Emergency Surgery Common Disease Diagnosis and Treatment Routine


Multiple injuries
Overview Multiple trauma refers to the human body at the same time or successively suffered more than two anatomical parts or organs of the trauma, and these traumatic timely
Being alone, but also a serious trauma.
Clinical manifestations
1. The injury is complex, serious injuries, and more performance for the Department of Physiological rapid chaos, weak pulse, blood pressure, oxygen barrier.
2. Significant reduction in effective circulation (including blood and the third gap was "high frequency of low-capacity shock.
According to different parts, organs and degree of injury, early clinical manifestations vary
(1.) Open wounds can flow out of the wound of different nature and quantity of liquid.
(2.) Brain injury showed varying degrees of mental changes and pupil changes.
(3.) Chest injuries often show respiratory dysfunction, circulatory dysfunction, hypoxemia and hypotension.
(4.) Abdominal injury early manifested as intra-abdominal hemorrhage, abdominal irritation or hypotension.
(5.) Spine, spinal cord injury may appear limb movement disorders or loss of feeling.
(6.) Long bone fracture can show limb deformation or movement disorders.
Diagnostic points
1. Rescue life as the first element, critically ill members should first rescue, after diagnosis.
2. detailed history, to understand the nature of the injured object and the body focus on the site.
3. vital signs unstable unstable wounded people, mainly physical examination, the initial diagnosis of fatal injuries should not move the wounded special
Special inspection, so as not to aggravate the injury, delay the rescue time.
4. Multiple injuries in clinical manifestations, overlap or cover each other, the early focus should be checked head, chest, abdomen and organ injury.
5. A wound injury treatment, shock still does not improve, should actively find the reason for the start of shock, can not meet a wound clinic
Broken, the best time to lose hand wood.
Complex injury, the development of changes in the injury celebration, the main open shield may be transformed. Therefore, the dynamic observation of the injury must be stabilized Pu
6. Multiple injuries, complex injuries, the development of changes in the injury celebration, the main shield may be transformed. Therefore, the trend has to be dynamic observation of injuries, to prevent missed diagnosis, misdiagnosis.
Treatment programs and principles
1. Resuscitation fluid to the main body, such as hematocrit <30 should enter the red blood cells.
2. Active hemorrhagic wounded who maintain systolic blood pressure prior to controlling bleeding 80 "85mdHk allowable hypotension levels, longer, more difficult to correct, more complications, so bleeding as soon as possible is still the key. Excessive, rapid Infusion increases blood pressure will only increase
Bleeding, and may lead to tissue edema. Therefore, it should be strictly monitored and adjusted at any time.
3. Maintain airway patency and gas exchange, adequate oxygen supply, maintaining 5a02> 90%.
4. General wounded by the initial body fluid recovery, systolic blood pressure up to 8090mg, you can continue to infusion under the premise of the appropriate surgical treatment
5. Where major blood vessels or visceral injury more bleeding, progressive deterioration of vital signs or physiological potential of the body has reached its limit, in the death
Triangulation (hypothermia, coagulopathy, acidosis, less severe injuries, such as without surgical intervention is difficult to reverse the deterioration of the trend and save
life. At this point can not tolerate large and complex surgery, should be controlled injury hand wood.
() The first step is immediate surgery, with the easiest way to control bleeding and live infection.
(2) The second step is ICU custody, including fluid recovery, respiratory support, correction of acidosis, hypothermia and coagulopathy.
(3) until the respiratory function, hemodynamic basically stable, the death triangle can be corrected, 2472 hours after injury for definitive surgery.

Source: AEM Editorial Office