枪伤和爆炸伤的急救与医院治疗。
The First Aid and Hospital Treatment of Gunshot and Blast Injuries.
机构信息
Department of Trauma, Orthopedic, Reconstructive, and Hand Surgery, Burns Medicine, Bundeswehr Central Hospital, Koblenz; Department of Trauma, Orthopedic, Septic, and Reconstructive Surgery, Sports Injuries, Bundeswehr Hospital, Ulm; Department of General, Visceral, and Thoracic Surgery, Bundeswehr Central Hospital, Koblenz.
出版信息
Dtsch Arztebl Int. 2017 Apr 7;114(14):237-243. doi: 10.3238/arztebl.2017.0237.
BACKGROUND
When gunshot and blast injuries affect only a single person, first aid can always be delivered in conformity with the relevant guidelines. In contrast, when there is a dynamic casualty situation affecting many persons, such as after a terrorist attack, treatment may need to be focused on immediately life-threatening complications.
METHODS
This review is based on pertinent publications retrieved by a selective search in Medline and on the authors' clinical experience.
RESULTS
In a mass-casualty event, all initial measures are directed toward the survival of the greatest possible number of patients, in accordance with the concept of "tactical abbreviated surgical care." Typical complications such as airway obstruction, tension pneumothorax, and hemorrhage must be treated within the first 10 minutes. Patients with bleeding into body cavities or from the trunk must be given priority in transport; hemorrhage from the limbs can be adequately stabilized with a tourniquet. In-hospital care must often be oriented to the principles of "damage control surgery," with the highest priority assigned to the treatment of life-threatening conditions such as hemodynamic instability, penetrating wounds, or overt coagulopathy. The main considerations in initial surgical stabilization are control of bleeding, control of contamination and lavage, avoidance of further consequences of injury, and prevention of ischemia. Depending on the resources available, a transition can be made afterward to individualized treatment.
CONCLUSION
In mass-casualty events and special casualty situations, mortality can be lowered by treating immediately life-threatening complications as rapidly as possible. This includes the early identification of patients with lifethreatening hemorrhage. Advance preparation for the management of a masscasualty event is advisable so that the outcome can be as favorable as possible for all of the injured in special or tactical casualty situations.
背景
当枪击和爆炸伤仅影响一个人时，始终可以根据相关指南进行急救。相比之下，当涉及到许多人（如恐怖袭击后）的动态伤亡情况时，治疗可能需要集中于立即危及生命的并发症。
方法
本综述基于 Medline 选择性搜索检索到的相关出版物和作者的临床经验。
结果
在大规模伤亡事件中，所有初始措施均根据“战术性简化外科护理”的概念，旨在使尽可能多的患者存活。必须在最初的 10 分钟内治疗典型的并发症，如气道阻塞、张力性气胸和出血。有体腔或躯干内出血的患者必须优先进行转运；肢体出血可以通过止血带充分稳定。院内治疗必须经常遵循“损伤控制性手术”的原则，优先处理危及生命的情况，如血流动力学不稳定、穿透性伤口或明显凝血功能障碍。初始外科稳定的主要考虑因素是控制出血、控制污染和冲洗、避免进一步的损伤后果以及预防缺血。根据可用资源，随后可以过渡到个体化治疗。
结论
在大规模伤亡事件和特殊伤亡情况下，通过尽快治疗立即危及生命的并发症，可以降低死亡率。这包括尽早识别有生命威胁性出血的患者。建议为大规模伤亡事件的管理做好预先准备，以便在特殊或战术伤亡情况下，所有伤员的结果尽可能有利。
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