ?????????? ??????????????????????????? Thai refer ????????????????????????????????? ??????: ???????????????????? ?????????????????????? case ??????????????? ??.???????????????????????? ??????????????????? refer audit????????????: ???????3.4 ????????? conference case ??.??????? ?????? 2 case ????????????? Case conference Trauma ( case 1) ???(????) ???? 47 ?? ???????? ??? 3 ???? ?????? ?????????????? ???????????????????????? ?? 30 ???? visit ER ???? 16.10 ?.Primary survey A : Patent, C-spine not tender B :equal BS RR=20, O2sat=100%C : PR=76/min, BP=127/77 mmHg, D : E4V5M6 pupil 2 mm RTLBEE : Back- tenderSecondary survey Motor proximal both leg gr.3 other gr 5AW Lt knee and Rt legA : none M : noneP : no known U/D no Hx smoking/no Hx chronic alcohol use L : last meal 12.00 ?.E: falling 3 m ??????? ??????????? ??????????????? ?????? ?????????????? ?????????? ??????????? ??????????CXR: no fracture rib .no pneumo/hemethorax /Film LS-spine: Compression Fracture L2 with dislocationImpression Compression Fracture L2 with dislocation/ Mild head injury-low risk/fall from heightMx consult ortho – admit at 17.40 ? plan set OR on call 19.40 ? ?????????????????????? ????????????? ??????????? coffee ground /Consult surg20.30 ?. E1V1M1 pupil 3 SRTLBE / Protect airway – intubation 21.08 ?. CT Brain NC ?? EDH right parietotemporal region and right cerebellum/SAH inbasal cistern and both svlvian fissure/Hemorrhagic contusion at Lt frontal /Rt uncal herniation21.30 ?. Refer5 day D/C by death???????????????????????1 ???????????????? associate injury ?????????????? head injury2 ??????????????????????????? trauma unit3. ??????????????????????????? acute deterioration ?? wardCase conference trauma (case 2)????????????? ???? 58 ?? ??? MC ??????????? 10 ???? ????????.Visit ER ???? 16.50 ?.Primary survey A : can t talk no stridor on hard collar - intubation B :equal BS decrease BS lung trachea in mid line RR=20, O2sat=96%C : PR=130/min, BP=113/82 mmHg,/ no active external bleeding/abdominal soft no contusion/Rt leg deformity – splint / Fast- negD : GCS E2V2M4 pupil 2.5 mm RTLBE/ no lateralizationE : Back- no wound /PR –no loose sphincter tone17.00 ?. Intubation /IV 1000ml17.24 ?. Film17.30?.Rt ICD /IV 2000 ml18.20?. revise Lt ICD +Rt ICD /IV 4000ml18.50?. ?????? Refer ??????? 19.15?. PRC 1 unit 19.30?. key Thai refer 19.50?. ??????? CT BP 60/30 mmHg, O2sat=80%20.10?. Revise Rt ICD 20.25?. ?????CT 20.56?. start CPR21.03?. ????????? refer / Death ER ?????????????????????????????? case multiple trauma ????????????????????????????????????????????? refer case multiple trauma????????????: ????????????????????? 4 ??????????? 4.1 ????????????????? ???? ?????? 20 ?? 63 ??????? ??. ??????????????? ??????????????????????????????????? ?????? ??.??????? ??. ??????? ??. ???????? ??. ?????????? ??. ????? ??.?????? ????????????????????????????4.2 ????????????????????????????????????????????????????????????????? 30 ?? 63 ????????????????????????????????????????????? ????????????????????????????????????? ??????????????? ??? ???.?????????????????????????????? ??????????????????????? 1 ?? 63 4.3 ?????????????????????????????????????????????????????????????????????????????????? ????????????? 7 ???? ??.???????????????? 3 ???? ??. ??????? 2 ???? ??. ?????? 2 ???? ??????????????????????????????????? 30 ?? 634.4 ?????????????????????????????????????????????????????????????? ?? 2564 1.???????????????????????????????????????????????????????????????????????????????????? EMR ???? EMT-B???????????? ???.????. ???????????????????????????????????????? (Trauma care)?????????????????????????EMS??????????? Trauma????? ????Telemed ???? ????? A S M1??????? ???? ??? ?? ???. ??????????? ???? 1669 CPR ?????? AED ???????????????????????? ???????????? ???? Paramedic ???????????????? EMS????? ????? ??????? ??????????????????? ????? EMS ????????????????????????????? ??????? ?????????????????? ?????????????????????????????????????TRAUMA EMS 1 ??? ??? ??.??????????????????????????????? ????????????? 2565 ????????? 2 ??? 1 ???????????????????????????? ???????????????????????????????????? 2564 ????????4.5 ??????????????????? ??? ???.?????? ???????? 14 ??????? 2563????????????: ??????? ??????? ?????????. ???????????????????????? (?.? ??????? ?????????) ???????? ?????????? ?????????????????????? (???????? ??????????) ................
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