Griggs W M, Morris R W, Runciman W B, Osborne G A, Paix A D
Trauma Service, Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia.
Qual Saf Health Care. 2005 Jun;14(3):e21. doi: 10.1136/qshc.2002.004499.
Anaesthetists are regularly involved in the management of patients who have suffered trauma. Acute physiological derangements can occur at any time after the original injury, with life threatening sequelae. These problems may be complex in nature and evolve rapidly, often with an obscure aetiology, so a systematic approach to them is essential.
To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK" supplemented by a specific sub-algorithm for trauma, in the management of anaesthesia involving trauma cases.
The potential performance of a structured approach for each of the trauma incidents among the first 4000 incidents reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual performance as reported by the anaesthetists involved.
There were 38 relevant reports relating to trauma in the first 4000 reports to AIMS. In 39% of these there was "emergency corner cutting", although in the majority the urgency was thought to have been more perceived than real. The previously described "core" crisis management algorithm for crises during general anaesthesia was an effective means of discovering (82%), diagnosing (68%), and correcting (66%) the majority of trauma incidents. However a sub-algorithm specific for the traumatised patient was required for unusual, obscure, or complex presentations.
Although the small numbers preclude validation of the sub-algorithm, it would have successfully managed all the trauma cases reported to AIMS.
麻醉医生经常参与创伤患者的管理。急性生理紊乱可在原发损伤后的任何时间发生，并伴有危及生命的后遗症。这些问题本质上可能很复杂且发展迅速，病因往往不明，因此系统的处理方法至关重要。
研究一种先前描述的核心算法“COVER ABCD - A SWIFT CHECK”，辅以创伤专用子算法，在涉及创伤病例的麻醉管理中的作用。
将报告给澳大利亚事件监测研究（AIMS）的前4000起事件中每起创伤事件的结构化处理方法的潜在表现，与参与的麻醉医生报告的实际表现进行比较。
在提交给AIMS的前4000份报告中有38份与创伤相关。其中39%存在“紧急走捷径”的情况，不过大多数情况下这种紧急程度被认为更多是感觉而非实际存在。先前描述的用于全身麻醉期间危机的“核心”危机管理算法是发现（82%）、诊断（68%）和纠正（66%）大多数创伤事件的有效手段。然而，对于不寻常、不明或复杂的情况，需要针对创伤患者的子算法。
尽管样本量小无法验证子算法，但它本可成功处理报告给AIMS的所有创伤病例。
