伤情评估和战场伤员分类(江)

伤情评估和战场伤员分类江雷卫生勤务学教研室精选课件MasscasualtiesAnylargenumberofcasualtiesproducedinarelativelyshortperiodoftime,usuallyastheresultofasingleincidentsuchasamilitaryaircraftaccident,hurricane,flood,earthquake,orarmedattack,thatexceedslocallogisticalsupportcapabilities.精选课件Thetermmasscasualtiesmeansthatalargenumberofcasualtieshasbeenproducedsimultaneouslyorwithinarelativelyshortperiodoftime.Italsomeansthatthenumberofpatientsrequiringmedicalcareexceedsthemedicalcapabilitytoprovidetreatmentinatimelymanner.Anabsolutedisparityexistsbetweenthenumberofpatients,theavailablemedicalresourcesandtimelytreatment.精选课件MasscasualtysituationAmasscasualtysituationispresentwhenonecombatmedicisconfrontedwithtwocriticallyinjuredpatientsatthesametime.Withalargenumberofcasualties,thedisparitymaybemultipliedmanytimes;thisgreatlydisruptsthedoctrinalapproachtotreatmentandevacuation.Inadditiontothetreatmentandevacuationofalargenumberofmilitaryandciviliancasualties,problemsmayoccurfromdisruptionsinthesupply,communication,andtransportationsystems.精选课件“在包扎所内最重要的是伤员优先分类，然后对所有伤员合理配置医疗救护工作，比起仓促慌忙上手术好得多，后者仅只能救活不多的伤员。”——[俄]皮洛果夫N.A.叶菲缅科主编（涂通今主译）：野战外科学，P5.人民军医出版社，2005年10月精选课件什么是伤情评估？伤情评估是指在战场上运用简明的应急诊断技术，迅速地对伤员情况进行初步判断，进而以量化标准来判定伤员损伤的严重程度，从而指导战场伤员分类救治，预测战伤结局以及评估救治质量。精选课件一、伤情评估方法院前评分院内救治和创伤研究评分精选课件伤情损伤程度治愈时间预后比例轻伤软组织伤30天内良好40%中等伤广泛软组织伤、60天内部分伤员机能35%上肢骨折、一般脏器伤障碍，影响归队重伤伤情严重、60天以上严重残废25%有生命危险或后遗症伤势分度与百分比精选课件院前指数（Pre-hospitalindex，PHI）轻伤：0-3分重伤：4-20分精选课件CRAMS评分法轻度：9-10分，重度：7-8分，极重度：0-6分精选课件创伤计分（Traumascore）1-16分，＜12分为重伤参数012345呼吸次数0<10>3525～3510～24幅度浅或困难正常循环SBP0<5050～6970～90>90毛细血管充盈无充盈充盈迟缓正常意识状态GCS3～45～78～1011～1314～15精选课件GlasgowComaScale，GCS精选课件校正的创伤积分(RevisedTraumaScore，RTS)精选课件简易战伤评分方法精选课件伤员伤势评估及处置顺序精选课件二、战场伤员分类精选课件TriageofmasscasualtiesTheevaluationandclassificationofcasualtiesforpurposesoftreatmentandevacuation.Itconsistsoftheimmediatesortingofpatientsaccordingtotypeandseriousnessofinjury,andlikelihoodofsurvival,andtheestablishmentofpriorityfortreatmentandevacuationtoassuremedicalcareofthegreatestbenefittothelargestnumber.精选课件HistoryThewordtriageisaFrenchwordmeaning"sorting",whichitselfhasbeeninfluencedfromtheLatintria"three".Thetermhashistoricallymeantsortingintothreecategories,althoughthisisnolongernecessarilythecase.MuchofthecreditformoderndaytriagehasbeenattributedtoDominiqueJeanLarrey,afamousFrenchsurgeoninNapoleon’sarmywhodevisedamethodtoquicklyevaluateandcategorizethewoundedinbattleandthenevacuatethoserequiringthemosturgentmedicalattention.Heinstitutedthesepracticeswhilebattlewasinprogressandtriagedpatientswithnoregardtorank.OthershavecitedtheRussiansurgeon,NikolaiPirogov,asdevelopingthetriagesystemduringtheCrimeanWar.精选课件Triageisaccomplishedbyhighlyexperiencedmedicalpersonnelwhocanmakesoundandquickclinicaljudgments.Medicalpersonnelidentifyeachpatientbyacategorytitlewhichindicatestheurgencyofhisreceivingtreatmentandlikelihoodofhissurvivalbasedupontheclinicalproblemsandavailabilityofmedicalcare.Rapidtriageassuresthattheavailabletreatmentisdirectedtothepatientswhohavethebestchancetosurvive.