伤情评估和战场伤员分类江

1、伤情评估和战场伤员分类江Mass casualties Any 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 capabilities. The term mass

2、casualties means that a large number of casualties has been produced simultaneously or within a relatively short period of time. It also means that the number of patients requiring medical care exceeds the medical capability to provide treatment in a timely manner. An absolute disparity exists betwe

3、en the number of patients, the available medical resources and timely treatment. Mass casualty situation A 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

4、many times; this greatly disrupts the doctrinal 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. N.A.叶菲缅科主编（涂通今主译）：野战外

5、科学，叶菲缅科主编（涂通今主译）：野战外科学，P5.人民军医出版社，人民军医出版社，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 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

6、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100 mmHg 毛细血管充盈迟毛细血管充盈迟sBP 85 99 mmHg 毛细血管无充盈毛细血管无充盈sBP 85 mmHg 呼吸呼吸R 正常正常 35 次次/分钟分钟 无自主呼吸无自

7、主呼吸 胸腹胸腹A 均无压痛均无压痛 胸或腹压痛胸或腹压痛 连枷胸、板状腹或连枷胸、板状腹或深穿刺伤深穿刺伤 运动运动M 遵嘱动作遵嘱动作 只有疼痛反应只有疼痛反应 无反应无反应 言语言语S 回答切题回答切题 错乱、无伦次错乱、无伦次 发音听不懂或不能发音听不懂或不能发音发音轻度：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0 3525351024幅度幅度浅或困难浅或困难正常正常循环循环 SBP0 90毛细血管充毛细血管充盈盈无充盈无充盈充盈迟缓充盈迟缓正常正常意识状态意识状态GCS345781011131415创伤计分（Tr

8、auma score）1-16分，分， 12分为重伤分为重伤Glasgow Coma Scale，GCSBest Motor ResponseEye OpeningBest Verbal ResponseObeys6Localizes Pain5Oriented, Conversing5Withdraws4Spontaneous4 Disoriented, Conversing4Abnormal Flexion3To Verbal Command3 Inappropriate Words3Extension2To Pain2 Incomprehensive Sounds2None1No Res

9、ponse1 No Response1Add the scores for each category.A total score of 7 or less indicates a severe injury.The most common patterns of comatose patients are M=5 of less, V=1, E=1.校正的创伤积分 ( Revised Trauma Score，RTS ) 编码值编码值cv 4 3 2 1 校正值校正值w GCS 1315 912 68 45 0.9368 SBP 89 76-89 5075 149 0.7326 RR 102

10、9 29 69 15 0.2908 简易战伤评分方法 A.呼吸次数（呼吸次数（/分）分）B.收缩压（收缩压（mmHg）C.神志昏迷状况神志昏迷状况等级等级积分积分等级等级积分积分等级等级积分积分102948941315429376893912369250752682151149145100303 6-92 1-51 00Systolic blood pressure904 89-763 75-502 491 00Glasgow coma scale15-134 12-93 8-62 5-41 30Priorities are assigned as:P1(T1)1-10P2(T2)11P3(T

11、3)12P1 Hold(T4)1-3Dead0The overlap in scores allows for the seriously injured to be placed in either category,depending on number of casualties and resources available of evacuation.Evacuation will be delayed when the number of casualties outstrips available transport. In this situation，the greater

12、time spent with the casualty will allow additional anatomical assessment of injuries. Where the primary determined by physiology does not match the anatomical severity of injuries, the priority can be upgraded Example:A soldier loses his left leg in a landmine incident.Immediate first aid is effecti

13、ve in stopping hemorrhage.He is transported to the division aid station.He cannot walk, his respiratory rate is 22 and his pulse is 110/minute.He is triaged ? for treatment(Triage Sieve).He then receives intravenous fluids and analgesia. His systolic BP is 115 mmHg, his respiratory rate is 20,he is

14、fully alert,with a GCS of 15. He scores 12 on his Triage Sort, which is P3 for evacuation.Clearly, he requires early surgical treatment and the surgeon upgrades his priority to P2 for evacuation to the field hospital.Chinese triage :wound markerSign of sortingadvanced triage systems In advanced tria

15、ge 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.Blue / 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 taken to a holding area and given