TraumeManual - Dansk OrtopÃ¦disk Selskab

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<strong>TraumeManual</strong> – Endeligt udkast – Version 1.1 Indholdsfortegnelse INDHOLDSFORTEGNELSE...............................................................................................................2 1 FORMÅL MED RAPPORTEN ........................................................................................................5 2 BAGGRUND.......................................................................................................................................6 3 KRAV TIL SYGEHUSE, DER MODTAGER TRAUMEPATIENTER.......................................6 3.1 FYSIOLOGISKE KRITERIER ..............................................................................................................6 3.2 ANATOMISKE KRITERIER................................................................................................................7 3.3 SKADESMEKANISME.......................................................................................................................7 3.4 PÅ SYGEHUSE, DER MODTAGER POTENTIELT SVÆRT KVÆSTEDE PATIENTER, BØR DER VÆRE: .......7 4 PRÆHOSPITAL BEHANDLING AF TRAUMEPATIENTER....................................................8 4.1 KOMMUNIKATION ..........................................................................................................................8 5 MODTAGELSE OG INITIAL BEHANDLING .............................................................................9 5.1 FORBEREDELSE ..............................................................................................................................9 5.2 PRIMÆR VURDERING OG RESUSCITERING (ABCDE).......................................................................9 5.2.1 A (airway)...............................................................................................................................9 5.2.2 B (breathing) ........................................................................................................................10 5.2.3 C (circulation) ......................................................................................................................10 5.2.4 D (disability).........................................................................................................................11 5.2.5 E (Exposure and environmental control)..............................................................................11 5.3 SEKUNDÆR VURDERING ...............................................................................................................12 5.4 FORTSAT BEHANDLING OG REEVALUERING ..................................................................................13 5.5 DEFINITIV BEHANDLING OG PLEJE ................................................................................................13 6 OVERFLYTNING OG TRANSPORTER .....................................................................................13 6.1 BEHANDLING UNDER TRANSPORT.................................................................................................14 7 RETNINGSLINIER FOR RADIOLOGI VED MULTITRAUMER...........................................14 7.1 INDLEDNING.................................................................................................................................14 7.2 TILTAG UNDER DEN PRIMÆRE GENNEMGANG...............................................................................15 7.3 CT-MULIGHEDER..........................................................................................................................16 7.3.1 CT cranie..............................................................................................................................16 7.3.2 CT ansigt ..............................................................................................................................16 7.3.3 CT thorax..............................................................................................................................16 7.3.4 CT abdomen..........................................................................................................................16 7.3.4 CT columna cervicalis..........................................................................................................17 7.3.5 CT columna thoracolumbalis ...............................................................................................17 7.3.6 CT bækken-proksimale femora .............................................................................................17 7.4 CT PROTOKOL..............................................................................................................................17 7.4.1 Cranie...................................................................................................................................18 7.4.2 Thorax-abdomen...................................................................................................................18 7.4.3 Rekonstruktioner foretages...................................................................................................18 8 KRANIE OG CEREBRUM.............................................................................................................19 8.1 INDLEDNING.................................................................................................................................19 8.2 TILTAG UNDER PRIMÆR GENNEMGANG ........................................................................................19 8.3 UDREDNINGS- OG BEHANDLINGSSTRATEGI ..................................................................................19 8.4 FORBEREDELSE AF TRANSPORT ....................................................................................................21 9 COLUMNALÆSIONER .................................................................................................................22 9.1 INDLEDNING.................................................................................................................................22 9.2 TILTAG UNDER PRIMÆR GENNEMGANG ........................................................................................22 9.3 UDREDNINGS- OG BEHANDLINGSSTRATEGI ..................................................................................22 9.4 FORBEREDELSE AF TRANSPORT ....................................................................................................23 2
<strong>TraumeManual</strong> – Endeligt udkast – Version 1.1 10 THORAXTRAUMER....................................................................................................................23 10.1 INDLEDNING...............................................................................................................................23 10.2 DIAGNOSTIK...............................................................................................................................23 10.3 BEHANDLING..............................................................................................................................24 10.3.1 Pneumo-/haemothorax........................................................................................................24 10.3.2 Costafrakturer/løs thoraxvæg.............................................................................................24 10.3.3Hjertetamponade ..................................................................................................................24 10.3.4 Esofagusperforation ...........................................................................................................24 10.3.5 Bronkieruptur .....................................................................................................................24 10.3.6 Aortaruptur.........................................................................................................................25 10.3.7 Penetrerende mediastinal læsion........................................................................................25 10.3.8 Diagphragmalæsion ...........................................................................................................25 10.3.9 Akut livreddende thorakotomi på traumestuen (”Akut åbning”)........................................25 11 ABDOMINALTRAUMER ............................................................................................................25 11.1 INDLEDNING...............................................................................................................................25 11.2 TILTAG UNDER PRIMÆR GENNEMGANG ......................................................................................25 11.3 UDREDNINGSSTRATEGI ..............................................................................................................26 11.4 BEHANDLINGSSTRATEGI ............................................................................................................26 11.4.1 Skudlæsioner.......................................................................................................................26 11.4.2 Stiklæsioner ........................................................................................................................26 11.4.3 Stumpe abdominaltraumer .................................................................................................27 11.4.4 Observerende behandling af parenchymatøse læsioner .....................................................27 11.5 FORBEREDELSE TIL TRANSPORT .................................................................................................28 12 UROGENITALTRAUMER ..........................................................................................................28 12.1 INDLEDNING...............................................................................................................................28 12.2 DIAGNOSTIK...............................................................................................................................28 12.3 BEHANDLING..............................................................................................................................29 13 TILSKADEKOMNE GRAVIDE OG BØRN...............................................................................29 13.1 INDLEDNING...............................................................................................................................29 13.2 TILTAG UNDER PRIMÆR GENNEMGANG ......................................................................................29 13.3 DIAGNOSTIK...............................................................................................................................29 13.4 UDREDNING OG BEHANDLING.....................................................................................................30 14 DET TILSKADEKOMNE BARN.................................................................................................30 14.1 INDLEDNING...............................................................................................................................30 14.3 TILTAG UNDER DEN PRIMÆRE GENNEMGANG.............................................................................30 14.3.1 Airway ................................................................................................................................30 14.3.2 Breathing ............................................................................................................................31 14.3.3 Circulation..........................................................................................................................31 14.3.4 Disability (neurologisk)......................................................................................................31 14.3.5 Environment .......................................................................................................................31 14.4 DIAGNOSTIK OG BEHANDLING....................................................................................................31 14.5 FORBEREDELSE AF TRANSPORT ..................................................................................................32 15 KARTRAUMER.............................................................................................................................32 15.1 INDLEDNING...............................................................................................................................32 15.2 DIAGNOSTIK...............................................................................................................................32 15.3 SKADER......................................................................................................................................33 15.4 BEHANDLING..............................................................................................................................33 15.4.1 Carotislæsion......................................................................................................................33 15.4.2 Abdominalkarskader...........................................................................................................33 15.4.3 Ekstremitetstraumer............................................................................................................33 15.5 KOMPLIKATIONER......................................................................................................................33 16 EKSTREMITETSLÆSIONER ....................................................................................................34 16.1 INDLEDNING...............................................................................................................................34 3
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