介绍:
Injured or burned patients are complex to manage not only because of the vast number of potential anatomic derangements [di'reindʒmənt] 精神错乱 but also because of the complex physiologic cascades 级联 triggered by injury. Although burns are associated with the most profound physiologic derangements, most medical issues are fairly similar across a wide range of injuries. As a result, needed interventions are often predictable regardless of the mechanism of injury.
EPIDEMIOLOGY
Trauma ['trɔ:mə; 'trau-] 创伤 is an enormous public health issue. In the United States alone each year, about 2.5 million people are injured and 40,000 killed in automobile crashes, and about 78,000 are injured and 32,000 killed by gunshots. Burns and falls follow in frequency. Worldwide, injury by trauma and burns is the leading cause of death in children and young adults. In the middle-aged and elderly, injury follows only cancer and heart disease as a cause of death. Many long-term survivors of trauma and burns have high degrees of disability, which creates a particularly difficult problem given the young age of many victims.
Death after injury has a trimodal distribution 三峰分布. At least 50% of fatalities occur within minutes of the injury as a result of massive hemorrhage ['heməridʒ] 出血 or nonsurvivable brain injury. Because no medical interventions are possible in such cases, the importance of prevention is paramount 预防最重要. Approximately one third of deaths occur within a few hours after the injury and are usually caused by hemorrhage, anoxia [æ'nɔksiə] 缺氧, or progressive brain trauma. This interval provides an opportunity for emergent intervention. Later fatalities are usually the result of multisystem organ dysfunction or overwhelming infection in the days and weeks after the injury.
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