Major trauma: Difference between revisions

From Wikipedia, the free encyclopedia
Browse history interactively
← Previous editNext edit →
Content deleted Content added
VisualWikitext
m cleaned up paragraph
Line 136: Line 136:


==Society and culture==
==Society and culture==

===Economics===
===Economics===
The average cost for the treatment of traumatic injury in the [[United States]] is around $334,000 per person, making it costlier than the treatment of [[cancer]] and [[cardiovascular]] diseases.<ref name="PHTLS">{{cite book |author= |title=PHTLS: Prehospital Trauma Life Support |publisher=Mosby/JEMS |location= |year=2010 |pages= |isbn=0-323-06502-3}}</ref> One reason of the high cost of injury is the increased possibility of complications which leads to the need for more interventions.<ref name="pmid18656640">{{cite journal |author=Hemmila MR, Jakubus JL, Maggio PM, ''et al.'' |title=Real money: [[complication (medicine)|complication]]s and hospital costs in trauma patients |journal=[[Surgery]] |volume=144 |issue=2 |pages=307–16 |year=2008 |month=August |pmid=18656640 |pmc=2583342 |doi=10.1016/j.surg.2008.05.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0039-6060(08)00289-4 |accessdate=2012-07-17}}</ref> Costs to maintain a trauma center are substantial as they are open continuously and maintain their readiness.<ref name="pmid14706578">{{cite journal |author=Taheri PA, Butz DA, Lottenberg L, Clawson A, Flint LM |title=The cost of trauma center readiness |journal=[[American Journal of Surgery]] |volume=187 |issue=1 |pages=7–13 |year=2004 |month=January |pmid=14706578 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002961003004379 |accessdate=2012-07-17}}</ref> In 2009 around 693.5 billion USD was lost due to traumatic injury in the United States.<ref>{{cite web | url=http://www.nsc.org/Documents/Injury_Facts/Injury_Facts_2011_w.pdf | title=Injury Facts | publisher=National Safety Council | accessdate=July 17, 2012}}</ref>
The average cost for the treatment of traumatic injury in the [[United States]] is around $334,000 per person, making it costlier than the treatment of [[cancer]] and [[cardiovascular]] diseases.<ref name="PHTLS">{{cite book |author= |title=PHTLS: Prehospital Trauma Life Support |publisher=Mosby/JEMS |location= |year=2010 |pages= |isbn=0-323-06502-3}}</ref> One reason of the high cost of injury is the increased possibility of complications which leads to the need for more interventions.<ref name="pmid18656640">{{cite journal |author=Hemmila MR, Jakubus JL, Maggio PM, ''et al.'' |title=Real money: [[complication (medicine)|complication]]s and hospital costs in trauma patients |journal=[[Surgery]] |volume=144 |issue=2 |pages=307–16 |year=2008 |month=August |pmid=18656640 |pmc=2583342 |doi=10.1016/j.surg.2008.05.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0039-6060(08)00289-4 |accessdate=2012-07-17}}</ref> Costs to maintain a trauma center are substantial as they are open continuously and maintain their readiness.<ref name="pmid14706578">{{cite journal |author=Taheri PA, Butz DA, Lottenberg L, Clawson A, Flint LM |title=The cost of trauma center readiness |journal=[[American Journal of Surgery]] |volume=187 |issue=1 |pages=7–13 |year=2004 |month=January |pmid=14706578 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002961003004379 |accessdate=2012-07-17}}</ref> In 2009 around 693.5 billion USD was lost due to traumatic injury in the United States.<ref>{{cite web | url=http://www.nsc.org/Documents/Injury_Facts/Injury_Facts_2011_w.pdf | title=Injury Facts | publisher=National Safety Council | accessdate=July 17, 2012}}</ref>

===Low and middle income countries===
Citizens of [[Developing country|low]] and [[middle income country|middle]] income countries (LMICs) often have higher mortality rates due to various reasons. Many of these countries do not have access to proper surgical care to deal with injury as many do not have a trauma system. In addition, most LMICs do not have a prehospital care system to initially deal and transport injured persons to appropriate facilities in a timely manor. Hospitals also lack the appropriate physical resources (equipment), [[organization|organizational]] resources (improvement efforts), or [[human resource]]s (trained staff).<ref name="care">{{cite journal |author=Sakran JV, Greer SE, Werline EC, McCunn M |title=Care of the injured worldwide: trauma still the neglected disease of modern society |journal=[[Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine]] |volume=20 |issue=1 |pages=64 |year=2012 |month=September |pmid=22980446 |doi=10.1186/1757-7241-20-64 |url= |accessdate=2012-11-11}}</ref><ref name="strength">{{cite journal |author=Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F |title=Strengthening the prevention and care of injuries worldwide |journal=[[Lancet]] |volume=363 |issue=9427 |pages=2172–9 |year=2004 |month=June |pmid=15220042 |doi=10.1016/S0140-6736(04)16510-0 |url= |accessdate=2012-11-11}}</ref>


