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Ashley Strobel 丁香诊所 美国马里兰大学

美国马里兰大学视频 / 时长61分钟

丁香诊所全科培训课程 03:运动损伤处理要点

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课程介绍

运动损伤是日常生活中常见的损伤,常由对肌肉韧带肌腱等组织的需求超出它本身的能力范围,某动作反复进行、举拉东西等造成,包括关节扭伤,肌肉韧带拉伤,筋膜炎等,引起关节处红肿、青紫、疼痛、僵硬、活动受限等临床表现。但扭伤和拉伤是两 个完全不同的概念,如扭伤(Sprain)是韧带拉长或撕裂,最常见踝部扭伤,拉伤(Strain)是肌腱部分或完全撕裂,最常见是后背拉伤。根据疼痛肿胀的程度,可以将损伤分为 3 度,在程度较轻时,他们的治疗都遵循 RICE 原则,即休息、冰敷、压迫(使用夹板,靴子)以及抬高,如仍然无法痊愈,则需要进一步寻求专业医师的治疗。

一位 39 岁的女性,3 天前发生车祸,主诉左侧颈部疼痛、头痛,体检发现 C5~C7 轻压痛,颈部前倾及侧向移动时有疼痛,头转向左侧时疼痛明显加重,颈部对抗运动时有疼痛,无瘀斑淤血,无水肿,无麻木抽动,此时病人需要做 X 片、CT 或 MRI 影像学检查吗?X 片等影像学检查结果能提示医生哪些信息?当医生接触到此类运动损伤的病人,应该怎样进行诊断?进一步给与什么治疗方案?

来自美国马里兰大学急诊和儿科医学讲师 Ashley Strobel 在丁香诊所「全科医生强化培训班」中详细讲解了运动损伤中的扭伤拉伤,从病因、临床表现、诊断思维、治疗方案、预后及恢复时间一一展开,结合数个病例为大家揭开扭伤拉伤之谜。

手外伤不会致命但会影响人的生活质量。所有手外伤制动时应保持手的功能位,以防止肌腱挛缩。腕管受伤,需在掌侧跨关节固定夹板,以更好的制动。

下列情况的手外伤可考虑使用抗生素:肌腱受伤,关节受损,开放性骨折,严重挤压伤,穿透伤,咬伤及免疫缺陷患者。

断指/趾

断下游离端应用生理盐水清洗,包上纱布,放入容器,冷藏保存。断端骨头未受损,需清水冲洗,加压止血;断端骨头受损,则需去掉碎骨,关闭缺口,缝合,3-6 周可治愈,知觉通常可恢复。

甲床下血肿

检查神经血管;x 光排除骨折;若无骨折可用针指甲刺破血肿减压。指甲若完整可不切除。

指甲修复

移开指甲,缝合甲床割伤,贴回指甲,缝合两端固定。

脱位如何复位?

检查神经血管末梢,然后神经阻滞,在伸展位进行固定。

舟月骨脱位: 复位后 X 线确保中掌骨和桡骨成直线,尺骨胫突在尺骨远端;腕骨,舟骨在大拇指基底部,舟骨和月骨间隙小于 3 mm;掌骨,头状骨,月骨,和桡骨成一条直线。

舟骨骨折

鼻烟窝触痛,因近段舟骨血供差,易缺血性坏死。包扎时前臂呈中立位,手腕外展 25 度,拇指呈持瓶位。包扎完成后检查毛细血管充盈是否完好。

第五掌骨骨折

又称拳击手骨折。握拳,所有手指指向大拇指根部,指向不对,则怀疑骨折。可注射利多卡因,手法复位。

甲沟炎:局麻后,切开引流,加压,每天热敷 8-12 次。

指头炎:作侧切口引流,注意避开神经血管,无需使用抗生素。

在丁香诊所「全科医生强化培训班」中,来自美国马里兰大学的急诊和儿科医学讲师 Ashley Strobel 与大家一起分享如何处理手外伤。

本期丁香诊所「全科医生强化培训班」共 96 期,骨科相关课程还包括以下内容:

丁香诊所全科培训课程 01:常见骨折 全科医生巧应对

丁香诊所全科培训课程 02:手外伤处理方法大盘点

丁香诊所全科培训课程 03:运动损伤处理要点

丁香诊所全科培训课程 04:关节炎的诊断及治疗

更多精彩内容请点击此处观看丁香公开课全部课程。

封面图片来源:shutterstock 网站

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Ashley Strobel 丁香诊所 美国马里兰大学

Ashley M. Strobel, 美国马里兰大学急诊和儿科医学讲师。MD, University of Maryland Upper Chesapeake Health


Postgraduate Education and Training:
2010‒2015 Combined Emergency Medicine and Pediatrics Residency
University of Maryland Medical Center
Baltimore, Maryland

2014-2015 Chief Resident
Combined Emergency Medicine and Pediatrics Residency

Education:
2006‒2010 Doctor of Medicine (magna cum laude)
St. George’s University School of Medicine
Grenada, West Indies

