By M. Hofman, H.-C. Pape FACS (auth.), Hans-Jörg Oestern, Otmar Trentz, Selman Uranues (eds.)
There at the moment is a transparent tendency to increasingly more unintentional accidents in aged humans, in recreation accidents and automobile crashes additionally in international locations which lately joined the eu Union and applicants to hitch the eu Union. sufferers anticipate first-class practical effects even after critical accidents. yet not like this improvement, Trauma surgical procedure as an self sustaining box, isn't but demonstrated in all ecu nations. for that reason, it kind of feels obligatory to bring together a booklet that covers the state of the art in Trauma surgical procedure. The publication additionally serves to harmonise the perform of Trauma surgical procedure in the ecu Union, and to organize for the examination of the U.E.M.S.
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Was the treatment not optimal? These questions cannot be answered. A 10 % risk of death means that on average, one out of ten similar patients would die. But the score cannot predict which patient will die. If such deaths in low-risk patients occur more frequently than one in ten, then it could be a matter of treatment quality. But in the individual case, this decision is not acceptable. In conclusion, a variety of trauma scores exist and new scores will continue to be developed in the future. Scores are used mainly in clinical studies and audit of care.
Champion HR, Copes WS, Sacco WJ, Lawnick MM, Keast SL, Bain LW, Flanagan ME, Frey CF (1990) The major trauma outcome study: establishing national norms for trauma care. J Trauma 30:1356–1365 10. Lefering R (2009) Development and validation of the Revised Injury Severity Classification (RISC) score for severely injured patients. Eur J Trauma Emerg Surg 35:437–447 11. Maegele M, Lefering R, Wafaisade A et al (2011) Revalidation and update of the TASH score: a scoring system to predict the probability of massive transfusion as a surrogate for life-threatening haemorrhage after severe injury.
Unconscious patients with a Glasgow Coma Scale (GCS) of 3–8 also have a potential “A” problem. Their airway is not safe because they can aspirate as a result of impaired reflexes. The treatment of choice is rapid sequence endotracheal intubation. It is important to reevaluate the patient after each intervention to ensure success. Good Clinical Practice (GCP) Guideline: Key recommendations for airway  Emergency medical services personnel must be regularly trained in emergency anesthesia, endotracheal intubation, and alternative ways of securing an airway (bag-valve-mask, supraglottic airway devices, emergency cricothyroidotomy) Multiply injured patients with apnoe or a respiratory rate below 6 must be anesthetized, intubated endotracheally, and ventilated in the prehospital setting Emergency anesthesia, endotracheal intubation, and ventilation should be carried out in the prehospital phase in multiply injured patients with the following indications: Hypoxia (SpO2 < 90 %) despite oxygenation after exclusion of a tension pneumothorax Severe traumatic brain injury (GCS < 9) Trauma-associated hemodynamic instability (BPsys < 90 mmHg) Severe chest injury with respiratory insufficiency (respiratory rate > 29 breaths per minute) The multiply injured patient must be preoxygenated before anesthesia After more than three attempts of endotracheal intubation, alternative methods must be considered for ventilation and securing an airway Alternative methods for securing an airway must be available when anesthetizing and endotracheally intubating a multiply injured patient When endotracheal intubation and emergency anesthesia are performed, electrocardiogram, blood pressure measurement, pulse oxymetry, and capnography must be used to monitor the patient During endotracheal intubation in the prehospital and in-hospital setting, capnometry/capnography must be used for monitoring tube placement and ventilation Normoventilation must be carried out in endotracheally intubated and anesthetized trauma patients For endotracheal intubation in multiply injured patients, emergency anesthesia must be carried out as rapid sequence induction because of the usual lack of a fasting state and risk of aspiration Manual in-line stabilization should be carried out for endotracheal intubation with the cervical spine immobilization device temporarily removed Grade (GoR) GoR A GoR A GoR B GoR A GoR A GoR A GoR A GoR A GoR A GoR A GoR B Life threatening “B” problems that must be detected are a tension pneumothorax or relevant pneumothorax or hemothorax that result in cardiorespiratory impairment.
General Trauma Care and Related Aspects: Trauma Surgery II by M. Hofman, H.-C. Pape FACS (auth.), Hans-Jörg Oestern, Otmar Trentz, Selman Uranues (eds.)