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A@HHDIM CKaH NPeAHOSHAveH AMUIb ANA : 1. pycckHx nonbaoeaTenes- Bpatien H yueHbX, B OcoGeHHOCTH 2, BECIMATHOTO pacnpocrpaterna ‘CKaHMPOBaHO NOTOM 1 KPOBbIO MYCAHR oF gponr-py; & i ee PREFACE PREFACE ‘The Trauma Mera eget were o a rend ket refer forall Peet ptt As nahn he Sprel Seren te fe a fee ane mes chet enti habe he eve re Uni caer taerch Hen Manel wich es guliabed i 164, The cope rd Tre ne Te Manual hae bor expended aida oeing c= aa sarin crtent erature sod he enterive cna agente othe ‘Benin toy hatshore aoe thon lt eery ost. hia une four ey wo cs eeverlyprevenind Pw chor nd eequeta te aes Mace care fer pu Pe retin ef tothe iy ee Seen meee cma rent and sverd cyt hi bak A pci resets Geyer are the ers pen town The apprcach the Se ec rng the nial rence exaace vo he recomendtins Er et ean Le Supper Curae team sport toremeciaon Ie ae a etdorite o onSelean nnd recut ote rue patie BOREAS end mechanic finn ave peered The oanarere of se agen aly 24 ce mi nea car a nd epi rte the cee ete ner capes. Appeals aut Arg Gea ies Sele aod ements ere ae equates, Ft acre iecrted numer gues to detail spe sree, proce ne ee ic hove attemgted wba Ue cntent ef Me Douro Mane cus terre We hep tat them sncepls previde nto ab tery Fale tothe manaperent ofthe tourna pan se being te iva seas of JoAnn Kavala, wo formated can epniaed Phe Traum Monae. Andras B. tman MD, PACS Mia hd MD FRCS ita Schenk, MD, FACS ‘Bonaldo MD, PACEP= ena w Hexaft-novsepon MYER 2 dour py == alee ee The Trauma Manual ‘Androw B.Peiteman, MD, FACS Priewor ef zp Diner oTrau and Suri! Cet! Care Unewsiy ef itabar eden! Center Plata, Pennevenia Michael Rhodes MD, FACS Profesor ef Suse ‘Toman eflrsen Unverty (Chairman, Depart of Supers (Chratons Care Heath Serine Wane, Bele ian Shwe, 24D, PACS Pele of Spry ‘Gone Dron of Trouratlgy and Serezal Crea Care {Univer of Teomeyivania Medal Corer Plaats, Peoseytania Donald M. Yeas: MD, FACEP- ‘weiateProfloner td Vie Chair ‘eportment ef Bmerseney Maine (nine of Pabungh Medal Center Pichu, Tenseytania r Lippincott RavenAogustons itor Hlabeth Greenspan ‘Developmental Esto Suan Niger Manufbtarigg Manager: Dernia'Roton Siperising Etter Kim Sea Prado Servi: Tethok Writers Assia, tndner che Leo Conger Lippnest- Raven Fletonic Predcten ‘riter 1 Domnall Crore fopyrght No'part ef may be reproduce teed im mvtrieval teen ‘ned ay tr r by any mere —eleteni terial eosin ‘resterniee”guthas the per writan corset tthe publisher exept ‘uotiens cme in erital are and renews fer efron re pe ‘Bee Haweublnherss B87 Pant Wasngion Square) Phiadlphisy PA ‘ater appearing i this bck prepared by individual a pat of thr il diet 8 Crnermentenplyeer stl evre byte abe enone eo Print inthe United State of Ari Library f Congress Catalogingin-Publication Data ‘Thera manuel editor, Anew Petra et Tpghes lgraphical referent and inde, ISBN ostewee 1 "TraumetloeyHondtck, manvala ot 2. Wed st inriee Hendina, eis te. Sango enrjenceeHandbeksy ‘aie Pema Arce TONES 1 Wounds td ijuriee—tardhecks. 