Frank Matthias, Schmucker Uli, Stengel Dirk, Fischer Lutz, Lange Joern, Grossjohann Rico, Ekkernkamp Axel, Matthes Gerrit
Department of Trauma and Orthopedic Surgery, Ernst-Moritz-Arndt-University, Greifswald, Germany.
J Trauma. 2010 Nov;69(5):1191-5. doi: 10.1097/TA.0b013e3181c452e7.
Visually estimated amount of blood loss may influence decision making in the prehospital setting. The purpose of this study was to determine the ability and accuracy of paramedics and emergency physicians to visually estimate a volume of external blood loss and the influence of different vital signs.
In a prospective, blinded, observational design, participants were asked to visually estimate the amount of blood in six simulated trauma scenarios. Casualties were provided with a simulated injury, and a certain amount of artificial blood that was poured on the casualties' clothing and on the floor. In addition, vital signs (i.e., blood pressure and heart rate) were given. Each two moulage patients were provided with the same injury pattern and the same simulated blood loss. Although one patient seemed to be normovolemic, the other seemed to be hypovolemeic by the given vital signs.
With regard to all given amounts of blood loss, providing vital parameters suggesting instability (i.e., low blood pressure, high heart rate) led to a higher estimation of the lost blood volume in both paramedics and emergency physicians. However, estimations were influenced impressively by the given parameters. For both stable and unstable patients, small actual volumes were overestimated, whereas higher volumes tended to be underestimated. Neither occupational status (emergency physician or paramedic) nor gender or level of experience influenced accuracy of estimated blood loss significantly.
视觉估计失血量可能会影响院前急救环境中的决策。本研究的目的是确定护理人员和急诊医生视觉估计外部失血量的能力和准确性，以及不同生命体征的影响。
在一项前瞻性、盲法、观察性设计中，要求参与者在六种模拟创伤场景中视觉估计出血量。为模拟伤员提供模拟损伤，并将一定量的人造血倒在伤员的衣服和地板上。此外，还给出了生命体征（即血压和心率）。每两名模拟伤员具有相同的损伤模式和相同的模拟失血量。尽管一名患者似乎血容量正常，但根据给定的生命体征，另一名患者似乎血容量不足。
对于所有给定的失血量，提供提示不稳定的生命参数（即低血压、高心率）会导致护理人员和急诊医生对失血量的估计更高。然而，估计受到给定参数的显著影响。对于稳定和不稳定的患者，实际少量的失血量被高估，而大量的失血量往往被低估。职业状态（急诊医生或护理人员）、性别或经验水平均未显著影响估计失血量的准确性。
