Trauma WeaponInjury Qing TangZhu M D Ph D DepartmentofMicrosurgery OrthopedicTraumaTheFirstAffiliatedHospitalSunYat SenUniversity Aimsofthislecture KnowthephysiologicalresponsesofourbodiesfollowingtraumaKnowthefeaturesofdifferenttypesoftraumaLearnhowtocareanacutelyinjuredpatientbasedonthepriorityKnowsomegeneralknowledgeaboutweaponinjury Outline PartI BasicscientificknowledgeabouttraumaPathophysiologyoftraumaWoundhealingPartII TraumaEpidemiology injurypreventionClassification triageInitialassessment carePartIII WeaponInjuryBlastinjuryNuclearweaponinjuryChemicalweaponinjuryCombinedinjury PartI Basicscientificknowledgeabouttrauma PathophysiologyoftraumaImmuneresponsetotraumaChangesinorganfunctionfollowingtraumaWoundhealing ImmuneResponsetoTrauma Dynamicstagesintheimmuneresponsetotrauma Changesinorganfunction CardiovascularsystemBloodloss hypovolemia shock hearfailureLungHypercapniaHypoxiaAdultRespiratoryDistressSyndrome ARDS AcuteLungInjury ALI KidneyHypovolemia renalhypoperfusion Toxin mediated radiocontrast antimicrobials renalparenchymalinjuryRhabdomyolysisLiverGastrointestinaltract bleedingBrain WoundHealing A inflammatoryphaseB proliferationphaseC Remodelingphase Primaryhealing Secondaryhealing PartII Trauma Epidemiology injurypreventionClassification traumatriageInitialassessmentandcareoftheinjuredpatientPrehospitalphaseIn hospitalphase TheFactsaboutTrauma LeadingcauseofdeathOverallages Rank4Aged1to44 Rank1Aged1 34 morethantoallothercausesofdeathcombinedNonfatalInjuries USA 2019 8 ofallhospitaldischarges37 ofallemergencydepartmentvisitsThehighestrateofinjuryIndevelopingareas countriesRapideconomicchangeandurbanizationRoadtrafficincidencecausedGlobal 1 18milliondeaths 30millioninjuriesUSA 45 000deaths 357 000hospitalizationChina 120 000deaths 550 000injures LifetimeCostofInjury 406Billion USA 2000 IsTraumaPreventable TraumaOccursrandomly unpredictably Doesnotoccurbyaccident PrimarypreventionPreventtheoccurrenceofthetraumaitselfSecondarypreventionLimitenergytransfertotheindividualMinimizetheseverityoftraumaTertiarypreventionInstituteoptimalcarefortheinjuredpatientImproveoutcomefollowingtrauma PartII Trauma Epidemiology injurypreventionClassification traumatriageInitialassessmentandcareoftheinjuredpatientPrehospitalphaseIn hospitalphase Classification BaseontheintegrityofskinClosedinjuryOpeninjuryBaseontheinjurysiteBaseonthemechanismofinjury MOI BaseontheseverityRelatedtothefeatures treatmentoptions andprognosisoftrauma ClosedInjury OpenInjury Classificationbasedontheinjurysite ClassificationbasedonMOI MechanicalinjuryBluntinjury motorvehicleaccident MVA fall crushPenetratinginjury stab impale firearmBlastinjuryTemperature associatedinjuryBurns coldinjuryFirearm associatedinjurySpecialinjuryChemical biological radiationinjuryCombinedinjury ClassificationbasedontheseverityDisasterTriage ParametersAbilitytoambulateRespiratoryfunctionSystemicperfusionLevelofconsciousness GreenWalkingwoundedRed immediatetransportRR 30RR2RR 30 CR 2 unconsciousYellow delayedtransportBlack unsalvageable SimpleTriageAndRapidTransport START PartII Trauma Epidemiology injurypreventionClassification traumatriageInitialassessmentandcareoftheinjuredpatientPrehospitalphaseIn hospitalphase Algorithmforprehospitalcare SceneAssessment SafetyDangerousenvironmentsStandardprecautionsBloodandbodyfluidmaycontainpathogensSituationNumberofpatientsandtheiragesNeedforadditionalassistancesKinematics MOIMVAFallsOccupational recreationalinjuryPenetratinginjury InitialAssessment PrimarysurveyAirwayBreathingCirculationDisability neurologicevaluation Expose environmentcontrolSecondarysurvey ImmediateMeasuresattheScene BasicLifeSupport BLS BasicairwaymanagementSupplementaloxygenRescuebreathingCardiopulmonaryresuscitation CPR ControlofexternalhemorrhageFluidtherapySpinalimmobilizationC collarLongbackboard GoldenPrinciplesofPrehospitalTraumaCare EnsurethesafetyoftheprehospitalcareprovidersandthepatientAssessthescenesituationtodeterminetheneedforadditionalresourcesRecognizethekinematicsthatproducedtheinjuriesUsetheprimarysurveyapproachtoidentifylife threateningconditionsProvideappropriateairwaymanagementwhilemaintainingcervicalspinestabilizationSupportventilationanddeliveroxygentomaintainanSpO2 95 ControlanysignificantexternalhemorrhageProvidebasicshocktherapy includingrestoringandmaintainingnormalbodytemperatureandappropriatelysplintingmusculoskeletalinjuries GoldenPrinciplesofPrehospitalTraumaCare Considertheuseofthepneumaticantishockgarmentforpatientswithdecompensatedshock SBP 90mmHg MaintainmanualspinestabilizationuntilthepatientisimmobilizedonalongbackboardForcriticallyinjuredtraumapatients initiatetransporttotheclosestappropriatefacilitywithin10minofarrivalonsceneInitiatewarmed intravenousfluidreplacementenroutetothereceivingfacilityAscertainthepatient smedicalhistoryandperformasecondarysurveywhenlife threateningconditionshavebeensatisfactorilymanagedorhavebeenruleoutAboveall donofurtherharm PartII Trauma Epidemiology injurypreventionClassification trau