2. Erageney Macine— tapabeoks 8 Tnstelagybandheaks WO 59 77 Ieee bose 1666 frtaaett DNiAWIe (bey of Congrene orgies Care en taken to ete the acursey ef te infrmation peed and to ‘cee eel aed rat ev te bra no ahr ‘ret rej er errs emis cr or any concent om pation ‘ofthe aforation tm the eck and eke warranty eugrss or hgh, wh ‘Repetto the contr fe usin “Th others ctor and pub have exerted evry flr to nur that dag teteton anddoage st eth the ets inetd with corte een ‘Eons wn prac at Ue se of putation However iw fener emnrthy ‘Shauuce ln government repuatons nd the cna fa frat ating to ‘ap therapy nol rg rnctira the reder surged to hak page et fo ‘ich Gr fr any change rs ndcatens nd congealed Cares al pr {tuts This portelalyimgartan when the scommended agent sn oF Inleuenly employe ra ‘Some dg and pedal eves proente in thi ubiestin ave Food and Dr ‘Aine (FDA) dearane fr miedo in etd car eta. ie repnity ofthe bean sare provider tosoertain Une FDA stat cach ‘gerd planned fort nti chal pie : i i i i i i ‘To the peep within our trauma systems who provide care to the trauma patent to the residents and ellos wo motivate us and 0 our wives And children who give meaning 0 what we doCea Renete-sonsepcite MRT se dpowespy 3o= _—__—— ‘CONTENTS gonrenrs Ccontbuting Authors Foreword hy Ral D. Stewart Foreword by Dealt Trankey 1 troduction to Tue Care Miia! D. Gresser 2K Pattee of Blut ry ‘Tiethy Bar ao Ace Pita, {28 Mechanism of inj Penetrating rua 1 Christopher DiGiacomo 3. The Physiologic Response to nkry Brian G Hasbrecht 4 sone hae DPaequale 5 Measurement of jury Severity ‘Theodere R Delridge 6 Prenosptal Tage end Traumatic Arest Ronald N Rath and Vincent. Beweso Se 7 Proposal Tmerapy ‘Kathy J. Rincet and Kevin 8. Toke 18 Rett Teams: Compostion, Dvection, and Gommunleston ‘the Treume Conor Owen rayne 2 Artest Transport Brie A Davie and chal Rhodes 10 tetmoeptl Transport eto Aloe Serra 11 Tea Te Action ‘Thode R Delridge 12 Orgortation Pir to Traum Paton iv Wiliam § HeTand Michael Rhodes 12 Trauma Resusctaton Michel Roden aA mn ‘Trauma Airaay Management age B kimi Kathy Wiener and aes W Krogh Mchae D Panu nd Niche! Rides raging of aura Patients Mehl P Fedele ‘aura Docursrtaton Miche! Res and Mark. Cielo eahosptl Taneport of Trauma Patios Sandra A Arold and Jesh N, Dist ‘operating Room Practice Michal Rhode ead nary Donald We Mason Injuries of he Spine! Cord and Spinal Column ‘Denald WMtaron ‘Trectnen of SotTiesve Wounds ofthe Face James ML Rusevage and Gary Paterson ‘ny Ort Mesdtactenjares eae aden aa Gary: Patton ptaiie injures ‘ardall 1. Beaty Penetrating Nock Woume Markt bse Blunt Heck njry ‘erate jay Males A. Powell Damian Mahan, and Andrew Batman ‘Abomine! nury Darrell € Boone aod Andrew Pitman ‘Ancona! Vaca ry Michal B, Shape Damige Control Michael Reto _Abdominl Compernent Syndrome ‘Mariya Borst an Anthony 0. ier 13 ry we 228 208 8 £ aH Henabo-tonmepenn MYCRIB om gpown.By > 8 8 e Genitourinary injuries Michael Rose ‘onmopect njries Pal Froude and Boe Bian Michael Lit ene Gary 8 Gewon Hana Traume Stoven L Berar Ramos Ll and N. Abe Nat Compartment Syndrome kin MC Kane, -Rnabdomyotsis Joke ML Kane, Pepheral Vasu injures Toul Alason Darrel CBee, el Andrew B Poitzman Sote-isue juries Mihoe! Rhode Pores nthe ICU Care of the Adu Tawa Pationt Ssh BL Dab and Raye Bay _Arwstosi for the Trtumsa Patent mee W Kosh Pain Management in to Tau Ptint imety Cantos snd DonaléN.Yealy ypoherna, Cold nr, ae Drown Snel A Taber ‘Blood Tnetusion and Compllestions Heid 1 Frankel Nutiton Metaboli nthe Trauma Paton David J Powner ‘Support of he Potent Organ Donor Sean H Oct Bumstoalation fery onal R Keudor Pediatrie Traumascris Abus somes BL Lye Care of he Pregnant Traum Paton Anthony 6. deh, James Carica, Wii Shes