战时创伤性心跳骤停的现场急救和发展趋势

战时创伤性心跳骤停(TCA)的主要原因包括失血性休克和张力性气胸等,其战现场急救流程为在快速识别导致TCA原因的基础上,实施集束化急救措施,即快速纠正导致TCA的可逆性原因,进行高质量的心肺复苏.伤员恢复自主心跳后,后送至下一级救治机构继续复苏治疗,后送途中维持液体复苏的延续性.未来要针对TCA战现场早期识别、致伤机制...     

63例特重烧伤休克期转运的体会

目的探讨特重烧伤休克期转运的可能性。方法收集分析近5年9批63例伤后48h内转运的特重伤员资料。结果全部伤员均成功平稳转运,除2例分别于伤后9、19天死于多脏器功能衰竭外,余61例全部治愈。结论特重烧伤原则上应就地抗休克后转运,当治疗条件太差时,应迅速补充血容量后在继续补液的同时用快速平稳的运输工具转运。     

The therapeutic problems of medicine in catastrophes

There are lack of principle differences between the problems of medical aid during the military and civil disasters, and therefore one can draw a conclusion concerning the validity and necessity of using the experience of military medics in disaster medicine during peace-time. The following aspects are discussed: organization of therapeutic caring of the victims during Chernobyl's AES disaster, earthquake in Armenia and accident in chemical enterprise "Nitrogen" in Jonava. Requirements to the teams for emergency medical service have been formulated with determination of Principles of putting them into practice; the further directions of therapeutic aid improvement are outlined.     

休克期飞机转运成批严重烧伤病人的探讨

休克期长途转送严重烧伤病人危险性较大，以往对路程较远者多不主张长途转运，作者于2000年8月经过各方面的努力和认真准备，成功地用飞机在休克期长途转送了一批危重烧伤伤员，经过顺利，所有伤员经过积极的有效的后续治疗全部成活。因此作者认为只要处理好各个环节，加强转送途中伤员的病情观察和处理，可以在休克期用飞机长途转送危重烧伤伤员。此次转运为以后战时烧伤伤员转送积累了经验。     

Der Einsatz mobiler Röntgentechniken bei der odonto-stomatologischen Identifizierung von Katastrophenopfern

The use of dental radiology in cases of mass disaster is an absolute necessity. Radiographs usually permit identification of dental fragments containing as little as one tooth if a restoration or unique anatomical characteristic is present. Unfortunately the conditions at the scene are usually not adequate to use standard x-ray equipment. The paper presented here gives an overview of different types of mobile x-ray machines and digital radiographic techniques which are useful in disaster victim identification.     

Maximizing postmortem oral-facial data to assist identification following severe incineration

Purpose

This paper reviews the literature for methods of maximizing the postmortem oral-facial information available for a comparison to be made for identification following an incident resulting in incineration.

Method

A search was initially instigated utilizing PubMed, Scopus, and Google Scholar, with further library searches and correspondences among peers around the world leading to a comprehensive review of the literature.

Conclusion

Maximizing postmortem dental evidence in a severe incineration event requires correct recognition and recording of dental data. Odontologists should attend the scene to facilitate this recognition. The information should be documented, photographed, and stabilized before retrieval. Wrapping, padding, and further support of the remains during transportation to the examination mortuary will aid this process. Examination at the mortuary requires further photography, complete charting, and radiographic examination of any dental material available, as well as awareness of other possible medical evidence, to enable identification of the human remains.     

Autoerotische Asphyxie

A 39-year-old man was found dead, bound and gagged in the bedroom of his apartment. The circumstances at the death scene were consistent with an autoerotic accident using an unusual self-rescue mechanism with the aid of electrical equipment and a timer. The death scene is discussed in terms of the feasibility of self-bondage and gagging without external assistance.     

The principles of rendering surgical care in catastrophes

Organization of surgical service in disaster is based on the principles of military medicine, provided for conducting triage, evacuation measures and timely rendering all types of medical aid. In extreme situations during peacetime skilled surgical is provided in medical institutions, deploying with the help of medical teams arriving to the most proximal of disaster focus zones. It is important to follow the main aspects of military surgery with the strategy of surgical procedures, therapy of shock, combined and multiple trauma, prevention of wound infection.     

