In the management of the pregnant trauma patient, the critical point is that resuscitation of the fetus is accomplished by resuscitation of the mother. (critical 紧要的、关键的)
处理孕妇创伤病人时，最关键的是抢救胎儿是通过抢救母亲完成的。
Therefore, the initial evaluation and treatment of the pregnant injured patient is identical to that of the nonpregnant injured patient. (identical 同一的、完全相同的)
所以，对创伤孕妇的诊断和治疗和非受伤孕妇是相同的。
Rapid assessment of the maternal airway , breathing, and circulation and ensuring an adequate airway avoids maternal and fetal hypoxia.
快速评估母亲呼吸道、呼吸和循环，保证呼吸道通畅避免母亲和胎儿缺氧。
In the later stages of pregnancy, as already described, uterine compression of the vena cava may result in hypotension from diminished venous return, so the pregnant trauma patient should be placed in left lateral decubitus position. (compression 压缩、挤压 decubitus 卧姿、褥疮)
在妊娠后期，如已描述的那样，子宫压迫腔静脉可引起静脉回流减少的低血压，所以创伤孕妇应摆放为左侧卧位。
If spinal cord injury is suspected, the patient may be secured to a backboard and then tilted to the left. (secure 安全的、有把握的 backboard 靠背板、后部挡板 tilt 使倾斜、使偏斜)
假如怀疑脊柱损伤，病人可先仰卧在硬板然后转向左侧。
The increased blood volume associated with pregnancy has important implications in the trauma patient. (implication 涉及、牵连) 因妊娠所增加的血容量与外伤关系密切。
Signs of blood loss such as tachycardia and hypotension may be delayed until the patient loses nearly 30% of her blood volume.
失血体征如心动过速、低血压可能延迟到病人失血达到近30%的血容量。
As a result, the fetus may be experiencing hypoperfusion long before the mother manifests any signs. (perfusion 灌注) 结果，在母亲出现表现前，胎儿可能存在长时间的血流灌注不足。
Early and rapid fluid resuscitation should be administered even in the pregnant patient who is normotensive. (administer 执行，实施 normotensive 血压正常)
要早期快速输液，甚至对血压正常的孕妇也是如此。
Chapter 41 Diagnosis of Sudden Cardic Death(SCD) 心源性猝死的诊断 第118页
SCD is death due to instantaneous, unanticipated circulatory collapse within 1 hour of initial symptoms and is often, but not always, due to a cardiac arrhythmia.
(instantaneous 瞬间的、即刻的、即时的 unanticipated 不曾预料到的)
心源性猝死是指出现初始症状1小时内的未能预料的循环衰竭死亡，并不少见，但不全是心律失常。
More than 70% of all sudden natural deaths have a cardiac cause, and 80% of these are attributable to coronary artery disease. (attributable 可归于┄的)
70%以上的自然猝死有心脏的原因，心脏原因中80%跟冠状动脉疾病有关。
In assessing prognosis and planning a treatment strategy, it is useful to classify SCD as either primary (without a clear trigger) or secondary.(strategy 策略、战略 trigger 触发、引起)
在评估预后和制定治疗方案时，将心源性猝死分为原发性（无明确的诱发因素)和继发性是实用的。
A primary episode has a 10 to 30% 1-year recurrence rate, whereas most secondary episodes are associated with recurrence rates of less than 2%.
episode 一段情节、插曲、有趣的事 associated with 联合
原发性的在1年内有10~30的复发率，而大多数继发性的合在一起复发率小于2%。
Identifiable reversible precipitants of secondary ventricular fibrillation (VF) include transient ischemia possibly related to vasospasm;
identifiable 可确认的 reversible 可逆的 precipitant 仓促的、突然的
transient 短暂的、瞬时的
可确认的可逆性继发性心室颤动（VF)的发作包括可能因血管痉挛的短暂缺血；
hypokalemia resulting from diuretics; hyperkalimia secondary to renal failure, angiotensin-converting enzyme inhibitors, prostaglandin inhibitors,or potassium-sparing diuretics;
hypokalemia 低钾血症 angiotensin-converting enzyme血管紧张素转化酶
prostaglandin 前列腺素 sparing 节俭的、保守的
利尿剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾利尿剂所致的高钾血症；
proarrhythmia secondary to antiarrhythmics, tricyclics, and antihistamines;
proarrhythmia 致心律失常作用 tricyclic 三环的、三环分子
antihistamine 抗组织胺类
继发抗心律失常药、三环类药和抗组胺类药的心律失常；
or substance abuse with drugs such as cocaine and amphetamines.
administer abuse 滥用、陋习 amphetamine 安非他明、苯异丙胺
或可卡因或安非他明类药物的滥用。
可确认的可逆性继发性心室颤动（VF)的发作包括可能是血管痉挛的短暂缺血；利尿剂引起的低钾血症；肾功能衰竭、血管紧张素转化酶抑制因子、前列腺素抑制因子、或保钾利尿剂所致的高钾血症；抗心律失常药、三环类药和抗组胺类药引起的心律失常；或可卡因或安非他明类药物的滥用。
Therapy is directed toward removing or treating the acute precipitant.
