伤情评估和战场伤员分类(江).ppt

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1、伤情评估和战场伤员分类伤情评估和战场伤员分类江江 雷雷卫生勤务学教研室卫生勤务学教研室Mass casualtiesAny large number of casualties produced in a relatively short period of time,usually as the result of a single incident such as a military aircraft accident,hurricane,flood,earthquake,or armed attack,that exceeds local logistical support capa

2、bilities.Thetermmasscasualtiesmeansthatalargenumberofcasualtieshasbeenproducedsimultaneouslyorwithinarelativelyshortperiodoftime.Italsomeansthatthenumberofpatientsrequiringmedicalcareexceedsthemedicalcapabilitytoprovidetreatmentinatimelymanner.Anabsolutedisparityexistsbetweenthenumberofpatients,thea

3、vailablemedicalresourcesandtimelytreatment.Mass casualty situationA mass casualty situation is present when one combat medic is confronted with two critically injured patients at the same time.With a large number of casualties,the disparity may be multiplied many times;this greatly disrupts the doct

4、rinal approach to treatment and evacuation.In addition to the treatment and evacuation of a large number of military and civilian casualties,problems may occur from disruptions in the supply,communication,and transportation systems.“在包扎所内最重要的是伤员优先分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类，然后对所有伤员合理配置医疗救护工作，比

5、起仓促慌忙上手术好得多，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。后者仅只能救活不多的伤员。”俄俄 皮洛果夫皮洛果夫N.A.叶菲缅科主编（涂通今主译）：野战外科学，叶菲缅科主编（涂通今主译）：野战外科学，P5.人民军医人民军医出版社，出版社，2005年年10月月什么是伤情评估？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。一、伤情评估方法院前评分院前评分院内救治和创伤研究评分伤伤情情损伤程度损伤程度治愈时间治愈时间预后预后比例比例轻轻伤伤软组织伤软组织伤

6、30天内天内良好良好40%中等伤中等伤广泛软组织伤、广泛软组织伤、60天内天内部分伤员机能部分伤员机能35%上肢骨折、一般脏器伤上肢骨折、一般脏器伤障碍，影响归队障碍，影响归队重重伤伤伤情严重、伤情严重、60天以上天以上严重残废严重残废25%有生命危险有生命危险或后遗症或后遗症伤势分度与百分比伤势分度与百分比院前指数（Pre-hospital index，PHI）指标指标012345SBP(KPa)13.311.5-13.310-11.40-9.9脉搏脉搏(次次/分分)51-119=120=50呼吸呼吸(次次/分分)正常正常浅费力浅费力100mmHg毛毛细细血管充盈血管充盈迟迟sBP8599m

7、mHg毛毛细细血管无充盈血管无充盈sBP85mmHg呼吸呼吸R正常正常35次次/分分钟钟无自主呼吸无自主呼吸胸腹胸腹A均无均无压压痛痛胸或腹胸或腹压压痛痛连连枷胸、板状腹或枷胸、板状腹或深穿刺深穿刺伤伤运运动动M遵嘱遵嘱动动作作只有疼痛反只有疼痛反应应无反无反应应言言语语S回答切回答切题题错错乱、无乱、无伦伦次次发发音听不懂或不能音听不懂或不能发发音音轻度：轻度：9-10分，重度：分，重度：7-8分，极重度：分，极重度：0-6分分参数参数012345呼吸呼吸次数次数03525351024幅度幅度浅或困难浅或困难正常正常循循环环SBP090毛毛细细血管充血管充盈盈无充盈无充盈充盈充盈迟缓迟缓正常

8、正常意意识识状状态态GCS345781011131415创伤计分（Trauma score）1-16分，分，12分为重伤分为重伤Glasgow Coma Scale，GCSBestMotorResponseEyeOpeningBestVerbalResponseObeys6LocalizesPain5Oriented,Conversing5Withdraws4Spontaneous4 Disoriented,Conversing4AbnormalFlexion3ToVerbalCommand3 InappropriateWords3Extension2ToPain2 Incomprehensi

9、veSounds2None1NoResponse1 NoResponse1Addthescoresforeachcategory.Atotalscoreof7orlessindicatesasevereinjury.ThemostcommonpatternsofcomatosepatientsareM=5ofless,V=1,E=1.校正的创伤积分(Revised Trauma Score，RTS)编码值编码值cv4321校正校正值值wGCS131591268450.9368SBP8976-8950751490.7326RR10292969150.2908简易战伤评分方法 A.呼吸次数（呼吸次

10、数（/分）分）B.收收缩压缩压（mmHg）C.神志昏迷状况神志昏迷状况等等级级积积分分等等级级积积分分等等级级积积分分1029489413154293768939123692507526821511491451003036-921-5100Systolicbloodpressure90489-76375-50249100Glasgowcomascale15-13412-938-625-4130Priorities are assigned as:P1(T1)1-10P2(T2)11P3(T3)12P1 Hold(T4)1-3Dead0Theoverlapinscoresallowsforthe

11、seriouslyinjuredtobeplacedineithercategory,dependingonnumberofcasualtiesandresourcesavailableofevacuation.Evacuationwillbedelayedwhenthenumberofcasualtiesoutstripsavailabletransport.Inthissituation，thegreatertimespentwiththecasualtywillallowadditionalanatomicalassessmentofinjuries.Wheretheprimarydet

12、erminedbyphysiologydoesnotmatchtheanatomicalseverityofinjuries,theprioritycanbeupgradedExample:Asoldierloseshisleftleginalandmineincident.Immediatefirstaidiseffectiveinstoppinghemorrhage.Heistransportedtothedivisionaidstation.Hecannotwalk,hisrespiratoryrateis22andhispulseis110/minute.Heistriaged?for

13、treatment(TriageSieve).Hethenreceivesintravenousfluidsandanalgesia.HissystolicBPis115mmHg,hisrespiratoryrateis20,heisfullyalert,withaGCSof15.Hescores12onhisTriageSort,whichisP3forevacuation.Clearly,herequiresearlysurgicaltreatmentandthesurgeonupgradeshisprioritytoP2forevacuationtothefieldhospital.Ch

14、inesetriage:woundmarkerSignofsortingadvanced triage systemsIn advanced triage systems,secondary triage is typically implemented by paramedics,battlefield medical personnel,or by skilled nurses in the emergency departments of hospitals during disasters,injured people are sorted into five categories.B

15、lue/Expectant They are so severely injured that they will die of their injuries,possibly in hours or days(large-body burns,severe trauma,lethal radiation dose),or in life-threatening medical crisis that they are unlikely to survive given the care available(cardiac arrest,septic shock);they should be

16、 taken to a holding area and given painkillers to ease their passing.Red/Immediate They require immediate surgery or other life-saving intervention,first priority for surgical teams or transport to advanced facilities,cannot wait but are likely to survive with immediate treatment.Yellow/Observation

17、Their condition is stable for the moment but requires watching by trained persons and frequent re-triage,will need hospital care(and would receive immediate priority care under normal circumstances).Green/Wait They will require a doctors care in several hours or days but not immediately,may wait for

18、 a number of hours or be told to go home and come back the next day(broken bones without compound fractures,many soft tissue injuries).White/Dismiss They have minor injuries;first aid and home care are sufficient,a doctors care is not required.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14796mmHg。