==Special populations==
==Special populations==

Revision as of 16:34, 11 November 2012

For other uses, see Trauma.
Major trauma
SpecialtyEmergency medicine Edit this on Wikidata

Trauma (from Greek τραῦμα, "wound"[1]) also known as injury[2] is a physiological wound caused by an external source.[3][4] It can also be described as "a physical wound or injury, such as a fracture or blow."[3][5][6] Trauma is the sixth leading cause of death worldwide, accounting for 10% of all mortalities, and is therefore a serious public health problem with significant social and economic costs.

Classification

Trauma can be classified by the affected area of the body.[7][8]

Trauma may also be classified by the affected demographic group. For example, trauma involving a pregnant woman, pediatric, or geriatric patient.[7] It may also be classified by the type of force applied to the body, such as blunt trauma or penetrating trauma.

Injury scales

ABS

Further information: Abbreviated_Injury_Scale

The Abbreviated Injury Scale (AIS) is an anatomical-based coding system created by the Association for the Advancement of Automotive Medicine to classify and describe the severity of specific individual injuries. AIS is one of the most common anatomic scales for traumatic injuries. The first version of the scale was published in 1969 with major updates in 1976, 1980, 1985, 1990, 1998, 2005, and 2008

Injury Severity Score

Further information: Injury Severity Score

The Injury Severity Score (ISS) is an established medical score to assess trauma severity. It correlates with mortality, morbidity and hospitalization time after trauma. It is used to define the term major trauma.

Severity Scale (Israel)

Israeli emergency medical services and police officers[9] medical corps[10] and media[11][12] uses 4 level Severity scale before evacuation to medical facility: Light/slight (פצוע קל) Medium/moderate (פצוע בינוני) serious (פצוע קשה) and mortal (פצוע אנוש), it correlated with the amount of immediate medical care that is needed to provide for a patient in order for him to stay alive. The CBS uses that scale also to describe the injured in traffic accidents and recommended that definition would also include hospitalization [13] to comply with IRTAD.

Causes

The leading cause of traumatic death is blunt trauma,[14] motor vehicle accidents[14] and falling accidents, subsets of blunt trauma, are the number one and two causes of traumatic death.[15] The use of drugs such as alcohol and illicit drug use increase the risk of trauma, by making traffic collisions, violence, and abuse more likely.[8] Other drugs such as benzodiazepines increase the risk of trauma in elderly people.[8] In addition, intentional injury is a common cause of traumas.[16] Penetrating trauma is caused when a foreign body such as a bullet or a knife enters the tissue of the body, creating an open wound. In the United States, most deaths caused by penetrating trauma occur in urban areas, and 80% of these deaths are caused by firearms.[17] Blast injury is a complex cause of trauma because it commonly includes both blunt and penetrating trauma, and may also be accompanied by a burn injury.

Prevention

By identifying risk factors present within a community and creating solutions to decrease the incidence of injury, trauma referral systems can help to enhance the overall health of a population.[18] Commonly injury prevention strageties are utilized to prevent injuries in children as they are a high risk population.[19] Generally, injury prevention strageties involve education of the general public to specific risk factors and developing strageties to mitigate injury.[20]

Pathophysiology

The body responds to traumatic injury both systemically and locally at the injury site.[21] This response attempts to protect vital organs such as the liver, to allow further cell duplication, and to heal the damage.[22] Healing time depends on sex, age and severity of injury.[23]

Inflammation, common after injury, protects against further injury and starts the healing process. Runaway inflammation can, however, cause organ failure. Immediately after injury, the body produces more glucose through gluconeogenesis, and burns more fat via lipolysis. Next, the body tries to replenish its energy stores of glucose and protein via anabolism. In this state the body will temporarily increase its maximum expenditure.[clarification needed][23][24]

Diagnosis

Radiograph of a close-range shotgun blast injury to the knee. Birdshot pellets are visible within and around the shattered patella, distal femur and proximal tibia.
Radiograph of a close-range shotgun blast injury to the knee. Birdshot pellets are visible within and around the shattered patella, distal femur and proximal tibia.

