Trauma

Páginas: 285 (71079 palabras) Publicado: 19 de febrero de 2013
Crit Care Clin 20 (2004) xi – xii

Preface

Trauma

John C. Mayberry, MD, FACS Martin A. Schreiber, MD Guest Editors

The final decades of the previous century generated remarkable advances in the medical care of injured patients. Trauma system development, trauma provider education, shock and resuscitation research, advances in operative techniques and anesthesia, and the evolution ofcritical care have all contributed to improved outcomes for severely injured patients. Trauma care is now a multidisciplinary effort that requires the attention and commitment of a large variety of prehospital and hospital services. Although trauma surgeons have historically led the effort to save the lives of these patients, physicians of all specialties are essential for trauma services andprograms to flourish. Critical care physicians will frequently encounter injured patients in their intensive care units, especially in community hospitals. A knowledge of the fundamental principles of injury, resuscitation, and coagulation that are unique to trauma patients is vital for critical care physicians of all specialties. This issue of the Critical Care Clinics attempts to summarize both thebasic and more complex concepts of trauma patient care that have been established by laboratory and clinical research. The majority of authors are published experts in the topics they present, and they have been asked to explain their understanding

0749-0704/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/S0749-0704(03)00111-8

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J.C. Mayberry, M.A.Schreiber / Crit Care Clin 20 (2004) xi–xii

of pathophysiology and optimal management to critical care practitioners that desire an update on these recent dramatic developments. John C. Mayberry, MD, FACS Martin A. Schreiber, MD Department of Surgery Mail Code 223A Oregon Health & Sciences University 3181 SW Sam Jackson Park Road Portland, OR 97239, USA E-mail addresses: mayberrj@ohsu.edu (J.C.Mayberry) schreibm@ohsu.edu (M.A. Schreiber)

Crit Care Clin 20 (2004) 1 – 11

Initial management of the trauma patient
Christopher F. Richards, MDa,b,*, John C. Mayberry, MD, FACSc
a

Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA b Department of Emergency Medicine, Oregon Health & ScienceUniversity, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA c Division of General Surgery, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA

The management of severely injured patients can be complex and requires a familiarity with a large body of clinical information that encompasses several specialties. Thus, organized traumasystems with designated trauma centers and trauma specialists have proven valuable for managing the multiply injured patient [1,2]. Unfortunately, only 35 states have formal trauma systems [3]. Critical care of the severely injured patient may therefore, at many centers, fall to other critical care physicians. This article discusses the prehospital and initial management steps of the multiply injuredpatient, focusing on established principles of therapy with which a critical care specialist should be familiar.

Epidemiology Trauma is one of the leading causes of critical illness and death in the United States. In 2001, injury trailed only heart disease and deliveries as the most common first-listed discharge diagnosis category at nonfederal hospitals (over 2.4 million patients) [4]. In 2000,unintentional injury was the fifth leading cause of death (97,900 people) [5]. The leading cause of injury in the United States is the motor vehicle crash (MVC), which resulted in 3,033,000 injuries and 42,116 fatalities in 2001 [6]. About one third of trauma patients evaluated at a level 1 trauma center will be admitted to a critical care unit, with a mean length of stay of 5 days [7]. Several...
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