Pathophysiological substantiation of medical evacuation of the wounded persons, suffering injuries of the extremities on the levels of medical support
Onbjective. To determine the optimal scheme of medical evacuation for the wounded persons, suffering the combat trauma of the extremities, bаsing on clinic-statistical analysis of changes in the homeostasis indices.
Маterials and methods. Complex pathophysiologic investigation, concerning 378 wounded persons, suffering a combat traumas of the extremities in accordance to 26 indices of homeostasis, was conducted. Dynamic physician’s control with determination of the trauma severity in accordance to the AdTS (Admission trauma Scale) on all levels of medical support was accomplished.
Results. There was established, that in a case of organization of a consequent delivery of traumatological help to the wounded persons, suffering severe and extremely severe combat trauma of the extremities, estimated by the AdTS as 5 points and more, on levels of medical support due to timely conducted antishock measures and the operative interventions performed a severe respiratory-circulatory disorders - (5.2 ± 0.6) standard units - have had changed steadily towards moderate - (7.7 ± 0.2) standard units. Меdical evacuation of a wounded persons through one or two levels leads to development of definite respiratory-circulatory disorders - (2.8 ± 0.9) standard units, significant lowering of a one-time and a minute productivity of the heart with tendency for cardio-vascular and respiratory insufficiency occurrence: a power іndex - (19.0 ± 4.1) ml/m2, the heart іndex - (2.1 ± 0.3) l/min/m2. In a wounded persons, suffering nonsevere trauma, estimated using a AdTS lesser than 5 points, the shortening of quantity of the medical support levels do not influence the patients’ general state, аnd a respiratory-circulatory disorders owes a moderate character - (8.16 ± 1.37) standard units.
Conclusion. Меdical evacuation of wounded persons, suffering nonsevere trauma (lesser than 5 points in accordance to AdTS) must be conducted in accordance to a shortened scheme; while in a severe one (5-9 points in accordance to AdTS) and in extremely severe trauma (more than 9 points in accordance to AdTS) - after conduction of the antishock measures and stabilization of state on every level of medical support.
Dougherty P, Gherebeh P, Zekaj M, Sethi S, Oliphant B, Vaidya R. Retrograde versus antegrade intramedullary nailing of gunshot diaphyseal femur fractures. Clin. Orthop. Relat. Res. 2013;471(12):3974-80. doi:10.1007/s11999-013-3058-8.
Franke A, Bieler D, Wilms A, Hentsch S, Johann M, Kollig E. Treatment of gunshot fractures of the lower extremity: Part 1: Incidence, importance, case numbers, pathophysiology, contamination, principles of emergency and first responder treatment Unfallchirurg. 2014;117(11):975-84. doi:10.1007/s00113-014-2635-y. [In German].
Franke A, Bieler D, Wilms A, Hentsch S, Johann M, Kollig E. Treatment of gunshot fractures of the lower extremity: Part 2: Procedures for secondary reconstruction and treatment results. Unfallchirurg. 2014;117(11): 985-94. doi: 10.1007/s00113-014-2636-x. [In German].
von Lübken F, Achatz G, Friemert B, Mauser M, Franke A, Kollig E, Bieler D. Update on gunshot wounds to extremities. Unfallchirurg.2018;121(1):59-72. doi:10.1007/s00113-017-0449-4. [In German].
Bauhahn G, Veen H, Hoencamp R, Olim N, Tan ECTH. Malunion of Long-Bone Fractures in a Conflict Zone in the Democratic Republic of Congo. World J Surg. 2017;41(9):2200-206. doi:10.1007/s00268-017-4008-5.
Bennett PM, Sargeant ID, Myatt RW, Penn-Barwell JG. The management and outcome of open fractures of the femur sustained on the battlefield over a ten-year period. Bone & Joint Journal. 2015;97-B(6):842-6. doi:10.1302/0301-620X.97B6.34962.
Buecking В, Wack С, Oberkircher L, Ruchholtz S, Eschbach D. Intra- and periarticular heterotopic ossification in the knee after a low-velocity gunshot wound treated with retrograde intramedullary nailing of the femur. J. Orthop. Trauma. 2011;25(7):77-82. doi:10.1007/s11999-012-2419-z.
Papasoulis E, Patzakis MJ, Zalavras CG. Antibiotics in the treatment of low-velocity gunshot-induced fractures: a systematic literature review. Clin Orthop Relat Res. 2013;471(12):3937-44. doi:10.1007/s11999-013-2884-z.
Patel NM, Yoon RS, Cantlon MB, Koerner JD, Donegan DJ. Intramedullary nailing of diaphyseal femur fractures secondary to gunshot wounds: predictors of postoperative malrotation. J. Orthop. Trauma. 2014;28(12):711-4. doi:10.1097/BOT.0000000000000124.
Poyanli O, Unay K, Akan K, Guven M, Ozkan K. No evidence of infection after retrograde nailing of supracondylar femur fracture in gunshot wounds. J. Trauma. 2010;68(4):970-4. doi:10.1097/TA.0b013e3181bb974b.
Tosti R, Rehman S. Surgical management principles of gunshot-related fractures. Orthop Clin North Am. 2013;44(4):529-40. doi:10.1016/j.ocl.2013. 06.006.
Khomenko IP, Korol SO, Matviichuk BV. Klinichno-organizaciyni osoblivosti nadania travmatologichnoi dopomogi poranenim z defektami myakih tkanin pri vognepalnih ta minno-vibuhovich ushkodzhinnyah kincivok. Travma.2018;5:129-33. doi:10.22141/1608-1706.5.19.2018.146655 [In Ukrainian].
Tischenko MI, Smirnov AD, Danilov LN. Harakteristika I klinicheskoe priminenie integralnoi reografii - novogo metoda izmereniya udarnogo obioma. Kardiologiya. 1973;(11):54-62 [In Russian].
Zarutskiy YaL, Korol SO, Kreshun EA. Diferenciyovana taktika nadania travmatologichnoi dopomogi poranenim z boyovimi travmami kincivok na etapah medichnoi evakuacii. Odeskii medichniy zhurnal.2017;(3):18-23 [In Ukrainian].
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