Physical examination

The purpose of the primary physical examination is to identify any life-threatening problems. Upon completion of the primary examination, the secondary examination is begun. This may occur during transport or upon arrival at the hospital. The secondary examination consists of a systematic assessment of the abdominal, pelvic and thoracic area, complete inspection of the body surface to find all injuries, and a neurological examination. The purpose of the secondary examination is to identify all injuries so that they may be treated. A missed injury is one which is not found during the initial assessment, such as when a patient is brought into a hospital's emergency department, but manifests itself at a later point in time.[25]

Imaging

Persons with major trauma commonly have chest and pelvic X-rays taken,[8] and, depending on the mechanism of injury and presentation, are subject to a Focused assessment with sonography for trauma (FAST) exam to check for internal bleeding. For those with relatively stable blood pressure, heart rate, and sufficient oxygenation, CT scans are considered effective.[8][26] Full-body CT scans, known as pan-scans, improve the survival rate in those who have suffered major trauma.[27] These scans use intravenous injections for the radiocontrast agent, but not oral administration.[28] There are concerns of radiation exposure from CT scans on the kidneys. However routine CT scans on the kidneys have shown no associated harm.[26] A complete scan takes around ten minutes.[8] In the U.S., CTs or MRIs are performed on fifteen percent of trauma victims in emergency rooms.[29] Where blood pressure is low or the heart rate is increased, likely from bleeding in the abdomen, immediate surgery bypassing a CT scan is recommended.[30]

Surgical techniques

Surgical techniques, using a tube or catheter to drain fluid from the peritoneum, chest, or the pericardium around the heart, are often used in cases of severe blunt trauma to the chest or abdomen, especially when a person is experiencing early signs of shock. In those with low blood-pressure, likely because of bleeding in the abdominal cavity, cutting through the abdominal wall surgically is indicated.[8]

Management

Color photograph of a United States Navy hospital corpsman listening for correct placement of an endotracheal tube in a simulated trauma victim during a search and rescue exercise. His assistant is holding a bag of intravenous fluid.
A Navy corpsmen listens for the correct tube placement on an intubated trauma victim during a search and rescue exercise

Stabilization and transportation

Further information: Trauma center
Color photograph of a room designed to handle major trauma. Visible are an anesthesia machine, a Doppler ultrasound device, a defibrillator, a suction device, a gurney, and several carts for storing surgical instruments and disposable supplies.
Typical trauma room

Before arriving at a hospital, the use of stabilization techniques improve the chances of a person surviving the transport to the nearest trauma-equipped hospital. A healthcare provider should ensure their own safety and take appropriate isolation precautions. A primary survey is then performed, consisting of checking and treating airway, breathing, and circulation followed by an assessment on the level of consciousness.[25] To prevent further injury, unnecessary movement of the spine is minimized by securing the neck with a cervical collar, and the back with a long spine board with head supports. This can be accomplished with other medical transport devices such as a Kendrick extrication device, before moving the person.[31]

Rapid transportation of those who are severely injured is improves the outcome in trauma.[8] If a person is in imminent danger of death, first responders will typically "load and go," meaning they will minimize time between arriving to nearest appropriate facility by performing important interventions in the back of an ambulance, rather than on scene.[25] Helicopter EMS transport reduces mortality when compared to ground based transport in adult trauma patients.[32] Before arrival to the hospital, the availability of advanced life support does not greatly improve the outcome for major trauma, when compared to the administration of basic life support.[33][34] Evidence is inconclusive in determining support for prehospital intravenous fluid resuscitation while some evidence has found it may be harmful.[35]

People who have suffered trauma may require specialized care, including surgery and blood transfusion with successful outcomes occurring if this occurs as quickly as possible during the golden hour of trauma. This is not a strict deadline, but recognizes the many deaths which can would be prevented by appropriate care occurring in the short time following injury.[36] Hospitals with designated trauma centers have improved outcomes when compared to hospitals without them.,[8] and if people who have experienced trauma are transferred directly to a trauma center it can improve the outcome.[37] In certain traumas, such as maxillofacial trauma, it can be beneficial to have a highly trained health care provider available to maintain airway, breathing, and circulation.[38]

Community-based trauma referral systems seek to decrease overall injury-related morbidity and mortality in addition to preventing years of life lost within a population by ensuring the provision of optimal care during both the acute and late phases of injury.[18] The care of acutely injured people is a public health system is an issue which involves bystanders, community members, health care professionals, and health care systems. It encompasses prehospital assessment and care by emergency medical services personnel, emergency department assessment, treatment, and stabilization, and in-hospital care among all age groups.[39] An established trauma system network is also an important component of community disaster preparedness, facilitating the care of people who have experienced natural disasters and terrorist attacks.[18] In those with cardiac arrest due to trauma CPR is considered futile but still recommended.[40]

