不要笑~~~  要有同理心~~

让脱臼的下巴复位的手法重点在 1分34秒的图示那里~~

重点1: 患者要放松肌肉~~  在家里处理的话,先刷个牙也有一定的效果

重点2: 进行复位操作的人要带医用橡胶手套,最好用医用棉纱包好大拇指避免被咬到

重点3: 向下,向后的施力方向。

 

网上也可以搜到许多相关建议,

这里也有很详细的指引~~

http://www.ncemi.org/cse/cse0402.htm

Presentation

The patient's jaw is "out" and will not close, usually following a yawn, or perhaps after laughing, a dental extraction, jaw trauma or a dystonic drug reaction. The patient has difficulty speaking ans may have severe pain anterior to the ear. A depression can be seen or felt in the preauricular area and the jaw may appear prominent.

 

What to do

      If there was no trauma (and especially if the patient is a chronic dislocator) proceed directly to attempt reduction. If there is any possibility of an associated fracture, obtain x rays first.

 

  • Have the patient sit on a low stool, his back and head braced against something firm--either against the wall, facing you, or with the back of his head braced against your body, facing away from you.
  • With gloved hands, wrap your thumbs in gauze, seat them upon the lower molars, grasp both sides of the mandible, lock your elbows, and, bending from the waist, exert slow, steady pressure down and posteriorly. The mandible should be at or below the level of your forearm.
  • In a bilateral dislocation, attempt to reduce one side at a time.

(以上就是一般在家里自己复位的重点了)

  • If the jaw does not relocate easily or convincingly, you may want to reassess the dislocation with x rays, and try again using intravenous midazolam to overcome the muscle spasm and 1-2ml of intraarticular 1% lidocaine to overcome the pain. Inject directly into the palpable depression left by the displaced condyle.
  • After reducing the dislocation it will be comforting to apply a soft cervical collar to reduce the range of motion at the temperomandibular joint (TMJ). Recommend a soft diet and instruct thepatient to refrain from opening his mouth too widely. Prescribe analgesics if needed.
  • If reduction cannot be obtained using the above techniques, then consider admission for reduction under general anesthesia.

What not to do:

  • Try not to get your thumbs bitten when the jaw snaps back into position. Maintain firm, steady traction and protect your thumbs with gauze.
  • Do not put pressure on oral prostheses that could cause them to break.
  • Do not attempt to reduce a TMJ dislocation with the patient's jaw at the height of your shoulders or above. You will need the leverage you get from having the patient in a lower position.
  • Do not try to force the patient's jaw shut.

    Discussion

  • The mandible usually dislocates anteriorly, and subluxes when the jaw is opened wide. Other dislocations imply the presence of a fracture and require referral to a surgeon. Dislocation is often a chronic problem (avoided by limiting motion) and associated with temporomandibular joint dysfunction. If dislocation is not obvious, then consider other conditions, such as fracture, hemarthrosis, closed lock of the joint meniscus, and myofascial pain.
  •  

    另外再补充一篇也是相关的转贴文章,里面的信息也是很有用:

    http://www.teeth.idv.tw/drchou/dislocation.htm

    [轉] 下巴脫臼的處理方法

    掉下巴是令人痛苦又尷尬的事!

     「講(吃)到落下頦」是用來罵人話講太多或吃太多。

       疲倦時忍不住要張大嘴巴打哈欠,吸進一大口氣,頓時感到全身通暢,倦意
    全消之際,下巴關節頭滑出關節窩之外,越過前方高起之峰項,落到山的另一
    邊。哈欠兒畢,下巴關節頭再也回不來了!

       如果兩邊都脫臼,嘴巴合不起來,開的大大,口水滴流而出;如果只有單邊
    脫臼,嘴巴可以合小一點,但歪向一側。習慣性脫臼的人通常會自動歸位,不
    常脫臼的人則需要緊急求救。

    處理的方式通常是“反向操作”,也就是以大拇指伸入口內,貼著大臼齒向下
    壓,先解除關節頭後方阻礙,再向後上送回。如果肌肉太緊張,無法向下壓,
    醫師可能會先注射鎮靜劑,或以麻醉針劑打入緊縮的肌肉,待肌肉鬆弛再推下
    巴。

        脫臼時下顎關節頭在前,原來蓋在關節頭上的關節盤滑向後方,如果因為
    肌肉緊張,無法壓下卻勉強推回,將傷害關節盤及韌帶。因此必須先使肌肉放
    鬆,再“輕輕送回。

    在此介紹一種方法,不必打針吃藥也可使關節頭離開阻礙,不用蠻力也不會傷
    害韌帶,可以助人也可自救。

       一、對於經常脫臼、關節較鬆弛者:以拇指壓在下顎臼齒咬合面上,另四指
    扣住下巴,也就是先固定一側,再以旋轉方式將準備送回的一側向下向後旋轉,
    反之固定已復位的一側,再將對側旋轉送回。左右連續動作仿如橫寫之數字「8」
    。原則是:一次只送回一側關節,如果不能輕易「滑」回去,則停止嘗試,改
    採下法。 。

     

     二、對於對於.不常脫臼者:將紗布捲成2公分直徑,塞入脫臼側的最後上下臼
    齒之間,令病人咬住,並以手掌扥住下巴向上用力,如此將形成槓桿將關節頭
    拉下。5分鐘後取出紗布,再令病人左右搖動下巴,通常可自動復位。如不能復
    位,再咬3分鐘後再試,或以前段所述的手法操作,幫忙復位。注意單側脫臼只
    咬脫臼的一側,也就是歪下巴的對側,雙側脫臼則兩邊都塞紗布,本法利用摃
    桿作用使關節向下拉而脫開阻礙。沒有拉扯肌肉使肌肉更緊張的問題,病人也
    可同時舒緩緊張情緒。

    手頭沒有紗布時可用棉花、衛生紙代替。無人幫肋時,病人也可自助完成。

      容易掉下巴或己有顳顎關節問題的人應避免張大嘴巴,平常可練習”純旋轉
    式張口法”,一般張口時下顎關節頭不僅旋轉同時也向前向下滑,滑過頭就回
    不來。因此練習只旋轉不渭動可避免脫臼。

    練習時舌尖頂住門牙後面粗粗的地方,兩手食指指向下顎關節,想像有一根軸
    橫貫兩端,下巴沿軸旋轉張口幅度以舌尖不脫離原位為準。

    打哈欠、打噴涕時以雙手大姆指托住下巴,其它四指壓住鼻子讓哈欠照打,但
    避免突然張大,如此可避免脫臼。

    看牙醫時應告知牙醫師,請牙醫師準備一種特殊裝置,可卡在上下臼齒之間也
    就是不必張大嘴巴,反而是靠著休息,因為長時間張大後肌肉會緊張,鬆緊不
    協調,容易脫臼。

    ---------------------------------------------------------------------------------

    打哈欠,看笑话的时候嘴巴可别张太大了,呵呵~

    HTH~!

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