Earthquake spine and spinal cord injury treatment

 Due to a variety of injuries in the earthquake may cause the injured spinal cord injury paralysis and the most serious consequences. Spinal injuries rational and effective treatment of early injuries is very important, within one year after the accident, the death of patients, 90% died in the hospital way. 24 hours after injury of the spinal cord injured patients still alive, 85% of people could survive more than 10 years. paraplegia caused by spinal cord injury caused permanent disability would be to the wounded, as a result of complications of paraplegia will threatening their lives, to the wounded and the families I have tremendous pain and heavy burden. According to the American Spinal Injury Association (National Spinal Cord Injury Association) statistics, at present the spine, spinal cord injury patients with the most common causes of death are respiratory function failure and kidney failure. Meanwhile, a growing number of spinal cord injury patients with spinal cord injury died of unrelated causes, such as cancer or cardiovascular disease .2008 May 12 Wenchuan earthquake area, causing heavy casualties and serious damage to property. The earthquake caused major damage to the body caused by the housing collapse and crushing crushing, fracture is most common, about 50%, of which 1 / 4 as spinal fractures, spinal cord injury caused by the different levels will be left behind of a permanent disability caused by complications of paraplegia would threaten their lives, to bring great pain to the patient's own, but also a heavy burden to society .32 years ago, Tangshan earthquake caused hundreds of thousands of wounded , there are more than 5,000 patients with spinal cord injury, the treatment of 3,817 people survived, they launched a series of studies has provided us with valuable experience. According to preliminary incomplete statistics, the earthquake caused a one-time human spinal cord injury 5000-7000 (spinal cord injury, SCI). about their treatment there are many we need to sum up the place.
I. Mass casualty classification
earthquake has caused the general characteristics of catastrophic accidents: sudden and strong, the relative concentration quantity, injury disease complex social influence. so timely and effective implementation of organization and management is the key to the work of batch treatment of sick and wounded. And on the spine and spinal cord injury wounded scientific and efficient assessment and classification, sorting is where the basis of the work.
spinal cord injury according to the injured area, stability can have a variety of classification of spinal cord injury caused by the earthquake, mostly at low speed and kinetic energy of crushing injury, a small number of high fall injury. combined with earthquake victims the need for treatment may be the severity of injury mechanism and injury classification. spinal injuries according to the mechanism of fracture and dislocation into flexion and hyperextension type. flexion is severe spinal flexion, or bending when the heavy punching head, shoulder or back so severe spine flexion injury. flexion spine fractures and dislocations occurred in the first 1,2 cervical, lower cervical, thoracolumbar junction and lumbar spine 4,5. To the rear of the vertical force or from a sudden buckling of the spine caused by indirect violence. can be played by vertebral compression, interspinous ligament rupture, severe vertebral fractures and accessories are, forward displacement of the previous paragraph. quake injured in this type most common. weights hyperextension type is directly from the rear spinal shock, or injured his back falling from a height, back or waist blocked, so that the spine over extension, subject to external forces or forehead, forcing the neck extension, type of spinal fractures caused by hyperextension dislocation, often accompanied by anterior longitudinal ligament injury , Annex fractures, severe setback on the spine. hyperextension type of spinal fracture-dislocation occurred in the cervical spine. classified by mechanism of injury can effectively guide the on-site treatment and transport the injured.
according to severity of injury, combined with ISS site Points Table, spinal fracture and dislocation can be divided into: mild injury, moderate injury, at the end of severe life-threatening injury, serious life-threatening injuries, survival difficult to be critical injuries. mild injury refers to cervical, thoracic and lumbar sprain simple; moderate spine injury that spinous process, transverse dislocation or fracture, or chest, vertebral compression fractures is less than 20%; the end of life-threatening injuries and severe spinal cord contusion that transient neurologic symptoms associated with intervertebral disc prolapse with nerve root compression syndrome, spine is not stable fracture or dislocation, spinal nerve root and neck, thoracic, lumbar plexus tear, avulsion fracture, multiple vertebral fractures, or thoracic and lumbar vertebral compression fracture of greater than 20%; serious life-threatening spinal cord injury that is not fully injury; survival difficult to set risk serious injury means injury or cervical spinal cord running through the following cervical dislocation 4, spinal cord or cauda equina tear, break, running through injury. according to the severity of injury classification of spinal cord injury classification to guide the evacuation of the wounded and the treatment is important to determine.