Intravenous fluids

Traditionally, high volume intravenous fluids were given in people who are unable to provide adequate perfusion to tissues (hemodynamically unstable) due to trauma.[41] This is still appropriate in those cases with isolated extremity trauma, thermal trauma, or head injuries.[42] The current evidence supports limiting the use of fluids for penetrating thorax and abdominal injuries allowing mild hypotension to persist.[7][42] Targets include a mean arterial pressure of 60 mmHg, a systolic blood pressure of 70–90 mmHg,[41][43] or until adequate mentation and peripheral pulses are observed.[41]

As no intravenous fluids used for initial resuscitation has been shown to be superior to warmed Lactated Ringer's solution, it continues to be the solution of choice for the treatment of trauma victims.[41] If blood products are needed, a greater relative use of fresh frozen plasma and platelets to packed red blood cells has been found to result in improved survival and less overall blood product usage,[44] with a ratio of 1:1:1 being recommended.[43] Cell salvage and autotransfusion can also be used as treatment.[41]

Blood substitutes such as hemoglobin-based oxygen carriers are in development. As of 2011 however, there are none available for commercial use in North America or Europe.[41][45][46] The only countries where these products are available for general use is South Africa and Russia.[45]

Medications

In people who are bleeding due to trauma, tranexamic acid decreases the mortality rate.[47][48] For severe bleeding, say from bleeding disorders, a protein that assists blood clotting, recombinant factor VIIa, may be appropriate,[8][42] While it decreases blood use it does not appear to decrease the mortality rate.[49] In those without previous factor VII deficiency it use is thus not recommended outside of trial situations.[50] Various other medications may be used in conjunction with other procedures in order to stabilize a person who sustained a significant injury.[7]

Surgery

Damage control surgery is employed in the management of severe trauma in which there is a cycle of metabolic acidosis, hypothermia, and hypotension.[8] It involves performing the least number of procedures to save life and limb,[8] with less critical procedures being left until the victim is more stable.[8]

Prognosis

Trauma used to lead to death in one of three stages: immediate, early, or late. Immediate deaths were usually due to apnea, severe brain or high spinal cord injury, or rupture of the heart or of large blood vessels. The early deaths occurred within minutes to hours and were often due to hemorrhages in the brain's outer meningeal layer, tears in arteries, blood around the lungs, air around the lungs, ruptured spleen, liver laceration, or pelvic fracture. This period was known as the golden hour, often deciding whether a patient lived. Late deaths occurred days or weeks after the injury.[25] These stages may no longer be relevant in the United States due to improved care.[8]

Long term prognosis is frequently complicated by pain, with over half of people having moderate to severe pain one after injury.[51] Many victims also experience a reduced quality of life years following an injury,[52] with twenty percent of victims sustaining some form of disability.[53] Physical trauma can lead to development of post-traumatic stress disorder, or PTSD.[54] That being said, one study has found no correlation between the severity of trauma and the development of PTSD.[55]

Epidemiology

Further information: List of preventable causes of death
Deaths from injuries per 100,000 inhabitants in 2004[56] Template:Multicol
  no data
  < 25
  25-50
  50-75
  75-100
  100-125
  125-150
Template:Multicol-break
  150-175
  175-200
  200-225
  225-250
  250-275
  > 275
Template:Multicol-end
Incidence of accidents by activity in Denmark

Trauma is the sixth leading cause of death worldwide[57] resulting in five million or 10% of all deaths.[58] It is the fifth leading cause of significant disability.[57] About half of deaths due to trauma are in people aged 15–45 years and in this age it is the leading cause of death.[58] Death from injury is twice as common in males as females.[58] The primary causes of traumatic death are central nervous system injury, followed by substantial blood loss.[57]

Research

See also: Traumatology

For the most part, major research on trauma occurs during war and similar conflicts.[59] Some research is being done on patients who were admitted into an intensive care unit or trauma center and received a trauma diagnosis caused a negative change in their health related quality of life outlook, with a potential to create anxiety and symptoms of depression.[60] New preserved blood products are also being researched for use in prehospital emergent care as currently it is not practical to use the current blood products in a timely fashion it an out-of-hospital rural setting or in a war time situation.[61]

Society and culture

Economics

The average cost for the treatment of traumatic injury in the United States is around $334,000 per person, making it costlier than the treatment of cancer and cardiovascular diseases.[62] One reason of the high cost of injury is the increased possibility of complications which leads to the need for more interventions.[63] Costs to maintain a trauma center are substantial as they are open continuously and maintain their readiness.[64] In 2009 around 693.5 billion USD was lost due to traumatic injury in the United States.[65]

