Monchal T, Hornez E, Prunet B, Beaume S, Marsaa H, Bourgouin S, Baudoin Y, Bonnet S, Morvan J-B, Avaro J-P, Dagain A, Platel J-P, Balandraud P
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Sainte Anne, BP 600, 83800 Toulon cedex 9, France.
Service de Chirurgie Viscérale, Hôpital d'Instruction des Armées Percy, Clamart, France.
J Visc Surg. 2016 Aug;153(4 Suppl):3-12. doi: 10.1016/j.jviscsurg.2016.04.014. Epub 2016 May 31.
Severe trauma patients should be received at the hospital by a multidisciplinary team directed by a "trauma leader" and all institutions capable of receiving such patients should be well organized. As soon as the patient is accepted for care, the entire team should be prepared so that there is no interruption in the pre-hospital chain of care. All caregivers should thoroughly understand the pre-established protocols of diagnostic and therapeutic strategies to allow optimal management of unstable trauma victims in whom hemostasis must be obtained as soon as possible to decrease the morbid consequences of post-hemorrhagic shock. In patients with acute respiratory, circulatory or neurologic distress, several surgical procedures must be performed without delay by whichever surgeon is on call. Our goal is to describe these salvage procedures including invasive approaches to the upper respiratory tract, decompressive thoracostomy, hemostatic or resuscitative thoracotomy, hemostatic laparotomy, preperitoneal pelvic packing, external pelvic fixation by a pelvi-clamp, decompressive craniotomy. All of these procedures can be performed by all practitioners but they require polyvalent skills and training beforehand.
严重创伤患者应由以“创伤负责人”为首的多学科团队在医院接收治疗，所有有能力接收此类患者的机构都应组织完善。患者一旦被收治，整个团队就应做好准备，以确保院前护理链不中断。所有护理人员都应透彻理解预先制定的诊断和治疗策略方案，以便对不稳定的创伤受害者进行最佳管理，必须尽快实现止血，以减少出血性休克后的不良后果。对于出现急性呼吸、循环或神经功能障碍的患者，无论哪位值班外科医生都必须立即进行多项外科手术。我们的目标是描述这些挽救手术，包括对上呼吸道的侵入性处理、减压性开胸术、止血或复苏性开胸术、止血性剖腹术、腹膜前盆腔填塞、用骨盆夹进行骨盆外固定、减压性颅骨切开术。所有这些手术所有从业者都能进行，但他们需要具备多方面技能并事先接受培训。