精选课件分类的意义战场伤病员分类是实施战场伤病员救护管理的一个重要环节。战时伤员数量大，伤病种类复杂，救治时间紧迫，救治力量有限。由此产生了救治需要与可能之间的矛盾,重伤病员与轻伤病员之间、部分伤病员与全体伤病员之间救治的矛盾。为解决这些矛盾，就必须对伤病员进行分类。通过分类将有限卫勤力量首先用到需挽救生命的危急伤员上。精选课件分类的目的分类的目的在于保证每个伤病员得到及时合理的救治和后送。保证在伤病员众多的条件下,做好救治工作，使救治工作有条不紊地进行；充分发挥卫勤人力物力作用，促进医疗后送工作的多快好省。区分伤病的轻重缓急,确定救治和后送的先后次序;根据伤类、伤情,确定伤员救治;确定伤员后送体位和工具。以保证各种伤员得到最合理的处置。精选课件分类的方法伤部伤类伤型伤情精选课件急救优先等级紧急处置——重伤优先处置——中度伤常规处置——轻伤期待处置——危重伤精选课件Treatmentcategories:PsystemsP1-ImmediateTreatmentP2-DelayedTreatmentP3-MinimalTreatmentP1Hold-ExpectantTreatment精选课件Immediate.Thiscategoryisforthepatientwhoseconditiondemandsimmediate,resuscitativetreatment.Anexampleofthistreatmentisthecontrolofhemorrhagefromanextremity.Generally,theproceduresusedareshortindurationandeconomicalintermsofmedicalresources.(Approximately20percentofthecasualtiesarenormallyinthiscategory.)精选课件Delayed.Thiscategoryisforthepatientwhoseconditionissuchthat,withtheapplicationofmodestemergencyprocedures,thepossibilityofdiseaseordeathincreasesverylittlebydelayingmajordefinitiveproceduresuntiltheycanbeperformed.Anexampleofthisemergencyprocedurewouldbeanadequatelysplintedclosedfracture.(Approximately20percentofthecasualtiesarenormallyinthiscategory.)精选课件Minimal.Thiscategoryisforthepatientwhocanbereturnedtosomeformofdutybyperformingproceduresrequiringminimalresources.Followuptreatmentmaybeneededafterthedisparityphaseisterminated.(Approximately40percentofthecasualtiesareinthiscategoryandmostareambulatory.)精选课件Expectant.Thiscategoryisforthepatientwhoseinjuriesaremassiveandtheprobabilityofhissurvivalisquestionable.Examplesofpatientsinthiscategoryarethosewithsevereheadinjuriesormassivesevereburns.Providingthegreatestgoodforthegreatestnumberduringtheperiodofmedicaldisparitydictatesthataminimalnumberofmedicalpersonnelmanagethiscategoryofpatients.Patientsshouldbemanagedwithalertness(expectancy)tochangesintheircondition.Theyshouldbegivensymptomaticandsupportivecareuntiltheavailablemedicalresourcespermitanintensiveeffortintheirbehalf.(Approximately20percentofthecasualtiesarenormallyinthiscategory.)精选课件TheT(Treatment)systemoftriage,isanalternativetothePsystemandisroutinelyusedbytheRN,theRAF,NATOallies,theInternationalCommitteeoftheRedCross,civilianambulanceservicesandinciviliandisasterprograms.精选课件Therelationshipbetweenthetwosystemsisasfollows:P1isequivalenttoT1P2isequivalenttoT2P3isequivalenttoT3P1HoldisequivalenttoT4DeadisstillDead.精选课件TriagefortreatmentAsimple,safe,rapidandreproduciblesystemisrequiredthatcanbeappliedbyanyServicemanwithappropriatemedicaltraining．Physiologicalsystemsthatlookattheconsequencesofinjury(achangeintheVitalSigns：RespiratoryRate,PulseRateandCapillaryRefillTime[CRT]aremorereliablethananatomicalsystems（whichrequireextensiveclinicalknowledgeandaneedtoundressthecasualty）精选课件TriageSieveSimpletriageandrapidtreatment(START)triagealgorithm精选课件精选课件Triageisonlya“snapshot”ofhowthecasualtyisatthetimeofassessment．