2001‒2005 Bachelor of Science (majors: Spanish and Biology)
University of Wisconsin-Madison
Madison, Wisconsin


Foreign Language: Fluent in Spanish

Certifications:
March 28, 2014 Neonatal Resuscitation Program
August 13, 2014 Pediatric Advanced Life Support
September 3, 2014 Basic Life Support
July 17, 2015 Advanced Cardiac Life Support
April 22, 2010 ECFMG Certification


Medical Licensures:
2015 Maryland (active)
2015 Minnesota (pending)

Clinical Employment History:
2015 – present Assistant Professor, Department of Emergency Medicine
Director of Pediatric Emergency Medical Education
Hennepin County Medical Center and University of Minnesota Masonic Children’s Hospital
Minneapolis, MN

2015- present Pediatric Emergency Medicine Physician
University of Maryland Upper Chesapeake Health
Bel Air, MD


Other Employment History
April 2010‒present Interviewer and Representative, Interview Committee,
St. George’s University


Professional Memberships:
2010‒2015 Emergency Medicine Residents Association (EMRA)
2010-2015 American College of Emergency Physicians (ACEP)
2010-2015 American Academy of Pediatrics (AAP)
2010-2015 American Academy of Emergency Medicine (AAEM)
2013‒2015 American Medical Society for Sports Medicine (AMSSM)

Honors and Awards:
2015 University of Maryland Department of Pediatrics, Carol Carraccio Service Award
2010 Gold Humanism Honor Society, St. George’s University
2010 Magna Cum Laude, St. George’s University
2007‒2010 Iota Epsilon Alpha Honors Society, St. George’s University

Institutional Service:
2014-2015 EM-Pediatrics Residency Curriculum Development
March 2014 ED Optimization QI Project, Cannon Design, University of Maryland Medical Center
September 2011 Medical Team, Baltimore Grand Prix, with Dr. Benjamin Lawner and Dr. Wade Gaasch

National Service:
2015-2016 Chair, Pediatric Emergency Medicine Division, Emergency Medicine Residents Association
2014‒2015 Pediatric Section Editor, EMResident
2013‒2015 Vice Chair, Pediatric Emergency Medicine Division, Emergency Medicine Residents Association

Teaching Service:
Invited Lectures
July 8, 2015「High Yield Pediatric Orthopedic Emergencies」, University of
Maryland Emergency Medicine Pediatrics Grand Rounds [CME].

Lectures:
January 2012「From the Rock to Charm City,」IEA Honors Society Lecture, St. George’s University, Grenada, West Indies
February 2013「Neonatal Seizures Secondary to Transient Hypoparathyroidism: A Review of Neonatal Seizure,」Hotbox Case Presentation, Department of Pediatrics, University of Maryland Medical Center
March 2013 Instructor, EMT-1 Cadaver Airway Course, Community College of Baltimore Country, Baltimore MD
June 2013「Pediatric Electrocardiograms: The Math and the Mystery,」Junior Lecture, Emergency Medicine Residency, Pediatric Emergencies Conference, University of Maryland Medical Center
July 2013 Instructor, Emergency Medicine Student Cadaver Lab, University of Maryland School of Medicine, Baltimore, MD
March 2014「Here’s Looking at You, Kid: Pediatric Ophthalmologic Emergencies」Senior Lecture Conference, Emergency Medicine Residency, University of Maryland Medical Center
May 2014「Anaphylaxis: Pediatric versus Adult,」Division of Pediatric Allergy and Immunology Elective, University of Maryland Medical Center
September 2014「Hematuria: A Case of Adenovirus Cystitis,」Hotbox Case Presentation, Department of Pediatrics, University of Maryland Medical Center
October 2014「Fever and Abdominal Pain Presenting as Right Tibial Osteomyelitis: A Review of Osteomyelitis,」Hotbox Case Presentation, Department of Pediatrics, University of Maryland Medical Center
February 2015「Picking out a Cardiac Infant in the ED: MISSION IMPOSSIBLE?」Senior Presentation, Department of Emergency Medicine, University of Maryland Medical Center

Simulation Education Sessions, Instructor, Pediatric Residency:
May 2013 Pediatric Supraventricular Tachycardia
July 2014 Pediatric Lumbar Puncture and Intraosseous Access Skills
July 2014 Laceration, Bite, and Abscess I&D Skills
August 2014 Pediatric Respiratory Distress: Part I
August 2014 Pediatric Respiratory Distress: Part II
August 2014 Intravenous Access and Phlebotomy Skills
August 2014 Laceration Repair and Abscess I&D Skills
January 2015 Airway, Laceration, and LP Refresher Skills Lab
January 2015 Pediatric Supraventricular Tachycardia
February 2015 Pediatric Septic Shock
February 2015 Pediatric Nursing Intravenous Access and Phlebotomy Skills
更多

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