Application of the Calspan scene measurement system to the investigation of aircraft accidents.

Investigation of transportation accidents usually involves some measurement of physical evidence at the scene. Accurate accident scene data facilitates reconstruction of the accident events and possible determination of the cause. The Calspan Scene Measurement System combines computer technology with civil engineering to provide a useful opitcal measurement device for recording the location of physical evidence at the accident scene. The Calspan Accident Investigation Vehicle, currently under development, is designed to enable investigation teams to completely analyze the evidence and causes of automobile accidents. The concepts and equipment in this system are readily adaptable to the study of aviation accidents.     

Fatality due to acute fluoride poisoning in the workplace

We report a case of a 65-year-old worker who suffered a third-degree skin burn to 5% of his total body surface area as a result of being splashed in the face with hydrofluoric acid (HF). He died shortly thereafter without having received adequate first aid. His serum fluoride concentration was markedly increased at 6.38 mg/dl with hypocalcemia and hyperkalemia. We concluded that he died of HF poisoning. In this case he might have managed to avoid death if he had not been working alone and if he had received adequate first aid on the scene as soon as possible. We re-emphasize the need for the immediate initiation of first aid on the scene and the distribution of information on the risks of HF to workers.     

印尼海啸救援中亚齐机场的伤病员医疗转运模式

目的 探讨印尼海啸救援中亚齐机场伤病员医学转运模式,为合理利用救援资源提供依据.方法 回顾总结在印尼海啸灾难救援中,中国国际救援队首次与其他国家救援队在灾区亚齐机场联合转运伤病员的过程.结果 在航空医疗救援组织上,由美国国际开发总署、国际移民组织及美国军方共同发起,成立亚齐机场联合医学转运中心.由美国军方、印尼政府、澳大利亚和新加坡空军使用直升机飞赴交通不便的难民营及岛屿,将伤病员转运到亚齐机场,再由中国、美国、澳大利亚等多个国家的医务工作者或志愿者提供急救医疗服务:检伤分类,快速处置并后送分流到市内各级医疗机构.由该中心进行检伤分类、快速处置并转运的急危重伤病员共217名,其中居前3位的伤病分别为外伤(伤口)感染、急性呼吸系统疾病、急性消化系统疾病.结论 联合医学转运中心建立了一种从灾难现场到医院的医疗救援模式:现场→直升机→机场转运中心→后方医院,极大地提高了救援效率.在联合医学转运中心基本框架下,多国救援队、军队及多个国际组织共同参加的伤病员转运工作,最大限度地实现了救灾资源的整合利用.强大的垂直空运能力对于救灾快速反应具有至关重要的作用,有效解决了交通瓶颈问题.     

Clinically intensive medical training for combat

Medical training aimed at the rifleman, aidman, and unit operational level for a Ranger Battalion is described. Instruction in patient survey, cardiopulmonary resuscitation, first aid, intravenous resuscitation, and evacuation is given to all Rangers. Approximately one Ranger per rifle squad is trained as a certified Emergency Medical Technician. Aidmen attend advanced formal schooling and the Battalion runs its own medical sustainment training and Expert Field Medical Badge programs. Casualty play is integrated into exercises. We believe this training increases survivability of soldiers in the field and improves their morale and battlefield effectiveness. These programs can be applied to many organizations and situations.     

汶川地震伤员医疗救治模式的探讨

目的 探讨汶川地震灾难救援中,军事医学救援的作用和地位.方法 收集了四川省德阳市某医院在5月12日～5月31日收治的1420例地震伤员资料.分析伤情特点、早期军事医学救援的方法、内容及效果.结果 1420例中,共有1821处损伤,单个部位伤1089例(76.69%),多部位伤331例(23.31%).单个部位伤明显多于多部位伤(P<0.01);四肢损伤、体表和软组织损伤多于其它部位损伤(P<0.01);伤员流在震后前2天最多(68.80%),明显多于其它时间(P<0.01);对968例伤员进行了分类分检;伤后12小时以上才得到救治的伤员最多(P<0.01).结论 军事医学救援应在地震后24小时内快速展开,对规范救治秩序、保证批量伤员救治有效进行将起到重要作用,"德阳模式"探索了一种军事医学救援的重要方法,军事医学救援足今后灾难救援的新趋势.     