Low and middle income countries

Citizens of low and middle income countries (LMICs) often have higher mortality rates due to various reasons. Many of these countries do not have access to proper surgical care to deal with injury as many do not have a trauma system. In addition, most LMICs do not have a prehospital care system to initially deal and transport injured persons to appropriate facilities in a timely manor. Hospitals also lack the appropriate physical resources (equipment), organizational resources (improvement efforts), or human resources (trained staff).[66][67]

Special populations

In children

Main article: Pediatric trauma

Accidents are the leading cause of death in children 1–14 years of age.[53] In the United States approximatively sixteen million children go to an emergency department due to some form of injury every year.[53] Boys are more frequently injured then girls by a ratio of two to one.[53] The top five worldwide unintentional injuries in children are as follows:[68]

Cause Number of deaths resulting
Traffic collision

260,000 per year

Drowning

175,000 per year

Burns

96,000 per year

Falls

47,000 per year

Toxins

45,000 per year

An important part of managing trauma in children is weight estimation as the accurate dosing of medicine may be critical for resuscitative efforts.[69] A number of methods to estimate weight exist including the: Broselow tape, Leffler formula, and Theron formula.[70]

In pregnancy

Trauma occurs in about 5% of all pregnancies,[71] and is the leading cause of maternal death. Pregnant women may additionally experience placental abruption, preterm labor, and uterine rupture.[71] There are diagnostic issues during pregnancy as ionizing radiation has been shown to cause birth defects[7] although the doses used for typical exams are generally considered "safe".[71] Due to normal physiological changes of pregnancy shock can be more difficult to diagnosis.[7][72] In those cases in which the woman is more than 23 weeks pregnant it is recommended that the fetus be monitored for at least four to six hours by cardiotocography.[71]

A number of treatments beyond typical trauma care may be needed in the care of a pregnant woman. As the weight of the uterus on the inferior vena cava can decease blood return to the heart, it is important to lay the women in late pregnancy on her left side or tilt the spine board.[71] Other measures that are recommended include: rho(D) immune globulin in those who are rh negative, corticosteroids in those who are 24 to 34 weeks who may need delivery, or a caesarian section in the event of cardiac arrest.[71]

