Accident & Emergency Department, Tuen Mun Hospital, Hong Kong, China.
World J Emerg Med. 2010;1(2):85-92.
This review aims to provide a concise overview of the trauma management evolution in the past decade. 1) Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2) Five stratified levels for DAM have replaced the non-specific conventional Plans A & B. 3) CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4) DPL has virtually been replaced by the FAST USG. 5) Direct whole-body MDCT provides rapid imaging diagnosis & expedites the definitive treatment but carries high radiation hazards. 6) The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7) DCR comprising of permissive hypotension, hemostatic resuscitation & DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP & platelet concentrates improves the outcome in massive blood transfusion. 8) DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9) A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP (pre-peritoneal pelvic packing) may further reduce mortality coupled with the necessary TCAE. 10) Injury prevention is equally important if not more than the trauma resuscitation & operation.
这篇综述旨在简要概述过去十年中创伤处理的演变。1）创伤护理重点除了传统的 ABCDE 之外，还包括对医护人员感染的防护和早期决策。2）DAM 的五个分层级别取代了非特异性的常规 A 计划和 B 计划。3）CT 扫描可能成为血流动力学不稳定患者的死亡之“隧”。4）DPL 实际上已被 FAST USG 取代。5）直接全身 MDCT 可快速进行影像诊断并加快确定性治疗，但具有较高的辐射危害。6）通过液体复苏反应进行的动态休克评估比静态血容量丢失模型提供更具针对性的结果评估。7）包括允许性低血压、止血复苏和 DCS 的 DCR 旨在克服创伤的致命三联征。早期输注新鲜冰冻血浆和血小板浓缩物等血液成分可改善大量输血的预后。8）DCS 的目的是纠正失调的生理状况，而不是完全恢复受损的解剖结构。9）针对骨盆骨折的预定义方案可能具有救命作用，新型的腹膜前盆腔填塞（Pre-PPP）可能进一步降低死亡率，并结合必要的 TCAE。10）如果不是比创伤复苏和手术更重要，那么预防伤害也同样重要。