earthquake injured during medical treatment often involved in various forms of transport and sorting of the wounded, the process of how to protect the safety of transport growing concern abroad has begun to develop appropriate guidelines, but no country uniform norms or standards, especially during transit emergency supplies on reasonable equipment, lack of relevant research.
two treatment methods (including first aid, emergency medicines and equipment, post-surgical and surgical fixation using equipment, etc.)
rescue the injured spinal cord injury has a strong professional, as rescue personnel or medical personnel with different background knowledge, we tend to save the special understanding of spinal cord injury there is a big difference in the degree. Thus, in addition to the earthquake crushing or falling objects fall break will be a direct result of the body of human spinal cord injury, but in the rescue process, if the scene to take measures to properly tend to the wounded will cause secondary damage that occurs simply injured spinal cord injury or damage to the original Development of spinal cord injury aggravated, this is Tangshan earthquake left us bitter lessons.
of spinal cord injury or suspected spinal fractures and dislocations of the rescue wounded wounded in addition to maintaining stable vital signs outside the spinal level should be maintained straight, not moving freely spine range of motion or trial, emphasizing to avoid distorting the spine, the spinal cord injury worse. to keep the injured spinal relatively stable, it protects the spinal cord. Therefore, buried in the ruins of the wounded to adhere to the hard race against time to rescue the same time, one of the survivors of spinal cord injuries correctly and standard first aid, to reduce the morbidity and mortality and improve quality of life of patients is extremely important to the future. In the earthquake on the site of the injured spinal cord injury correct rescue should note the following points: �� mining disaster scene, found the survivors buried under the rubble, rescue workers could be checked by a simple inquiry or the injured limb injuries to the general understanding of the wounded, to determine the head, chest , face, limbs, spine or without injury. If the physical loss of sensation, difficulty in hands and feet, can not perceive urine, it should be highly suspected spinal cord injury may exist. �� found in the ruins of the wounded, it should first remove the top of the injured body compression properties, and then smooth handling, do not forcibly pull the wounded. �� According to injured segments of spinal cord injury were divided into two types of spinal cord injury, the other is the thoracolumbar spinal cord injury, both moving in different ways. paralyzed limbs that have been wounded, to a high degree of suspicion of spinal cord injury. removal of the injured cervical spinal cord injury is: 1 live patient hands to protect head and neck, 3 people injured under the body with both hands Pinto from the neck back, torso hip lower limbs, go to the hardware board on a stretcher, a stretcher with a cloth or a towel head and neck on both sides of paper as a temporary fixed, if the conditions better wear a collar brake to prevent the neck from side to side in transit, increasing the life of spinal cord injury, or there dangerous. on the upper limbs were normal, and lower extremity motor and sensory dysfunction appears wounded, to consider that they have the thoracolumbar spinal cord injury, to carry the injured thoracic spinal cord injury is: to supine, legs straight, do not twisting the spine, from 3 people wounded Pinto with both hands placed on the hard plate on a stretcher. �� stretcher requirements: delivery of spinal cord injury patients should use a hard stretcher, if not rigid stretcher, can not use soft blankets, sheets and other materials, should be local materials, such as doors or plate, can also play the role of rigid stretcher. while minimizing loaded onto the lift under the patient to avoid secondary damage. combined with paraplegia should be soft mattress pad. �� ambulance during transport, should be wounded and the stretcher with cloth with a fixed together to prevent new damage caused by road bumps. �� spinal cord injury probably need for timely surgical treatment, the conditions for such procedures and technical requirements for a higher, not in the field should be sent to a treatment of the conditions of spinal cord injury medical institutions. �� rehabilitation and clinical treatment should also begin rehabilitation as early as possible in favor of patients with spinal cord injury functional recovery, reduce complications and improve quality of life.