ro as45 GoravicTaume Donald. Rouder 6 enabitation Lenin E Pane 47 Deep Vein Trombosisrophylanis Patrek Mel 40 rjur ProverionEpicomilogy sete H. Cake 4 Hovsestat Responsbities ‘50 Legal Eta, nc Fay suet: Support Services any Andersen, IT 51 Micotaneovs Procedures eal Rede pene ‘Axper: A: Org Foray W Andrew Kole eonan! .Finatay and Peter A DiMrio ‘oper: njry Seats ‘Append C: Commonly Used Ferrie and Values Anita .Courenlae ‘Appendix Tetons Prophyess Marilyn 3 Bort Appess :Frequenty Used Forme Subject naox a ae se o< exan w RewaRo-xonmepcns YVCRIE 9” fpone.py >= ee ‘CONTRIBUTING AUTHORS. Louis H Aloron, MO ee atten Unies of Petburgh, 497 Scie Halt, Pataburh, PA 156) Hector Alonso Stra, MO, MP, FACEP SEeett alone Chee Die of Bergen Medici, Emergency Modine a tern, Unter of Pert Ree Steed of Mec, Cacina Beieeny pte, PO Bor 980, Conlin, PR OO6d 38D Wary. Anerson MO Mesehaet Pres of Suro, Unies of Pnnaleaia Media Cntr, 9400 ‘Spree Src Phd, PA TOTO Senda A. Amo CAN NSH Ser arr Auer Unicery f Ptaburgh Maia Contr, 20 Lathrop ‘Sec Fis PEN, abr PA TOEES Rendall L Beaty, MO Retr Sheen or Knergeney Department ita Pres e Perse ts tas Lehron Stk, Unser of Ptburgh Mt Cote Plea, B 12218 StovenL Berard MO FB Pt rr erty tr, Sf lade PA Tamoty Rita, MO Men Perr of Seg Universo Pteburgh, 200 Lothrop Street, Pitre PA TESTS Dart. Boone, MD, FROSC Retna Profan of Surgery, Realy of Medicina, Dion of Surg, Menor tee eft 90 Prine Php Drie St slob’, Kec Sex, Gena Rib v6" uae Bost, MO ae et Sure! Coil Care Rl, University of Pitaburgh, A1O10 FU, Pidabargh tes Raye J. Buoy wD Fe a eral btnsce Care Uni, partment f Surers, The Wester Petula Hepa, 40 Prondehip Avena, Ptaburgh PA 16224 inert Coreos. UO saree rate Neier Prolong 800 Friendship Aten Pahang PA Ia224 ‘uae 0 Cpt ts, PO, MD Maing Rear Scions, Leioh Unicesity Amite Prefer of Surry Hae ie Uninerity, Amite Ceo Trane, Loh elle Heat 31770 Seth Cedar Crs osleverd Alta, PA 610 eteay Coben, MO, Set Fepeear a Bnerency Medicine and Public Heath, leshery Unitary ett entero rth Cor for Injury ewer ae Cone Sedat Pfs of Emergnay Medici, esstort Poem Health Servi Jeet: Unter of Ptabargh del Cnt, 80 Fan eth Aco, Prteurgh PA 15212Ata coro, 0, ete Sey, Uirdy Pure, 1 Fh ea, ite e200, Oy. ND ‘Aerotek CCM, Prion University Hest Sei tbh Fa a ——— ek Dav ie Prete of Emerson Mine, Unter echt, 601 Broad ‘rem, Bor 2000 Roca NY aes em ere oa Pfr of martes Hodis, Unter of Paurgh 290 M Face Suite 40 Paabergh Pees Oe Owing Dear ND ‘estat Proce Surry Dion of Treumetslg end Suet Cie Care, thirty ef eayeona:Piophisy BR 18 eee A tage, RPM, Se Parra Pe Nesters Poni Hep 40 Pity hen Ment Fei 0 rose Heo Unis f Pts Matic Center £00 Lat Str Pista Pa aged” "Oro Pte a Spor. Frewone Mo rman a Sefer Pfr fresh, Unive sent Neti ts Scie li Pang Pa a eh Scho a ra no tnt Prac of Sires, iivon of Tours, Sra Cal Car, Urea ef ena Sao Mart Sot Pepa ied ure tretonan Mo merci is mary Univer, Cle Meera Duin 9 Baten Siro, Ate a sean” tee Cle Mew ex epee, can 0 son of Corathraie Surer, Unset of Pabrgh Mati Cete, ro eae al Prabang PA 1618 _ S ir, Gresenan no ‘entnt Clad Prey, Unies of Naw Msc, Director of Trauma, Lavlce Ich Se 40 Cnn SE. Nba, a HOG ne Prin Depart ‘tas Pion Dprnen of Oohpat Surry Chi nf rt meine Creme of tty nel Cone 1010 Keun Bulding 9471 Ph feeb Purp, PA EAS Bran Hatt MD ‘Aslrd Prefser of urgry, Unvesy ofPtaburgh,DeSetot Ore Stet, ‘iti Unt Pann Ba Ts 