外科学教学课件：创伤TRAUMA.ppt

Anatomical Distribution of Penetrating Wounds (%) Conflict Head Neck Thorax Abdomen Limbs Other World War I 17 4 2 70 7 World War II 4 8 4 75 9 Korean War 17 7 7 67 2 Vietnam War 14 7 5 74 － Northern Ireland 20 15 15 50 － Falkland Islands 16 15 10 59 － Gulf War (UK)* 6 12 11 71 － Gulf War (US) * 11 8 7 56 － Afghanistan (US) 16 12 11 61 － Chechnya (Russia) 24 9 4 63 － Somalia 20 8 5 65 2 Average 15 9.5 7.4 64.6 3.5 * 80% caused by fragments; range of hits 1–45, mean of 9 Mechanism of Injury --For missile injuries, there are two areas of projectile-tissue interaction, permanent cavity and temporary cavity Idealized path of tissue disruption caused by an M-193 bullet fired from the M-16A1 rifle (10% gelatin as a simulation). Idealized path of tissue disruption caused by an AK-47 projectile, (10% gelatin as a simulation). 战伤救治基本原则： 快抢快救，先抢先救； 全面检查，科学分类； 在后送中连续检测与治疗； 早期清创，延期缝合； 先重后轻； 整体治疗。 战伤 Damage control is defined as the rapid initial control of hemorrhage and contamination, temporary closure, resuscitation to normal physiology in the ICU, and subsequent re-exploration and definitive repair. This approach reduces mortality to 50%. 通气术 心肺复苏 止血 包扎 骨折固定 搬运 检查并维持呼吸道通畅，检查胸部 有无创口，胸壁有无反常运动； 胸外心脏按压、人工呼吸； 压迫止血、加压包扎、止血带； 包扎外露伤口； 就地取材固定骨折； 妥善搬运 战伤急救六大技术： 战伤 Damage Control Surgery Damage control surgery is one of the major advances in surgical technique in the past 20 years. The principles of damage control have been slow to be accepted by surgeons around the world, as they contravene most standard surgical teaching practices - that the best operation for a patient is one, definitive procedure. er, emergency room; or, operating room er, emergency room; or, operating room; icu, intensive care unit The central tenet of damage control surgery is that patients die from a triad of coagulopathy, hypothermia and metabolic acidosis. The principles of the first ‘damage control’ procedure then are control of haemorrhage, prevention of contamination(污染) and protection from further