earthquake Traumatic spinal cord injury in particular has its features: high incidence, high morbidity, high cost, low mortality, and other characteristics were mainly young adults. It has become difficult global health problems, thus strengthening the basis of spinal cord injury to further improve the clinical treatment and functional rehabilitation intervention and related research is of great significance. spinal cord injury after surgical intervention, given early restoration, vacuum, fixed and integration, for the recovery of spinal cord injury and to create conditions for early rehabilitation . Thus, after spinal cord injury Surgical treatment of timely and correct manner, and its meaning is self-evident. However, the major loss of function after spinal cord injury axons from the spinal cord and neurons target the limited joint and spinal cord injury break ties evoked per death or apoptosis caused by pathological, so it determines the surgical intervention and the limited indirect. In addition, the past decade proved that experimental and clinical practice: secondary damage after spinal cord injury prevention, nerve cell transplantation, and as soon as possible start of rehabilitation training on the importance of functional recovery, after spinal cord injury shows the significance of comprehensive treatment. As early as 1999, the U.S. treatment of paraplegia in the Miami Plan (Miami project) Scientific Officer Dr. W. Dalton. Dietrich and Dr. Wise Young on the proposed Five Steps in patients with spinal cord injury therapy (Five steps to acure), and initiatives spine surgeon in patients with spinal cord injury law enforcement here as much as possible. �� the injection of large doses of methylprednisolone; �� According to traumatic situations surgical intervention and neurological protection measures; �� real Shixue Wang's cell transplantation; �� regeneration barriers to overcome; �� start rehabilitation as soon as possible. These therapies have been the world scientists and clinicians neural recognition. Therefore, we should fully understand a single surgical intervention on the treatment of spinal cord injury limited.
1. drug treatment of acute spinal cord injury caused by earthquake damage are not the most complete transection of the damage. Although some of the primary axonal injury exist, they are not dead However, if treatment is not timely or improper handling of primary injury, followed by secondary damage can result in permanent spinal cord dysfunction. primary injury in the trauma of a sudden has decided, is not reversible. and secondary damage is that people can be prevented or say, prevention is possible. based on spinal cord injury pathological process, it developed many drugs to prevent or reduce the secondary damage of spinal cord injury, or to promote the growth of axons, which is the treatment of spinal cord injury in hopes lie. as in the past, the clinical application of dimethyl sulfoxide, scopolamine, naloxone, a variety of antioxidants, free radical scavengers, superoxide dismutase, calcium channel antagonists are all products of this research. In recent years, scholars believe that the clinical application is more effective drugs to:
�� high-dose methylprednisolone (MP): hormonal agents for 60 years in the 20th century Start application in the clinical treatment of spinal cord injury, when the theory is based on hormones can reduce the secondary edema after spinal cord injury. In recent years, scholars from various countries in-depth study after that: previous corticosteroid treatment no significant effect of spinal cord injury, mainly dose is not enough. In order to clarify the clinical efficacy of methylprednisolone, the United States has organized three national acute spinal cord injury research (the National Acute Spinal Cord Injury Study, NASCIS), the first time in the United States National Spinal Cord Injury Study (NASCIS I) in , compared to 100 mg a day and 1.0 g methylprednisolone per day of loose-lung, spinal cord injury and found no significant difference between two groups, after which the system observed in animal studies of the MP on the therapeutic dose after acute spinal cord injury response curve, that the impact of 30mg/kg can minimize the amount of tissue damage and promote recovery of neurological function. In the Second National Acute Spinal Cord Injury Study (NASCIS ��) in 162 cases of spinal injury within 14 hours high dose MP in patients with high-dose naloxone and placebo treatment comparative observation. NASCIS �� results show that within 8 hours after injury high dose of MP-treated patients, the improvement in neurological function, with statistically significant, and in effect is still very obvious after one year, which led in 1997 to continue NASCIS �� clinical studies, all patients are limited to 3 to 8 hours after injury to receive treatment within the specific application methods are: the impact of dose to the first 30mg/kg from peripheral venous infusion completed within 15 minutes, 45 minutes after the interval, then 5.4mg/kg/h maintain 23 hours. in the control group and methylprednisolone on the appearance of exactly the same as placebo, with the same way treatment control group patients, two groups of patients 6 weeks after injury, six months and one year double-blind method for recovery of neurological function check, the three different periods of nerve function tests prove that: within 8 hours after injury in strict accordance with a prednisolone-based treatment program for treatment of patients, their neurological function, including exercise, acupuncture, pain and touch functions were significantly better than the placebo group, there are statistically significant. is now considered: high-dose MP treatment of acute spinal cord injury a wide range of effects, including improvement of microcirculation, inhibition of lipid peroxidation, reducing calcium influx and maintenance of neuronal excitability, etc., is considered as an effective clinical treatment of acute spinal cord injury medicine. The treatment time is limited to 8 hours after injury , such as 8 hours after the application of spinal cord injury, not only is ineffective, and complications increase.
