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一个创伤专家的共识:能力是需要早期改善创伤伤害的生存能力
Jennifer M Gurney1, Russ S Kotwal, John B Holcomb
1From the Joint Trauma System (J.M.G., R.S.K., S.J., B.J.S., J.W., H.M., A.J.R.), Defense Health Agency, Joint Base San Antonio-Fort Sam Houston, Texas; Department of Surgery (J.M.G., S.S., S.J., E.M.), Department of Military and Emergency Medicine (R.S.K., E.M.), and Department of Pathology (A.J.R., E.M.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Trauma and Acute Care Surgery (J.B.H.), University of Alabama at Birmingham, Birmingham, Alabama; The Geneva Foundation (A.M.S.), US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston; Department of Surgery, Trauma and Acute Care Surgery (B.E.), University of Texas Health San Antonio, San Antonio, Texas; Joint Medical Unit (M.S.), Joint Special Operations Command, United States Special Operations Command, Fort Liberty, North Carolina; San Antonio Uniformed Services Health Education Consortium (M.S.), Joint Base San Antonio-Fort Sam Houston, Texas; Defense Health Agency (S.J., S.S.), Colorado Trauma Medical Director, Colorado Springs, Colorado; Department of Trauma and Acute Care Surgery (K.G.), Cooper University Medical Center, Camden, New Jersey; HNL Lab Medicine (E.M.), Allentown, Pennsylvania; and Armed Forces Medical Examiner System (W.W., A.J.R.), Defense Health Agency, Dover Air Force Base, Delaware.
军事创伤审查确定了可能生存的战斗伤害. 血液输血和受伤后不久的大规模输血被认为是最有影响力的,可以提高潜在的可存活战斗伤亡者的生存率.
科学领域:
- 军事医学 军事医学
- 创伤外科 手术 创伤外科
- 紧急医疗 紧急医疗
背景情况:
- 死亡率审查对于推进军事创伤系统和改善护理至关重要.
- 了解与战斗相关的死亡情况,为创伤系统的协议和指导方针提供了信息.
- 这项研究确定了对战斗人员伤亡的潜在生存益处的干预措施.
研究的目的:
- 确定特定的医院前和医院干预措施,这些干预措施可以为潜在的可存活的战斗伤害提供生存益处.
- 通过检查整个护理连续性的必要干预措施,为军事创伤系统的努力提供信息.
主要方法:
- 审查了美国特种作战司令部的死亡人数与可能存活的战斗伤害 (2001-2021年).
- 一个由创伤外科医生,法医病理学家和医院前/紧急医疗专家组成的小组评估了干预措施.
- 确定了具有潜在生存益处的医院前,医院和复苏干预措施.
主要成果:
- 在100名可能存活的死亡人数中,75%在医院前死亡;62%受枪伤.
- 推的干预措施包括医院前输血 (95%) 和手指/管胸口 (47%).
- 全血输血被认为是关键的,其中74%需要≥10单位;5可能受益于医院前腹腔切除术.
结论:
- 系统地确定必要的干预措施,在战斗伤亡中提供生存益处.
- 创伤伤害后早期的输血和大规模输血显著影响生存率.
- 这些发现为创伤系统的发展提供了信息,并加强了对军事人员的护理服务.
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Flail Chest-II
Assessment:
1. Clinical Evaluation:
History:
Traumatic Memory