(removing 消除) 治疗是直接消除或处理急性发作。
SCD related to acute ischemia in the absence of prior MI often is associated with severe proximal occlusive disease, normal left ventricular function, normal signal-averaged ECG, and noninducibility [absence of ventricular tachycardia (VT) ]during electrophysiologic study.
MI myocardial infarction 心肌梗死 average 平均 inducibility 可诱导的
缺乏心肌梗死前兆的急性缺血性心源性猝死常与严重的近端梗阻疾病有关，电生理研究时心室功能正常，心电图正常信号普通，无法诱异[缺乏室性心动过速（VT)]
Most patients should undergo comprehensive evaluation of myocardial function and coronary anatomy.
(undergo 经历、忍受 comprehensive全面的、广泛的，能充分理解的)
大多数病人应该进行全面的心肌功能评价和冠状动脉解剖。
Echocardiography is useful for excluding hypertrophic cardiomyopathy and valvular heart disease; (echocardiography 超声心动图 hypertrophic cardiomyopathy 肥厚性心肌病)
超声心动图对肥厚性心肌病和瓣膜性心脏病在内的疾病很有用；
magnetic resonance imaging, for diagnosing arrhythmogenic right ventricular dysplasia;
magnetic resonance imaging 磁共振 dysplasia 发育异常、结构异常
磁共振对有心律失常性右室发育不良症的诊断很有用；
and myocardial biopsy, for identifying infiltrative diseases such as myocarditis, amyloidosis, hemochromatosis, and sarcoidosis.
infiltrative 渗透性的、浸润性的 amyloidosis 淀粉样变
hemochromatosis 血色素沉着 sarcoidosis 结节病
心肌活检对浸润性疾病如心肌炎、淀粉样变、结节病很有用。
Coronary angiography shoule be performed to assess for the presence of coronary occlusive disease and to exclude coronary artery anomalies.
应该进行冠状动脉血管造影评估冠脉阻塞性疾病的存在和排除冠脉的结构异常。
Myocardial perfusion scintigraphy provides complementary data for assessing ischemic burden.
(myocardial perfusion scintigraphy 心肌灌注闪烁照相术)
心肌灌注闪烁照相术对缺血程度估计提供辅助资料。
Left ventricular function can be assessed by contrast ventriculography, radionuclide ventriculography, or echocardiography.
(ventriculography 心室造影术 radionuclide ventriculography 放射性核素心室显像术)
通过对比心室造影、同位素心室造影或超声心动图可以评价左心室。
Evaluation of SCD survivors also includes Holter monitoring and/or electrophysiologic testing.
(Holter monitoring 动态心电图监护仪)
心源性猝死生还者的评价也包括动态心电图监护仪和/或电生理测试。
The Electrophysiological Study Versus Electrocardiographic Monitoring (ESVEM) trial showed, however, a 50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom antiarrhythnmic drugs successfully suppressed PVCs.
ventricular tachyarrhythmias 室性快速型心律失常
PVCs premature ventricular contraction 室性早搏
The Electrophysiological Study Versus Electrocardiographic Monitoring (ESVEM) trial showed, however, a 50% 2-year recurrence of ventricular tachyarrhythmias in patients in whom antiarrhythnmic drugs successfully suppressed PVCs.
但是，电生理研究加心电图监测的试验显示，用药物成功控制的室性早搏病人2年内50%复发
These data suggest a dissociation between PVC suppression and recurrence of VT; PVCs may represent a marker of left ventricular dysfunction rather than a trigger of SCD, or the arrhythmogenic substrate may change over time.
(dissociation 分裂、分离 substrate 底层、底物、基础)
这些资料提示室性早搏的控制和室性心动过速的复发是不相关的；室早可能是代表左室功能紊乱的一个信号，而不是心源性猝死的触发者，或心律不齐的基础可能因时间而变化。