�� ganglioside: ganglioside in normal development and differentiation of neurons play an important role in the experimental study exogenous gangliosides can promote neurite growth, increase the number of surviving axons site of injury.
2. surgical intervention in spinal cord injury the injured spinal cord injury in a clear and prognosis of the extent of preliminary judging, the next step on the need to spinal fracture site, fracture type to take the appropriate treatment. in the treatment of spinal cord injury, surgical treatment is of great significance. The main purpose of surgery is to provide immediate and long-term stability of the spine, relieve oppression, as far as possible restore nerve function, restore normal spinal alignment relationship. For the preliminary judging for the incomplete spinal cord injury should take a more positive attitude.
�� spinal cord injury factor: According to the imaging and pathologic anatomy, spinal cord damage from the injury factors or part of vertebral fractures films broke into the spinal canal due to disc, and the actual formation of the fracture when the force on the spinal cord injury, there are two, one at the moment of injury, fracture displacement of the nerve tissue impact on the spinal cord and nerve roots caused by traction or contusion; second chip fracture or disc tissue on the continued oppression of nerve tissue. The former is the moment has formed a dynamic irreversible damage, and thus reset the decompression surgery for such injury no precise meaning. while the latter is a continuous pressure, you need to lift as soon as possible. experimental results show that: the formation of the fractures suffered spinal cord injury in transient dynamic compression injury than the static state for large. and clinical imaging studies show The changes are still under the canal, so it does not fully reflect the extent of spinal cord injury. However, spinal compression, external forces continue to act on the spinal cord nerves, impeding the recovery of neurological function is an important factor that must as soon as possible relieve the pressure on the spinal cord, the entire complex fixed reconstruction of spinal stability, to create the conditions for spinal cord recovery.
�� surgical treatment of spinal cord injury purposes: First, reconstruction of spinal stability, so that patients in the early activities and reduce concurrent disease, and to create conditions for the comprehensive rehabilitation training; the second is to create a relaxed spinal nerve recovery within the environment. which include surgical treatment of fractures of the entire complex, orthopedic, spinal decompression or expansion, while the rigid fixation and fusion . At present more unstable fractures of the spine of scholars associated with nerve injury in particular, advocated prompt surgical treatment. �� surgical approach options: surgical approach chosen depends on the type of fracture, fracture site, fracture of time and surgeons familiar with the extent of the approach. �� posterior surgery: anatomy is relatively simple, less invasive, less bleeding, easier operation. applicable to large numbers spinal fractures, compression from the spinal canal in front of less than 50% of the fracture, such as Posterior restoration using the equipment correctly, can achieve satisfactory bone indirect reduction. spinal pedicle get back to bite except posterolateral spinal decompression, corpectomy, or line access to semi-circular or circular decompression. posterior surgical instruments can be used for various types of thoracic and lumbar fracture and dislocation. current fixation devices commonly used for the entire complex by the pedicle screw fixation system, the fixed segment is short, strong reduction are commonly used in RF, AF , USS fixed system can achieve three dimensions with six degrees of freedom of the entire complex fixed. posterior decompression surgery is mainly indirect, that the reset spinal fractures block the main force against the effect of axial distraction, with the posterior longitudinal ligament stretching, so that the fibrous ring attached to the vertebral fractures and soft tissue traction to complete the block. �� anterior: Imaging Show: Most spinal fractures caused by spinal cord injury or spinal cord compression and more from the anterior, posterior laminectomy and therefore can not be lifted from the anterior of oppression. particularly when the spine before the damage is already in the