References

  1. ^ τραῦμα, Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
  2. ^ Campbell, [edited by] John (2011). International Trauma Life Support for emergency care providers (7th ed. ed.). Boston: Pearson. pp. xxi. ISBN 978-0132157247. {{cite book}}: |edition= has extra text (help); |first= has generic name (help)
  3. ^ a b http://www.merriam-webster.com/medical/trauma
  4. ^ "Trauma". Dictionary.com. Dictionary.com, LLC. 2010. Retrieved 2010-10-31.
  5. ^ Elizabeth Martin, ed. (2010). Concise Medical Dictionary (Eighth ed.). Market House Books Ltd.
  6. ^ http://www.apa.org/topics/trauma/index.aspx
  7. ^ a b c d e f Marx, J (2010). Rosen's emergency medicine: concepts and clinical practice 7th edition. Philadelphia: Mosby/Elsevier. pp. 243–842. ISBN 978-0-323-05472-0. Cite error: The named reference "Rosen2010" was defined multiple times with different content (see the help page).
  8. ^ a b c d e f g h i j k l m n Bonatti, H; Calland, JF (2008). "Trauma". Emergency Medicine Clinics of North America. 26 (3): 625–48. doi:10.1016/j.emc.2008.05.001. PMID 18655938.
  9. ^ [1]
  10. ^ medical order 305.001/2, describe severity scale and evacuation scale
  11. ^ what does it mean when people have light/medium serious and mortal injuries
  12. ^ [2]
  13. ^ [3] , page 5
  14. ^ a b DiPrima Jr., PA. McGraw-Hill's EMT-Basic. McGraw-Hill. pp. 227–33. ISBN 978-0-07-149679-7.
  15. ^ Dickenson ET, Limmer D, O'Keefe MF (2009). Emergency Care. ISBN 978-0-13-500523-1.{{cite book}}: CS1 maint: multiple names: authors list (link)
  16. ^ Jeff Garner; Greaves, Ian; Ryan, James R.; Porter, Keith R. (2009). Trauma care manual. London: Hodder Arnold. ISBN 0-340-92826-3.{{cite book}}: CS1 maint: multiple names: authors list (link)
  17. ^ Medzon R, Mitchell EJ (2005). Introduction to Emergency Medicine. Philadelphia: Lippincott Williams & Willkins. pp. 393–431. ISBN 0-7817-3200-X.
  18. ^ a b c Hoyt, DB; Coimbra, R (2007). "Trauma systems". Surgical Clinics of North America. 87 (1): 21–35, v–vi. doi:10.1016/j.suc.2006.09.012. PMID 17127121.
  19. ^ Walker, Bonnie (1996). Injury Prevention for Young Children: A Research Guide. Greenwood. p. 2. ISBN 978-0313296864.
  20. ^ CDC Injury Fact Book. Atlanta, Georgia: National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, Georgia. 2006. pp. 35–101.
  21. ^ Boffard, Kenneth (2007). Manual of Definitive Surgical Trauma Care. London, England: Hodder Arnold Publishers. ISBN 9780340947647.
  22. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1383/surg.21.9.240.16923, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1383/surg.21.9.240.16923 instead.
  23. ^ a b Kenneth M Sutin; Marino, Paul L. (2007). The ICU book. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-4802-X.{{cite book}}: CS1 maint: multiple names: authors list (link)
  24. ^ Keel M, Trentz O (2005). "Pathophysiology of polytrauma". Injury. 36 (6): 691–709. doi:10.1016/j.injury.2004.12.037. PMID 15910820. Retrieved 2012-07-20. {{cite journal}}: Unknown parameter |month= ignored (help)
  25. ^ a b c d Committee on Trauma, American College of Surgeons (2008). ATLS: Advanced Trauma Life Support Program for Doctors (8th ed.). Chicago: American College of Surgeons. ISBN 978-1-880696-31-6.
  26. ^ a b McGillicuddy EA, Schuster KM, Kaplan LJ; et al. (2010). "Contrast-induced nephropathy in elderly trauma patients". J Trauma. 68 (2): 294–7. doi:10.1097/TA.0b013e3181cf7e40. PMID 20154540. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  27. ^ Huber-Wagner S, Lefering R, Qvick LM; et al. (2009). "Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study". Lancet. 373 (9673): 1455–61. doi:10.1016/S0140-6736(09)60232-4. PMID 19321199. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  28. ^ Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH (2004). "Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma". J Trauma. 56 (2): 314–22. doi:10.1097/01.TA.0000058118.86614.51. PMID 14960973.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  29. ^ Korley FK, Pham JC, Kirsch TD (2010). "Use of advanced radiology during visits to US emergency departments for injury-related conditions,1998–2007". JAMA. 304 (13): 1465–71. doi:10.1001/jama.2010.1408. PMID 20924012.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  30. ^ Neal MD, Peitzman AB, Forsythe RM; et al. (2011). "Over reliance on computed tomography imaging in patients with severe abdominal injury: is the delay worth the risk?". J Trauma. 70 (2): 278–84. doi:10.1097/TA.0b013e31820930f9. PMID 21307722. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  31. ^ Karbi, OA; Caspari, DA; Tator, CH (1988). "Extrication, immobilization and radiologic investigation of patients with cervical spine injuries". Canadian Medical Association Journal. 139 (7): 617–21. PMC 1268249. PMID 3046734.
