狗咬傷致股大動脈破裂到院前死亡－到院前外傷救治經驗分享

背景：根據統計，被狗隻咬傷之個案年齡多介於15－64歲之間，傷口部位以四肢傷口為主，若咬傷股大動脈此類重要大血管，常造成傷勢嚴重甚至死亡率高，院前外傷救治必須以控制出血與恢復血流為優先事項。個案簡介：本案56歲男性酒後逗弄彼特犬，遭彼特犬咬傷右腿股動脈失血過多致到院前死亡，救護人員抵達現場後，評估患者為創傷性到院前心跳停止（Out-of-Hospital Cardiac Arrest, OHCA）；剪除衣物後包紮傷口並綁上止血帶，使用Lucas自動壓胸機，建立喉頭外呼吸道，並建立靜脈導管注射腎上腺素，緊急送往急救責任醫院。結果：到院時患者仍無生命徵象，經積極搶救並大量輸血，仍無法恢復自發性循環，在家屬同意下停止急救。結論：救護人員仍能因救護對象情境不同而盡力施予急救，未來希望能透過更佳止血方式、止血敷料與更完備的急救訓練，冀望對大血管出血創傷能有更佳控制出血能力，以挽回更多寶貴生命。

關鍵字

狗咬；股動脈破裂；到院前心肺停止；緊急救護技術員；到院前

並列摘要

Background: The wounds of dog bites are mainly wounds on the limbs. If an important blood vessel such as the femoral artery is bitten, it often causes serious injuries and even high mortality. The pre-hospital trauma treatment must be priority to control bleeding and restore blood flow. Case description: A 56-year-old drunk man suffered from extensive blood loss after bitten by bull terrier. The dog bit his right inguinal area leaving a 15cm x 10cm open wound on his right proximal thigh. He became coma soon after this tragedy. His friend at the scene called 119 right away but no medical first aid was given. This patient was recognized as OHCA after EMT arrival and CPCR was performed immediately. During trauma OHCA procedure, cut off the clothes, bandage the wound and put on 2 tourniquets, use the Lucas automatic chest compression machine, and give Epinephrine (5min/time), establish the airway, I-gel, intravenous infusion, and urgently send to the emergency hospital. Results: No vital signs were detected, and the patient was aggressively resuscitated with blood transfusion in the hospital but no return of spontaneous circulation (ROSC). Resuscitation was stopped with the family's consent. Conclusion: EMT can try their best to the different situations of the rescued objects. In the future, it is hoped that better hemostasis methods, hemostasis dressings and more complete trauma training can be used to better control the bleeding of massive blood vessel trauma and save more precious lives.

並列關鍵字

Dog bite ； femoral artery rupture ； OHCA ； emergency medical technician ； pre-hospital

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