column (burst fracture, severe compression fractures) of the cases, such as then artificially remaining stability of the posterior column of the spine further damage, often to further increase the kyphosis after surgery (with or without internal fixation), so that further deterioration of anterior compression, which is in the past some of the posterior important factor in poor surgical results, but also some scholars in recent years to promote the important cause of anterior. In addition, as burst fracture involving the column, causing spinal cord compression in front of, in particular, over 50% of spinal compression, or spinal canal in front of a free bone that due to nerve tissue to be covered in a prominent bone in the rear, indirect reduction if they can not make bone forward, and after passing by extension reset or traction or further damage. which should be considered in the following circumstances anterior: a spinal cord injury who had anterior spinal syndrome, b are free to the anterior bone slices of severe burst fractures, c not all paralysis old burst fracture , d posterior surgery, does not relieve pressure caused by the front, e in front of the delayed pressure in patients with incomplete paralysis. anterior spinal cord injury is a new progress in the past 10 years, it can be fully carried out under direct vision vertebral front tube decompression, correction of deformity and fixed at the same time to complete fusion. The advantages of anterior surgery: surgery under direct vision through the anterior pressure caused by direct removal of material, complete decompression, the recovery of satisfactory sagittal spinal canal diameter, and restore spinal deformity correction of the physiological curve of large bone in the interbody strut graft fusion to restore vertebral body height, internal fixation to stabilize fusion area immediately available. Anterior screw-rod fixation devices include, nail plate titanium mesh and other systems and support.
in the earthquake disaster, the open spinal cord injury is not uncommon. For such victims, the scene where the memory should not be forced to stay out of the foreign body wounds, while the response to the wound with sterile after disinfection gauze bandage, as soon as conditions permit, the hospital delivered to the line following treatment. shall be open emergency surgery of spinal cord injury. Such injuries often combined brain, chest and abdomen, limbs and other organ damage may be present in patients with shock, coma, and other organs disorders, the treatment principle is to determine quickly and accurately on the basis of the disease, the first dealing with life-threatening injury, and then deal with spinal cord injury, but should avoid adding to the spinal cord injury. preoperative imaging to be the line to determine the location of foreign body, with or without adjacent organs through injury. When the abdominal cavity organs suspected penetrating wound should thoracotomy or laparotomy, isolation and protect organs pulled out after the foreign body under direct vision. surgical debridement required careful to avoid the exposed rock foreign body, foreign body remaining in multi-card in the lamina or vertebral body, the direction should be gently pulled along the piercing, do not shake in the wound to prevent further damage to the spinal cord. routine decompression, bite besides the spinous process and the lamina, removing bone fragments and spinal hematoma chip to control active bleeding. dural repair should be possible, if they really can not patch, applied hemostatic gauze covering the wound. If the stability of the spine is broken, the need to simultaneously spine Fixed fusion. incision before closure, the use of a large number of repeated saline wash the wound drainage tube placed to reduce the incidence of postoperative infection.
this major disasters in the earthquake, how to maximize the limited use of medical resources every doctor needs to be considered a real problem. Earthquake damage is not only re-injured spinal cord injury, and the large number. In the rescue, the clinician should make a correct prognosis of the wounded judge give full consideration to the level of the injured spinal cord injury, the degree of spinal cord injury, spinal fracture type, take simple and effective method of treatment, so not only to ensure treatment of the wounded, and make limited health care resources to maximize the rational utilization and improve treatment efficiency.
