Shatney C H
Department of Surgery, University of Florida College of Medicine.
Acta Anaesthesiol Belg. 1987;38(4):267-74.
The initial management of hemodynamically unstable polytrauma patients can be challenging. Although there are other possible causes of hypotension, such as tension pneumothorax, CNS injury and hemopericardium, in the vast majority of blunt trauma victims shock is due to blood loss. Whereas the diagnosis of circulatory collapse is clearcut, the rapid identification and control of the bleeding source may not be a straightforward matter. Such patients often have injuries to several body systems and thus have numerous potential sites of hemorrhage. Ideally, the injury pattern should be defined during resuscitation. The use of a trauma team and standardized protocols facilitate patient management. Clearly, airway patency and adequacy of ventilation must have top priority. Cervical spine immobilization should be maintained until a fracture has been ruled out. In concert with respiratory management, other members of the trauma team should secure adequate vascular access, resuscitate the patient and perform a physical examination. Physical findings dictate the order of further diagnostic and therapeutic maneuvers. In unstable patients the potential need for urgent surgical intervention must not be overlooked.
对血流动力学不稳定的多发伤患者进行初始处理可能具有挑战性。尽管低血压还有其他可能的原因，如张力性气胸、中枢神经系统损伤和心包积血，但在绝大多数钝性创伤受害者中，休克是由失血引起的。虽然循环衰竭的诊断很明确，但快速识别和控制出血源可能并非易事。这类患者通常有多个身体系统受伤，因此有众多潜在的出血部位。理想情况下，应在复苏过程中明确损伤模式。使用创伤团队和标准化方案有助于患者管理。显然，气道通畅和通气充分必须是首要任务。在排除骨折之前，应保持颈椎固定。与呼吸管理同步，创伤团队的其他成员应确保充分的血管通路，对患者进行复苏并进行体格检查。体格检查结果决定进一步诊断和治疗操作的顺序。对于不稳定患者，绝不能忽视紧急手术干预的潜在需求。