  32. ^ Sullivent, EE (2011 Jul-Sep). "Reduced mortality in injured adults transported by helicopter emergency medical services". Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 15 (3): 295–302. doi:10.3109/10903127.2011.569849. PMID 21524205. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  33. ^ Stiell IG, Nesbitt LP, Pickett W; et al. (2008). "The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity". CMAJ. 178 (9): 1141–52. doi:10.1503/cmaj.071154. PMC 2292763. PMID 18427089. {{cite journal}}: Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)
  34. ^ Liberman M, Roudsari BS (2007). "Prehospital trauma care: what do we really know?". Curr Opin Crit Care. 13 (6): 691–6. doi:10.1097/MCC.0b013e3282f1e77e. PMID 17975392.
  35. ^ Dretzke J, Sandercock J, Bayliss S, Burls A (2004). "Clinical effectiveness and cost-effectiveness of prehospital intravenous fluids in trauma patients". Health Technol Assess. 8 (23): iii, 1–103. PMID 15193210.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  36. ^ Tabers Cyclopedic Medical Dictionary. Philadelphia: F.A. Davis Company. 2009. pp. 2366–7\author=Davis FA. ISBN 978-0-8036-1559-5.
  37. ^ Nirula R, Maier R, Moore E, Sperry J, Gentilello L (2010). "Scoop and run to the trauma center or stay and play at the local hospital: hospital transfer's effect on mortality". J Trauma. 69 (3): 595–9, discussion 599–601. doi:10.1097/TA.0b013e3181ee6e32. PMID 20838131.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  38. ^ Krausz AA, El-Naaj IA, Barak M (2009). "Maxillofacial trauma patient: coping with the difficult airway". World Journal of Emergency Surgery : WJES. 4: 21. doi:10.1186/1749-7922-4-21. PMC 2693512. PMID 19473497. Retrieved 2012-08-02.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  39. ^ "Centers for Disease Control and Prevention Injury Prevention and Control: Injury Response: Acute Injury Care".
  40. ^ Vanden Hoek, TL (2010-11-02). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S829–61. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  41. ^ a b c d e f Cherkas, David (2011). "Traumatic Hemorrhagic Shock: Advances In Fluid Management". Emergency Medicine Practice. 13 (11). {{cite journal}}: Unknown parameter |month= ignored (help)
  42. ^ a b c Roppolo LP, Wigginton JG, Pepe PE (2010). "Intravenous fluid resuscitation for the trauma patient". Curr Opin Crit Care. 16 (4): 283–8. doi:10.1097/MCC.0b013e32833bf774. PMID 20601865.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  43. ^ a b Tintinalli, Judith E. (2010). Emergency Medicine: A Comprehensive Study Guide (Emergency Medicine (Tintinalli)). New York: McGraw-Hill Companies. p. 176. ISBN 0-07-148480-9.
  44. ^ Greer SE, Rhynhart KK, Gupta R, Corwin HL (2010). "New developments in massive transfusion in trauma". Curr Opin Anaesthesiol. 23 (2): 246–50. doi:10.1097/ACO.0b013e328336ea59. PMID 20104173.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  45. ^ a b "UpToDate Inc". Retrieved 2010-11-13.
  46. ^ Spahn DR, Kocian R (2005). "Artificial O2 carriers: status in 2005". Curr. Pharm. Des. 11 (31): 4099–114. doi:10.2174/138161205774913354. PMID 16378514.
  47. ^ Crash-2 Trial, Collaborators; Shakur, H; Roberts, R; Bautista, R; Caballero, J; Coats, T; Dewan, Y; El-Sayed, H; Gogichaishvili, T (2010). "Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial". The Lancet. 376 (9734): 23–32. doi:10.1016/S0140-6736(10)60835-5. PMID 20554319. {{cite journal}}: |first1= has generic name (help)CS1 maint: numeric names: authors list (link)
  48. ^ Cap, AP (2011 Jul). "Tranexamic acid for trauma patients: a critical review of the literature". The Journal of trauma. 71 (1 Suppl): S9–14. doi:10.1097/TA.0b013e31822114af. PMID 21795884. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  49. ^ Hauser CJ, Boffard K, Dutton R; et al. (2010). "Results of the CONTROL trial: efficacy and safety of recombinant activated Factor VII in the management of refractory traumatic hemorrhage". J Trauma. 69 (3): 489–500. doi:10.1097/TA.0b013e3181edf36e. PMID 20838118. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  50. ^ Simpson, E (2012 Mar 14). "Recombinant factor VIIa for the prevention and treatment of bleeding in patients without haemophilia". Cochrane database of systematic reviews (Online). 3: CD005011. PMID 22419303. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  51. ^ Rivara FP, Mackenzie EJ, Jurkovich GJ, Nathens AB, Wang J, Scharfstein DO (2008). "Prevalence of pain in patients 1 year after major trauma". Arch Surg. 143 (3): 282–7, discussion 288. doi:10.1001/archsurg.2007.61. PMID 18347276.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  52. ^ Ulvik A, Kvåle R, Wentzel-Larsen T, Flaatten H (2008). "Quality of life 2-7 years after major trauma". Acta Anaesthesiol Scand. 52 (2): 195–201. doi:10.1111/j.1399-6576.2007.01533.x. PMID 18005377.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  53. ^ a b c d Peitzman AB, Rhodes M, Schwab CW, Yealy DM, Fabian TC, ed. (2008). "Pediatric Trauma". The Trauma Manual (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 499–514. ISBN 0-7817-6275-8.{{cite book}}: CS1 maint: multiple names: editors list (link)
