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1、Trauma WeaponInjury Qing TangZhu M D Ph D DepartmentofMicrosurgery OrthopedicTraumaTheFirstAffiliatedHospitalSunYat SenUniversity Aimsofthislecture KnowthephysiologicalresponsesofourbodiesfollowingtraumaKnowthefeaturesofdifferenttypesoftraumaLearnhowtocareanacutelyinjuredpatientbasedonthepriorityKno
2、wsomegeneralknowledgeaboutweaponinjury Outline PartI BasicscientificknowledgeabouttraumaPathophysiologyoftraumaWoundhealingPartII TraumaEpidemiology injurypreventionClassification triageInitialassessment carePartIII WeaponInjuryBlastinjuryNuclearweaponinjuryChemicalweaponinjuryCombinedinjury PartI B
3、asicscientificknowledgeabouttrauma PathophysiologyoftraumaImmuneresponsetotraumaChangesinorganfunctionfollowingtraumaWoundhealing ImmuneResponsetoTrauma Dynamicstagesintheimmuneresponsetotrauma Changesinorganfunction CardiovascularsystemBloodloss hypovolemia shock hearfailureLungHypercapniaHypoxiaAd
4、ultRespiratoryDistressSyndrome ARDS AcuteLungInjury ALI KidneyHypovolemia renalhypoperfusion Toxin mediated radiocontrast antimicrobials renalparenchymalinjuryRhabdomyolysisLiverGastrointestinaltract bleedingBrain WoundHealing A inflammatoryphaseB proliferationphaseC Remodelingphase Primaryhealing S
5、econdaryhealing PartII Trauma Epidemiology injurypreventionClassification traumatriageInitialassessmentandcareoftheinjuredpatientPrehospitalphaseIn hospitalphase TheFactsaboutTrauma LeadingcauseofdeathOverallages Rank4Aged1to44 Rank1Aged1 34 morethantoallothercausesofdeathcombinedNonfatalInjuries US
6、A 2019 8 ofallhospitaldischarges37 ofallemergencydepartmentvisitsThehighestrateofinjuryIndevelopingareas countriesRapideconomicchangeandurbanizationRoadtrafficincidencecausedGlobal 1 18milliondeaths 30millioninjuriesUSA 45 000deaths 357 000hospitalizationChina 120 000deaths 550 000injures LifetimeCo
7、stofInjury 406Billion USA 2000 IsTraumaPreventable TraumaOccursrandomly unpredictably Doesnotoccurbyaccident PrimarypreventionPreventtheoccurrenceofthetraumaitselfSecondarypreventionLimitenergytransfertotheindividualMinimizetheseverityoftraumaTertiarypreventionInstituteoptimalcarefortheinjuredpatien
8、tImproveoutcomefollowingtrauma PartII Trauma Epidemiology injurypreventionClassification traumatriageInitialassessmentandcareoftheinjuredpatientPrehospitalphaseIn hospitalphase Classification BaseontheintegrityofskinClosedinjuryOpeninjuryBaseontheinjurysiteBaseonthemechanismofinjury MOI Baseonthesev
9、erityRelatedtothefeatures treatmentoptions andprognosisoftrauma ClosedInjury OpenInjury Classificationbasedontheinjurysite ClassificationbasedonMOI MechanicalinjuryBluntinjury motorvehicleaccident MVA fall crushPenetratinginjury stab impale firearmBlastinjuryTemperature associatedinjuryBurns coldinj
10、uryFirearm associatedinjurySpecialinjuryChemical biological radiationinjuryCombinedinjury ClassificationbasedontheseverityDisasterTriage ParametersAbilitytoambulateRespiratoryfunctionSystemicperfusionLevelofconsciousness GreenWalkingwoundedRed immediatetransportRR 30RR2RR 30 CR 2 unconsciousYellow d
11、elayedtransportBlack unsalvageable SimpleTriageAndRapidTransport START PartII Trauma Epidemiology injurypreventionClassification traumatriageInitialassessmentandcareoftheinjuredpatientPrehospitalphaseIn hospitalphase Algorithmforprehospitalcare SceneAssessment SafetyDangerousenvironmentsStandardprec
12、autionsBloodandbodyfluidmaycontainpathogensSituationNumberofpatientsandtheiragesNeedforadditionalassistancesKinematics MOIMVAFallsOccupational recreationalinjuryPenetratinginjury InitialAssessment PrimarysurveyAirwayBreathingCirculationDisability neurologicevaluation Expose environmentcontrolSeconda
13、rysurvey ImmediateMeasuresattheScene BasicLifeSupport BLS BasicairwaymanagementSupplementaloxygenRescuebreathingCardiopulmonaryresuscitation CPR ControlofexternalhemorrhageFluidtherapySpinalimmobilizationC collarLongbackboard GoldenPrinciplesofPrehospitalTraumaCare Ensurethesafetyoftheprehospitalcar
14、eprovidersandthepatientAssessthescenesituationtodeterminetheneedforadditionalresourcesRecognizethekinematicsthatproducedtheinjuriesUsetheprimarysurveyapproachtoidentifylife threateningconditionsProvideappropriateairwaymanagementwhilemaintainingcervicalspinestabilizationSupportventilationanddeliverox
15、ygentomaintainanSpO2 95 ControlanysignificantexternalhemorrhageProvidebasicshocktherapy includingrestoringandmaintainingnormalbodytemperatureandappropriatelysplintingmusculoskeletalinjuries GoldenPrinciplesofPrehospitalTraumaCare Considertheuseofthepneumaticantishockgarmentforpatientswithdecompensat
16、edshock SBP 90mmHg MaintainmanualspinestabilizationuntilthepatientisimmobilizedonalongbackboardForcriticallyinjuredtraumapatients initiatetransporttotheclosestappropriatefacilitywithin10minofarrivalonsceneInitiatewarmed intravenousfluidreplacementenroutetothereceivingfacilityAscertainthepatient smedicalhistoryandperformasecondarysurveywhenlife threateningconditionshavebeensatisfactorilymanagedorhavebeenruleoutAboveall donofurtherharm PartII Trauma Epidemiology injurypreventionClassification trau
