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腹痛的處理 Abdominal pain (updated 5-2014)

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發表於 2013-4-9 00:33:41 |顯示全部樓層
現在跟進一下之前一個有關肚痛的新聞: 「女子浪茄行山肚痛 - 直升機送院 : 早上(2012年11月11日) 11時44分�\,6人於西 貢浪茄行山時,其中一名女子突然肚痛,報警求助,直升機到場將女子送院治理。」 網上對這個認為是濫用資源的批評,大家可以自行查閱。通常並非"屙左就得" 或 "急屎連的士錢都節省"
跟據醫學書籍,非創傷的腹部痛症最少有一百幾十個原因。 在野外急救員的立場,我們不需要評估是什麼痛症,而是要評估是否危急(red flag signs)。

大家可以跟據下列幾個指引作為參考:
(1) http://www.wildmedcenter.com/uploads/5/9/8/2/5982510/wfa_sop_v_dec_2012.pdf
Page 8: Common Medical Problems
Indentify red flag signs 紅旗徵狀 and symptoms necessitating evacuation
- Abdominal pain (local tenderness, fever, persistent vomiting, getting worse over 12 hrs)
- Vomiting and diarrhea (blood, fever, tenderness, what goes out exceeds intake)
- Any noticeable blood in stool, urine, or vomit
- Cough/URI (respiratory distress, fever, coughing up colored phlegm)
- UTI (fever, back pain/tenderness, vomiting)
- ENT (visual problems more than blurring, fever, airway compromise)
- Fever (abnormal mental state, headache, other as above)

(2) http://www.wildmedcenter.com/uploads/5/9/8/2/5982510/wfr_sop.pdf
Page 8: Backcountry Medical Problems

(3) Google book: The Outward Bound Wilderness First-Aid Handbook
http://books.google.com.hk/books?id=SSPhzelgdKEC&printsec=frontcover&hl=zh-TW#v=onepage&q&f=false
Page 171-172, Serious Abdominal Pain:
Red Flags 紅旗徵狀 (任何一樣, 而並要全中) :
- Constant, localized pain and tenderness         
- Aggravated by movement and palpation         
- Persistent fever
- Bloody vomit or diarrhea
- Tachycardia
- Lasts more than 24 hours
Anticipate:
- Volume shock
- Systemic infection
Treatment:
- Maintain hydration
- Maintain body core temperature
- Restrict foods to easily absorbed sugars
- Emergency evacuation (in position of comfort)

(4) Remote Area Nurses Emergency Guidelines 2012-2013: pp 25-26
http://www.ambulance.vic.gov.au/Media/docs/RAN-Guidelines-81ae0568-940d-404d-acd9-aae84eeeea0c-1.PDF

(5) NOLS-WMI notes: Abdominal Illness and Injury
http://www.facebook.com/notes/nols-wilderness-medicine-institute/abdominal-illness-and-injury/10151002480546331
(This link is added on 1 May 2013.)

在香港,所有的急救員訓練課程都好少提到腹部痛症的處理。各位可以參考這個「嚴重腹痛」的個案 (一心攻頂!棄生病山友見死不救,冷血5 隊友遭起訴: http://www.setnews.net/News.aspx?PageGroupID=6&NewsID=21854 )。 作為一個野外急救員或領隊,你會怎樣做呢?

CDEM Self Study Modules, The Approach to Abdominal Pain: http://www.cdemcurriculum.org/ssm/approach_to/abd_pain.php



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