汶川地震伤员伤情特点及救治分析

目的 探讨汶川地震伤员伤情特点及早期救治. 方法 收集四川省德阳市第一人民医院在2008年5月12-30日收治的1 420例地震伤员资料,分析伤情特点和早期救治.结果 1 420例伤员中,共有1 821处损伤.其中单个部位伤1 089例,占76.69%,多部位伤331例,占23.31%;四肢损伤、体表和软组织损伤多于其他部位损伤;单个部位伤明显多于多部位伤(P＜0.01);伤员流在震后2 d最多,占68.80%,明显多于其他时间(P＜0.01);19～45岁年龄组伤员多于其他年龄组(P＜0.01);伤后12 h以上才得到救治的伤员最多(P＜0.01). 结论 在灾难救援中,救治速度是关键,救治的黄金时间和救治重点应在震后2 d;在救治中应遵循损害控制原则,平时加强自救瓦救训练和急救知识培训可能挽救更多伤员的生命.     

汶川大地震中伤员阶梯救治原则探讨

目的 探讨阶梯救治原则在地震灾害紧急医疗救援中的应用价值和方法改进.方法 对参加四川汶川大地震的现场医疗急救、前方医院和后方医院的医疗工作进行总结分析.结果 现场救治伤员4 689例次,处置危重伤员413例,完成清创术等各类手术197例,3例重伤员死亡,开放伤口感染率近80%;前方医院收治伤员1 400多例次,完成手术200台次,抢救危重伤员110例次,截肢率3.0%,伤口感染率66.8%;后方医院为125例伤员开展了1-5次/部位的确定性手术治疗,术后无医院感染,无死亡,无截肢.结论 阶梯救治原则是重大自然灾害批量伤员救治的基本原则,急救人员应尽早开展现场急救;后送力量是保障救治成功率的重要因素,完善伤票制度能显著提高救治效率;前方医院主要开展生命支持、创面处理和简单骨折的救治工作;确定性专科治疗应在后方医院进行.     

从金秀县医疗卫生调查窥见农村地区烧伤快速反应机制的现状与对策

目的:通过研究金秀瑶族自治县烧伤快速反应机制所存在的问题,提高我国农村地区整体烧伤防治水平.方法:采用问卷调查方式,由调查员统一发放填写,然后将调查表汇总统计并分析.结果:广西壮族自治区金秀瑶族自治县交通不便,消防知识认识不到位,医务人员缺乏烧伤的急救与后送知识;96.3%以上患者对医疗条件不满意;在对各级医师关于烧伤急救与后送的调查中,有83%的医师缺乏正确的急救与后送治疗经验,其中乡村医师高达100%,不及格者高达67%.结论:在广大农村地区完善烧伤监控体系,建立统一协调、分工明确的烧伤快速反应机制,保证快速反应,提高预警能力,建立包括救护、消防、伤员运送等各部门在内的处理紧急事故一体化机制和体系势在必行.     

Sports doctors' resuscitation skills under examination: do they take it seriously?

As 64% of sports medicine doctors were unable to show proficiency at basic life support and assessment and management of a seriously injured patient with a potential spinal injury in the last two examinations for a University of Bath diploma in sports and exercise medicine, it was decided that a reminder is required of the importance of acquiring, at the very least, some basic resuscitation skills. An analysis and comment on the results from the first aid component of the examination is also presented.     

《烧伤治疗大全》内容简介——一部系统介绍烧伤皮肤原位再生技术的新书

目的:结合分析地震灾害中常见急性特异性感染--气性坏疽的病理改变和救治原则,探讨原位再生治疗技术在气性坏疽救治中的辅助治疗作用.方法:分析四川汶川地震灾害中气性坏疽病理报道资料,根据创伤外科中应用原位再生治疗技术救治各类伤员的体会,提出气性坏疽的治疗与预防方法及出现并发症的紧急处理方案,并予以实施.结果:应用原位再生治疗技术在汶川地震灾害的医疗救助中,有效地预防了气性坏疽的发生,中国抗震救灾创疡专家医疗队负责或指导的救治伤员没有发生气性坏疽感染的病例.结论:原位再生治疗技术可以有效预防地震灾害中常见急性特异性感染--气性坏疽,应列入自然灾害中医疗救助的首选疗法,在医疗单位普及推广应用.