Inpatient care with multiple injuries
Traumatology / / August 12, 2017
affected treatment with multiple traumas requires great effort of many experts, significant resources, powerful equipment.Completely create such conditions can only large hospital - in a general hospital, surgical center in an ambulance, in special research centers.Affected with multiple fractures and non-severe concomitant brain damage, breast, pelvis hospitalized in the trauma unit, patients with severe concomitant brain injury be hospitalized in the neurosurgical department with severe concomitant injury chest and abdomen - the surgical (thoracic, abdominal) department.
Regardless of hospital admission capacity hard hit performed by the same principles.Delivered to the emergency room shift affected (only once!) From the stretcher on board a special mattress set on a gurney.Any further movement of victims (in the operating room, intensive care, X-ray room, and so on. N.) Is carried out only with a shield.When using the ambulance, stretcher tires victim shifting at all excluded, because it is placed o
assess the severity of damage and planning resuscitation programs begin before receipt of the patient in the clinic (on the basis of medical emergency data).The tactics of character and antishock measures clarify and supplement at the initial examination and during the subsequent detailed examination of the patient.The victims with multiple fractures and associated injuries require close monitoring for at least 1-2 days, despite the stable hemodynamics.In this regard, they immediately placed in the intensive care unit (or operating) the intensive care unit, located in the waiting room.
specifics of intensive care services requires maximum standardization of all measures of emergency aid.On the operating table is placed in advance complete with sets of sterile instruments (for thoracotomy, laparotomy, craniotomy, tracheotomy, etc.), On a mobile table - sets for arteriovenous and venesection with ready-made systems for transfusion therapy for hematologic table - serum kits for the determination of blood groups, Rh factor and the necessary equipment for the preparation of blood for transfusion.The refrigerator should be a blood supply to provide massive blood transfusion is required as a permanent contact with the blood transfusion station, donor item (for direct blood transfusion).Respiratory and anesthetic equipment must meet the requirements of modern intensive care service.
Complete control over the condition of patients with polytrauma, timely correction of vital functions are inconceivable without clinical and biological blood rapid tests, urine, cerebrospinal fluid, and so on. D. This information is available only when the clock work of laboratories.
great importance in the organization of assistance to victims is hard to medical records, the completeness and accuracy of reference which helps to orient in a patient's condition to treat effectively and more reliably predict the outcome of polytrauma.In the acute phase, in addition to the "history", it is necessary to conduct a special card ( "shock", "emergency", etc...), In which a regular basis (every 2-4 hours, while threatening conditions - every 15-30 minutes) register of BP, heart rate, respiratory, central and peripheral temperature, state of consciousness, the volume of transfusion and urine, the introduction of drugs and carrying out diagnostic and therapeutic procedures, laboratory data, and so on. n. Daily summarize all performed medical procedures and evaluate themeffect, on the basis of which the plan further treatment program.
severity was injured in the first period depends on the development of traumatic shock, which can be expected with participation in multiple trauma fractures of the pelvis, thorax, lower limbs, in the presence of internal injuries, open fractures with extensive crush the soft tissues in the separation of the limbs,at least - for multiple serious bruises throughout the body.Heavy shock due mainly to massive blood loss when combined injuries of bones and internal organs (18.6%), in the separation and crushing limbs (9.6%), with open fractures (4.8%), as well as damage to vital organs- brain, lung, heart (12.5%).
Resuscitation at victims in a state of clinical death, begin with a closed heart massage and artificial ventilation.All other therapeutic measures in this critical moment stopped, except for transfusion therapy, the rate of which is necessary to immediately increase.To facilitate the flow of blood to the heart and the brain give the patient the Trendelenburg position, and for the prevention of irreversible changes in the central nervous system is carried out cooling the head.
- Treatment pelvis
- fractures Plaster bandages
- First aid and treatment for injuries of the abdomen
- struggle with pain in injuries
- Principles of treatment of concurrent fractures femur bone and tibia
- Multiple fracturesshin
- multiple fractures ankle
- struggle with acute blood loss in trauma
- tourniquet technique
- Transosseous osteosynthesis external fixation
- Combined treatment of injuries
- treatment of multiple rib fractures
should be rememberedthat precedes hypoxia reduces the duration of the state of clinical death to 1-2 minutes or less.Have affected young and middle age, as a rule, always manages to restore cardiac activity, but most of them during the period of asystole (and ineffective resuscitation) develop irreversible changes in the cerebral cortex.In patients older restore cardiac activity is rarely possible.
open heart massage it is advisable to perform only in the operating room, it is preferred in patients with multiple fractures of the ribs and sternum, the phenomena of cardiac tamponade, severe lung damage.When effective cardiac massage appears distinct pulsation of the carotid arteries, increases blood pressure to 8-10,7 kPa (60-80 mm Hg. Art.), Turns pink lip mucous shell, narrowing the pupils, restored corneal reflexes, spontaneous breathing, positive dynamics of ECG data.The stimulation of the heart muscle intracardiac administration of epinephrine (0.1% -1-2 ml) and calcium chloride (10% -5-10 ml) can be repeated every 5-10 minutes of resuscitation.Stimulating effect also have intravenous infusion of norepinephrine (0.1% -2-5 ml 250-500 ml of fluid).Electrical stimulation and defibrillation of the heart in patients with multiple injuries, tend to be less effective than in patients with impaired heart rate.