Inordertoidentifychangesinthecasualty’scondition，thetriagesievemustberepeatedateachlinkoftheevacuationchain.Itisimportantinitiallynottotrytopredicthowacasualtymaydeteriorate,thiswillleadtoover-triage（ahigherthannecessarytriagecategory）andcanoverwhelmthesystemwithP1andP2casualties.Triagefortreatment精选课件Limitedtimeandpersonnelresourcesmayprohibitamoredetailedtriageassessmentotherthanthatgivenbythetriagesieve.Whenpossible,theTriageSortcanbeusedtorefinethetriagesievedecisions．Triagesortusestherespiratoryrate,systolicbloodpressureandGlasgowComaScale，tonumericallyscorethecasualtyfrom0to12andgiveanindicationofpriorityforevacuationand/ortheneedforfurtherintervention．Thisscorehasaprovendirectrelationshiptooutcomefromsevereinjury.精选课件精选课件Prioritiesareassignedas:Theoverlapinscoresallowsfortheseriouslyinjuredtobeplacedineithercategory,dependingonnumberofcasualtiesandresourcesavailableofevacuation.精选课件Evacuationwillbedelayedwhenthenumberofcasualtiesoutstripsavailabletransport.Inthissituation，thegreatertimespentwiththecasualtywillallowadditionalanatomicalassessmentofinjuries.Wheretheprimarydeterminedbyphysiologydoesnotmatchtheanatomicalseverityofinjuries,theprioritycanbeupgraded．精选课件Example:Asoldierloseshisleftleginalandmineincident.Immediatefirstaidiseffectiveinstoppinghemorrhage.Heistransportedtothedivisionaidstation.Hecannotwalk,hisrespiratoryrateis22andhispulseis110/minute.Heistriaged?fortreatment(TriageSieve).精选课件Hethenreceivesintravenousfluidsandanalgesia.HissystolicBPis115mmHg,hisrespiratoryrateis20,heisfullyalert,withaGCSof15.Hescores12onhisTriageSort,whichisP3forevacuation.Clearly,herequiresearlysurgicaltreatmentandthesurgeonupgradeshisprioritytoP2forevacuationtothefieldhospital.精选课件Chinesetriage:woundmarker精选课件Signofsorting精选课件advancedtriagesystemsInadvancedtriagesystems,secondarytriageistypicallyimplementedbyparamedics,battlefieldmedicalpersonnel,orbyskillednursesintheemergencydepartmentsofhospitalsduringdisasters,injuredpeoplearesortedintofivecategories.精选课件Blue/ExpectantTheyaresoseverelyinjuredthattheywilldieoftheirinjuries,possiblyinhoursordays(large-bodyburns,severetrauma,lethalradiationdose),orinlife-threateningmedicalcrisisthattheyareunlikelytosurvivegiventhecareavailable(cardiacarrest,septicshock);theyshouldbetakentoaholdingareaandgivenpainkillerstoeasetheirpassing.Red/ImmediateTheyrequireimmediatesurgeryorotherlife-savingintervention,firstpriorityforsurgicalteamsortransporttoadvancedfacilities,"cannotwait"butarelikelytosurvivewithimmediatetreatment.精选课件Yellow/ObservationTheirconditionisstableforthemomentbutrequireswatchingbytrainedpersonsandfrequentre-triage,willneedhospitalcare(andwouldreceiveimmediateprioritycareunder"normal"circumstances).Green/WaitTheywillrequireadoctor'scareinseveralhoursordaysbutnotimmediately,maywaitforanumberofhoursorbetoldtogohomeandcomebackthenextday(brokenboneswithoutcompoundfractures,manysofttissueinjuries).White/DismissTheyhaveminorinjuries;firstaidandhomecarearesufficient,adoctor'scareisnotrequired.精选课件根据以下描述给出伤员创伤计分，并判断相应的急救优先等级。某部队战士赵晓明5小时前，被炮弹弹片炸伤右颞部。当即昏迷，战友包扎救下，到营救护所时清醒15分钟，曾呕吐二次，团救护所注射T.A.T1500单位，庆大霉素8万单位。目前伤员仍呈昏迷状态，伤侧瞳孔散大，对光反射消失，左下肢瘫痪，呼吸困难，脉搏55次／分，血压147／96mmHg。精选课件感谢亲观看此幻灯片，此课件部分内容来源于网络，如有侵权请及时联系我们删除，谢谢配合！