3. Rehabilitation spinal cord injury, in addition to actively prevent or reduce secondary injury in drug treatment, surgical treatment is to restore spinal cord to create a relaxed stable internal environment, to create conditions for early rehabilitation, reducing the long-term bed rest in patients with spinal cord injury due to complications. But how best to recover residual limb function and improve quality of life of patients, the establishment of standing or walking functions so that they can return to society as soon as possible, it is an important part of comprehensive rehabilitation, but also in patients with spinal cord injury important part of treatment. The following far as rehabilitation and ambulation of urinary a brief discussion of rehabilitation. In the past more than Thoracic and complete thoracic paraplegia is a wheelchair most of life activities, only the waist a complete paraplegia below the trained have access to standing and walking with a practical possibility. In recent years the rehabilitation engineering, rehabilitation, biomechanics, rehabilitation training, rehabilitation equipment, especially the development and progress of the walking machine, so that patients with thoracic paraplegia 4, the following can stand up with practical walking and participation in social activities as possible, this is spinal cord injury rehabilitation in recent years, new progress. to ARGO (Advanced Reciprocating Gait Orthosis) functions as the representative of the walker to help move has achieved good clinical results. the walker through body weight in patients with reciprocating movement to the side, and guide the patient's body forward, so that patients can really use your own leg standing and walking. ARGO walker will help not only in walking in the move function, and in patients during standing and sitting postures exchange also help move function, patients do not need a hand to switch parts of the hinge lock the knee, but by the knee brace to help move the elastic devices are, so that patients can stand up or sit down directly. by application of the training walker to help move to stand or walk, so that patients are the same height as normal person dialogue and exchanges on and enhance the confidence of self-reliance and reduce the psychological barrier of patients and enhance the ability to participate in social activities, promote the patient an early return to society. so ARGO to get rid of most of the long-term paraplegics wheelchair life possible. This is to improve spinal mobility in patients with spinal cord injury opened up a new way.
recent natural disasters in the treatment of acute lack of significant aspects of rehabilitation and disability program. we review the earthquake in Pakistan in 2005 after the end of it for spinal cord injury (SCI) experience and other natural disasters related to SCI articles found in these natural disasters, there are many, many people will occur SCI. earthquake epidemiology SCI few studies, as a result of SCI locations, the severity of disasters, resources, medical staff issues such as skills and cultural differ. lack of preparedness measures is the absence of severance programs, training of clinicians dedicated to the acute phase treatment and rehabilitation facilities, professional equipment and supplies and so on. developing countries lack the rehabilitation of medical experts to make the situation worse, while lack of a national registration system for spinal cord injury is a problem. and in built SCI units, because there is enough rehabilitation of medical specialists and hospital doctors, so there were no deaths, few complications, and most patients were discharged. technology, including: the establishment of airway patency, early spinal fixation, actively and maintain a good digestive and urinary system function, and the right skin care. discharge plan requires the broad support of the outside world, because SCI need to return to the disaster sites, the wounded and may have changed the face of professional and social needs. The success of the Pakistan earthquake in the rehabilitation of the wounded left us a very important Tip experience. that is, natural disasters, the establishment of a dedicated SCI centers are necessary. Meanwhile, the government disaster relief agencies and planners need to develop and rehabilitation experts to respond to natural disasters on the inevitable emergence of a large number of disabled persons medical treatment program.
three complications with multiple injuries to multiple injuries
site where a single trauma factors of 2 or more than 2 anatomical damage and at least a part of life-threatening injury, it is not simple sum of the parts of the trauma, but injury cover each other, there are interactive syndrome. Its main features include: �� severe illness, shock and the high incidence of severe hypoxemia; �� serious systemic physiological disorders, in a serious stress, the body defenses are weakened, prone to infection and multiple organ failure, organ failure, the more the higher mortality rate; �� missed diagnosis is high, because trauma is a multi-system, multi-site, the early symptoms is not obvious; �� treatment difficult . in spinal cord injury about 43% of patients and multiple injuries. treatment principle is to determine quickly and accurately on the basis of the disease, the first dealing with life-threatening injury, and then deal with spinal cord injury, but should avoid aggravating the process of spinal cord injury. treatment should change the treatment pattern: diagnosis by the usual diagnostic r r r treatment to salvage treatment. Avoid excessive auxiliary examination, so as not to affect the rescue time after injury.