  54. ^ "309.81 Posttraumatic Stress Disorder". Diagnostic and Statistical Manual of Mental Disorders. Washington, USA: American Psychiatric Association. 1994. pp. 424–429. {{cite book}}: |work= ignored (help)
  55. ^ Feinstein, A; Dolan, Ray (1991). "Predictors of post-traumatic stress disorder following physical trauma: an examination of the stressor criterion". Psychological Medicine. 21 (1). Cambridge University Press: 85–91. doi:10.1017/S0033291700014689. PMID 2047509.
  56. ^ "Death and DALY estimates for 2004 by cause for WHO Member States" (xls). World Health Organization. 2004. Retrieved 2010-11-13.
  57. ^ a b c Søreide K (2009). "Epidemiology of major trauma". The British journal of surgery. 96 (7): 697–8. doi:10.1002/bjs.6643. PMID 19526611.
  58. ^ a b c Porter, edited by Jason Smith, Ian Greaves, Keith (2010). Major trauma (1. publ. ed.). Oxford: Oxford University Press. p. 2. ISBN 978-0-19-954332-8. {{cite book}}: |first= has generic name (help)CS1 maint: multiple names: authors list (link)
  59. ^ Gulland A (2008). "Emergency Medicine: Lessons from the battlefield". BMJ (Clinical Research Ed.). 336 (7653): 1098–100. doi:10.1136/bmj.39568.496424.94. PMC 2386631. PMID 18483051. Retrieved 2012-07-17. {{cite journal}}: Unknown parameter |month= ignored (help)
  60. ^ Ringdal M, Plos K, Lundberg D, Johansson L, Bergbom I (2009). "Outcome after injury: memories, health-related quality of life, anxiety, and symptoms of depression after intensive care". J Trauma. 66 (4): 1226–33. doi:10.1097/TA.0b013e318181b8e3. PMID 19088550.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  61. ^ Alam HB, Velmahos GC (2011). "New trends in resuscitation". Current Problems in Surgery. 48 (8): 531–64. doi:10.1067/j.cpsurg.2011.04.002. PMID 21718901. Retrieved 2012-07-17. {{cite journal}}: Unknown parameter |month= ignored (help)
  62. ^ PHTLS: Prehospital Trauma Life Support. Mosby/JEMS. 2010. ISBN 0-323-06502-3.
  63. ^ Hemmila MR, Jakubus JL, Maggio PM; et al. (2008). "Real money: [[complication (medicine)|complication]]s and hospital costs in trauma patients". Surgery. 144 (2): 307–16. doi:10.1016/j.surg.2008.05.003. PMC 2583342. PMID 18656640. Retrieved 2012-07-17. {{cite journal}}: Explicit use of et al. in: |author= (help); URL–wikilink conflict (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  64. ^ Taheri PA, Butz DA, Lottenberg L, Clawson A, Flint LM (2004). "The cost of trauma center readiness". American Journal of Surgery. 187 (1): 7–13. PMID 14706578. Retrieved 2012-07-17. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  65. ^ "Injury Facts" (PDF). National Safety Council. Retrieved July 17, 2012.
  66. ^ Sakran JV, Greer SE, Werline EC, McCunn M (2012). "Care of the injured worldwide: trauma still the neglected disease of modern society". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 20 (1): 64. doi:10.1186/1757-7241-20-64. PMID 22980446. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
  67. ^ Mock C, Quansah R, Krishnan R, Arreola-Risa C, Rivara F (2004). "Strengthening the prevention and care of injuries worldwide". Lancet. 363 (9427): 2172–9. doi:10.1016/S0140-6736(04)16510-0. PMID 15220042. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  68. ^ BBC News Online (December 10, 2008). "UN raises child accidents alarm". London: BBC. BBC News. Retrieved 2010-10-31.
  69. ^ Rosenberg M, Greenberger S, Rawal A, Latimer-Pierson J, Thundiyil J (2011). "Comparison of Broselow tape measurements versus physician estimations of pediatric weights". The American Journal of Emergency Medicine. 29 (5): 482–8. doi:10.1016/j.ajem.2009.12.002. PMID 20825816. Retrieved 2012-09-08. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  70. ^ So TY, Farrington E, Absher RK (2009). "Evaluation of the accuracy of different methods used to estimate weights in the pediatric population". Pediatrics. 123 (6): e1045–51. doi:10.1542/peds.2008-1968. PMID 19482737.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  71. ^ a b c d e f Tibbles, Carrie (2008). "Trauma In Pregnancy: Double Jeopardy". Emergency Medicine Practice. 10 (7). {{cite journal}}: Unknown parameter |month= ignored (help)
  72. ^ Campbell, John Creighton (2000). Basic trauma life support for paramedics and other advanced providers. Upper Saddle River, N.J: Brady/Prentice Hall Health. pp. 239–47. ISBN 0-13-084584-1.

Further reading

External links

Wikimedia Commons has media related to Wounds.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Major_trauma&oldid=522494874"