Burgess A R, Poka A
Emerg Med Clin North Am. 1984 Nov;2(4):871-82.
This article, written for emergency room physicians, provides simple, practical guidelines for the assessment and immediate treatment of musculoskeletal injuries of the multiply injured patient. The importance of the team approach and multidisciplinary management is stressed. An algorithm is provided to aid the emergency physician in performing the initial assessment and treatment in an organized fashion, with proper priorities given to musculoskeletal injuries. A systematic, anatomically oriented head-to-toe examination is suggested, performed in a cyclic fashion, correcting serious life- or limb-threatening pathology first. During the examination, special attention is required to support the cervical spine until there is radiologic evidence that the spine is stable. The emergency physician should remember that injuries that are not obvious during initial assessment may easily be missed unless the patient is re-examined in detail when the vital signs are stabilized. This is especially true in an unconscious patient with head or pelvic injuries or compartment syndromes. Guidelines are given for emergency treatment of dislocations, open fractures, and wounds because these may be the responsibility of the emergency room physician, depending upon local policies, availability of specialty staff, or constraints of time.
本文是为急诊医生撰写的，提供了针对多发伤患者肌肉骨骼损伤评估及即刻治疗的简单实用指南。强调了团队协作方法和多学科管理的重要性。提供了一种算法，以帮助急诊医生以有组织的方式进行初始评估和治疗，并对肌肉骨骼损伤给予适当的优先级。建议进行系统的、按解剖顺序从头到脚的检查，以循环方式进行，首先纠正严重危及生命或肢体的病理状况。在检查过程中，在获得脊柱稳定的放射学证据之前，需要特别注意支撑颈椎。急诊医生应牢记，除非在生命体征稳定后对患者进行详细复查，否则初始评估时不明显的损伤很容易被漏诊。对于头部或骨盆受伤或患有骨筋膜室综合征的昏迷患者尤其如此。文中给出了脱位、开放性骨折及伤口的急诊治疗指南，因为根据当地政策、专科人员的可获得性或时间限制，这些可能由急诊室医生负责处理。
