Ở Anh, chấn thương là nguyên nhân phổ biến nhất gây tử vong ở bệnh nhân dưới 40 tuổi, kế toán cho hơn 3000 người chết và 30 000 bị thương nặng mỗi năm. Các báo cáo mang tính bước ngoặt của trường Cao đẳng Hoàng gia của bác sĩ phẫu thuật (1988) về quản lý của bệnh nhân bị chấn thương | 14 Resuscitation of the patient with major trauma Charles D Deakin In the United Kingdom trauma is the most common cause of death in patients aged below 40 years accounting for over 3000 deaths and 30 000 serious injuries each year. The landmark report of the Royal College of Surgeons 1988 on the management of patients with major injuries highlighted serious deficiencies in trauma management in the United Kingdom. In the same year the introduction of the American College of Surgeon s Advanced Trauma Life Support course aimed to improve standards of trauma care emphasising the importance of a structured approach to treatment. Resuscitation of the trauma patient entails a primary survey followed by a secondary survey. The primary survey aims to identify and treat life-threatening conditions immediately and follows the well established sequence of A airway and cervical spine stabilisation B breathing C circulation D disability neurological assessment and E exposure . The secondary survey is based on an anatomical examination of the head chest abdomen genito-urinary system limbs and back and aims to provide a thorough check of the entire body. Any sudden deterioration or adverse change in the patient s condition during this approach necessitates repeating the primary survey to identify new life-threatening conditions. Management and treatment of cardiac arrest in trauma patients follows the principles detailed in earlier chapters. The primary arrhythmia in adult traumatic cardiac arrest is pulseless electrical activity PEA and specific causes should be sought and treated. Paediatric traumatic arrests are usually due to hypoxia or neurological injury but in either case adequate ventilation is particularly important in the management of these patients. Receiving the patient Management of the trauma patient in hospital should begin with a clear and concise handover from the ambulance crew who should give a summary of the incident the mechanism of injury the clinical .
