Injury in America A Continuing Public Health Problem (1985) / Chapter Skim
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5 Treatment
5 Treatment
Pages 65-79
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From page 65... ...
The use of helicopters in Vietnam saved many lives by getting severely injured patients to definitive care in a minimum of time.' In civilian life, the system is varied and unstructured, but good ambulance standards have beep set in some areas, and helicopter services are available in 65
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From page 66... ...
What is the best method of getting a patient to a major center -- by air or ground transports' Between the extremes of urban and rural, consideration should be given to a system of movement to the nearest hospital, where resuscitation can be initiated, the severity of the injury assessed, and arrangements made for transfer to center. We need to knaw whether and under what circus stances patient care is improved by providing emergency surgery at ~ local hospital and then transferring a patient to a center immediately for continuing support.
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From page 67... ...
with the few centers where optimal treatment appears to be available and with foreign centers where alternative models are available (e.g., the West Germany helicopter service and the southern Sweden community hospital system) are essential.
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From page 68... ...
Injury tuba coos not involve the brain directly can nevertheless lead to myriad changes in function of the neuroendocr ine system. The precise mechanisms by which changed hormonal function leads to changed metabolism have not been defined.
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From page 69... ...
Three broad categories can be considered: injuries in which cellular changes alter function; injuries in which deformation of a physical structure produces major problemfi; and injuries that lead to loss of an organ.
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From page 70... ...
As vascular function fails, the bare ier between blood and brain becomes impaired, and fluid leaks from the bloodstream into the brain tissue. Brain cells, with impaired energy, suffer further as fluid separates them from their blood supply.
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From page 71... ...
. heading of physical alterations that cause major problems -- from milder injuries that cause a greenstick angulation or accentuate intervertebral disk degeneration, through hip fractures and band injuries, to major injuries that dislocate the spine or sever a limb.
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From page 72... ...
As important as knowledge are the backup facilities, including wellstocked blood banks, computed tomographic scanners, and capacity for cardiopulmonary bypass and renal dialysis. We have come a long way in the last 40 years in the management of injury, but muab remains to be learned.47 Table 5-1, at the end of this chapter, summarizes what we know in a broad, general way and what we need to learn.
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From page 73... ...
RECOMMErNDATIONS 1. Long-term collaborative studies should be instituted by epidemiologists, statisticians, biomedical engineers, trauma physicians, rehabilitation physicians, behavioral scientists, and health economists, to identify and evaluate factors that produce optimal results, to identify factors that result in less than optimal results, and to institute programs for promulgating optimal management techniques.
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From page 75... ...
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From page 79... ...
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