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重機騎士車禍拋飛「類土下座」昏迷：特殊姿勢之頸椎限制經驗分享
How To EMTs Extricate An MVC Major Trauma Patient From A Special Posture Named 〞quasi-Dogeza〞
摘要
背景：根據統計，近5年機車肇事件數逐年上升，尤以大型重型機車肇事比率偏高，因機車車體材質脆弱，機車駕駛除安全帽外鮮有其他防護裝備，一旦發生交通事故，高能量機轉下易導致較嚴重傷亡，而頭部傷害及頸椎傷害便是造成癱瘓或死亡的主要原因。個案簡介：本案傷者為44歲男性，於山區騎乘重型機車與廂型車發生事故。現場傷者意識昏迷，呈現「類土下座」姿勢，雙側上、下肢多處變形、骨盆不穩固合併有休克情形。救護人員到場後遵循頸椎限制原則，活用各單項頸椎限制技術，將傷者安全移動至長背板上固定，另給予骨折固定後送往急救責任醫院救治。結果：傷者到院後直入急救區，意識昏迷給予氣管內管插管，影像檢查發現右前臂開放性骨折、左側股骨封閉性骨折、骨盆骨折及腹內出血，後續收治加護病房治療，並於當晚恢復清醒。結論：因應多變的事故現場，救護人員應具備因地、因時制宜的處置能力，在符合頸椎限制原則下，綜合應用七大頸椎限制術，可避免傷者二次傷害、提升傷者預後。
並列摘要
Background: The traffic accident rate of motorcycles increases year by year. The motorcycles' fragile material and lack of protective equipment contributed to fatal injuries. Cervical spine injury is the main reason motor-cycle accidents lead to fatal injuries. Case description: In this case, a 44-year-old male rider had major trauma following a two-vehicle collision. The badly-injured patient remained unconsciously with an uncommon posture, recognized as 〞quasi-Dogeza.〞 EMTs took actions such as spinal immobilization, pelvic binders, splinting of fractures, and urgently sent to the emergency hospital. This case report aims to describe how to extricate the patient from the uncommon posture. Results: The unconscious patient was aggressively resuscitated with blood transfusion and placed in an endotracheal tube in the hospital. After resuscitation, this patient's consciousness was alert and vital signs were stable in the ICU. The patient suffered the following injuries: right forearm open fracture, left femur shaft fracture, intraperitoneal hemorrhage, and pelvic fracture. Conclusion: EMTs will face various scenes in their duties, and they should be able to use all their techniques, such as spinal immobilization, and knowledge to deal with all kinds of situations. Above all, the emphasis should be placed not only on preventing consequent injuries but enhancing the prognosis of patients.