multiple trauma first aid and early diagnosis. first aid principles: surface complex and serious injury of a large number of the wounded, first of all to take emergency measures to rescue a number of injuries when the first life-threatening injuries, including bleeding, airway obstruction, cardiac arrest, tension pneumothorax, abdominal Visceral bleeding hernia and so on. in the treatment of adherence to the multiple trauma injuries, especially head, neck, chest injuries of the wounded, the first airway should be maintained. of brain injury victims, should be promptly removed oral blood clots, vomit, sputum and secretions, endotracheal intubation immediately, if necessary When mechanical ventilation with a breathing machine. on maxillofacial trauma, cervical spine injury, laryngeal trauma victims, should be cut early stage cricothyroid membrane or trachea. I (Infusion, transfusion). refers to infusion, blood transfusion expansion volume and extracellular fluid. multiple trauma shock is the main pathological changes in the effective hypovolemia, microcirculation. Therefore, in severe multiple trauma rescue the wounded, the recovery is not secondary to the importance of blood volume to correct hypoxia. P (Pulsation) . refers to the monitoring of cardiac pump function. shock and multiple trauma injuries occur, in addition to considering hypovolemic shock, but also taking into account the cardiogenic shock, especially with chest trauma, multiple injuries may be due to cardiac contusion, cardiac compression Cyprus, myocardial infarction or coronary artery air embolism caused heart pump failure. Sometimes, hemorrhagic shock and cardiogenic shock may exist. in the emergency treatment of severe multiple injuries, necessary to monitor the ECG and hemodynamic changes such as central venous pressure (CVP) and mean arterial pressure (MAP). C (Control bleeding, control bleeding). is the rescue of multiple injuries in the emergency control bleeding obvious or hidden. Early diagnosis: the fluid at the same time, the vital signs stable situation, a more comprehensive patient examination and diagnosis is very important. In order not to miss important injuries, should bear in mind the respiratory (breathing), A = abdomen (abdomen), S = spina (spinal cord), H = head (head), P = pelvis (pelvis), L = limb (limbs), A = arteries (arteries), N = nerves (nerve). in case of emergency, according to the injury in a few minutes on the respiratory, circulatory, digestive, urinary, brain, spinal cord and the limb bones of the system the necessary checks, and then press each part of the rescue arrangement priorities injury order.
further diagnosis and treatment of multiple trauma. the re-assessment of multiple trauma: hidden deep in some clinical manifestations of early injury often is not obvious. Therefore, the initial examination concluded that in general is not complete. re-evaluation of priorities including whether the rupture of abdominal and presence of delayed intra-abdominal, intrathoracic and intracranial hemorrhage. definitive surgery: multiple parts of two or more injuries per capita need for surgical treatment, surgery is the key to successful treatment. should an emergency rescue team composed of According to various parts of life-threatening trauma to the patient determines the order of operations: �� traumatic brain injury required surgical treatment, and accompanied by abdominal organs injured, should be grouped at the same time. �� thoraco-abdominal injuries, the line profile can be grouped on the same stage thoracic, abdominal surgery; most cases, the chest was no bleeding, but the lung tissue laceration and leakage, should be closed thoracic drainage, re-laparotomy. �� a limb fracture, the need in the Caesarean section, profile thoracic surgery at the end of the debridement, external fixation. of closed fractures can be scheduled for processing.
treatment of multiple trauma in the entire process, saving lives is early, mid-term prevention and treatment of infection and multiple organ failure, post a Correction and treatment of various complications and deformities. The three stages are closely linked, and treatment should think of each step of problems in the next step and may be prevented, such as the shock of fluids to prevent kidney failure, and thus to quickly increase blood pressure to prevent prolonged hypotension; in a large number of anti-shock, but also to prevent the infusion fluid overload caused by pulmonary edema, cerebral edema and acute respiratory distress syndrome (ARDS). for emergency treatment before surgery, surgery should prevent infection, in addition to note that no operating outside the bacteria to intravenous antibiotics.
late complications of spinal cord injury patients to their quality of life and life has a direct impact, is the leading cause of death of such injured late. treatment of complications, mortality is spinal cord injury the important task of post-treatment. spinal cord injury are common complications of acute renal failure, urinary tract infections, lung infections, bed sores, decubitus infection, neurogenic bladder, fecal incontinence or constipation, fever, neuralgia, postural hypotension, deep vein thrombosis, heterotopic ossification, hyponatremia, autonomic dysfunction, testicular epididymitis and so on. According to the current research data, kidney disease factors in the deaths accounted for first, followed by bed sores infection, sepsis, cardiovascular system diseases. Treatment of urinary system for patients and patient Health ...