8 Meek Pent OFara aa ot tending Tru Sargro, Aust Profesor f Surgery, Unies ‘mt Mate Cot 380 Spr Str Pada Bk fb Merk. Jteson 0 eaten Sarr, University of Centr 07 Seif Hl mem nen of Piteburgh Medel Cont, $07 Sei Hall, Conteiators wilt Jon are rumen ef Surges, Unvarsiy f Ptaburgh 27 Sei Hall Puicorsh PA 10861 Sernae ent ren 1 ciel Cor ie Dona Pe ino Tea an Serie Cita Cre ‘AetePrer acrty of Pemaycema Medal Cer 980 Maret Siar Phaipe, PA 18108 TM Aecre Co iran Deartent of Arsthai, Wet Vii University Oba 4 Mergen, 2908 py > James WK. MO mes Se aul Anse, Prater Unive etl Mea hangh id Lahey Set C20, abr P1218 ae ee Siento Ar re, RAF Lobe UK, ‘epi (PSC Box S818 APO AB Goee4 sn Us MO Fen tte Seno, Unerty of Pitta, et James Me Lyn MD ret Peinrc Supers Director, Berd Pots Troe, Fn lef Mbrgh 706 PO hom, Pur PA Breer, Chios Hana ef Ps 3706 FWD ‘ona Mrion, MO, MS, FACS a ant of Neurepl Surery Diet, Bran rsa Reed ‘Ageia 0 Lar Sr, B40, iar, PA E218 407 Sexe Hell, Ptsburgh, PA o-€ exai w emane-nounepenn MYCRIL st apt. aan a oe, Coneron Hep, Unieraty of dnc Sire aerate Vinca sesso MD _— ree eee Brn Medicine, Univesity of Pada BeeIee oc Ste al Pabargh P1828 ann ea Susy, erst of Pte, 07 Sai ll, ‘crgh Pa e861 ‘Aso Pre of Serger Une of Kec honder Maia! Cntr, ‘atte Sr crs C2, Lennar a6 04 evn Tee Perency Men, Universi of Ptabroh See of einem Stein Se, Pgh P13 ces 0. Pasquale MO eee Me thigh Unter At Pore of Sure, Fe icra Cnet roam SCC Lich ely Ppt 1210 ‘BD? Cer Gat BtcodAllncn P 8108 cary. Paterson, MD er ner Divi of Plant Meri Sway Fie et Epa of Md 3650 Tre tr, 2 Seat Hal Pinburgh Pa ae‘iv Contributors feceon 8. Feteran ua, ‘efenar of Surry arco of Trauma Series, Unser of itaburgh Medic! Clee ttObUT Poaburgh PA 1ST? homes: tout Pen, MO ‘Attar Pretref Orthpatic Surgery, Chie Dion f Piel Modine and ‘ehattuaaon Unitas of Pittargh SEM fh Aces Bus 0, sung mrs Malssa& Powel uD [Asistant Profs if Surgery Uncraty of South Flr, Ty Geer ‘spt, rere Center fen BO. BH Top, P60? Davi Powne MO Proc, Diyarinent of Anxisiceg/CCM ending, Ulery of Push, 846 Soe all Petar, PA Tose cnet Rods. WO, FACS Prtewer ef Sues, These University, Charman, Deparment ef Surers Craton Care Sree 40745 Ot Sten Raed Site 28 Nawork DE rats Pat Rll MD ean Prof f Sera, Universi of Fon lenia Mie Contr, 640 Ark Stet Fe For Pepa PX 108 tm a Insti of Brgy Modine, Department of Surges ison of Emergency Matcve Univer of haa Souder Perblend Memorial Heel, Terr Hines Botan, Dalton 13 1558 fen em uo 7 ‘ett Prof ef Breen Malic, Unser of Petabrgh Matic! Code, io Neve Plce te, Psbrgh,f o813 Meee. etonde, MO. FACS, ‘Asset Potro Super Dion of rus end Suri! Cra Care Gira Poweshena Nalal Cone th ond Sra Sr Pipi, James Russvoge, MO, OND ‘Amciate Pots ef Plas aed Haconstrutive Sarge, Universo Psbrgh, re St Ha Patan PTs? “ ‘clam Sera Mo, FACS Suc ral Ce imcray oR al Ca Ps Ce Ft Fn 30 Moret Sa, Patpte, FA TO104 Michel 8.Shapra MO ‘er roof Sr Ueto Pmnashana Mata Cet 00 Sane A Tabermen ‘Ascot Pre, Dit of Suey cri eth /CCM, Univesity ‘ish, O66 Sct at Pgh Pa TIS 7” ren tyr Mo ony eal Briel: Urry Pag Cote fr Brees Medicine, 230 McKee Place, Suite 400, Pittsburgh, PA 15213 Aetnony 0, Udon MO ‘Aart Pere Serger, Users of Piebrgh 971 ith venue, Ste Soa Peturgh Fase ees o-¢ we nn sponse per | Emerwency Medicine, Ra angela COM, Meine a Bre At Pah Lap Sire, taarh P18 Donal Ye MO FACEP — fe MO ACE pga ef rere Maing er ho tM Ps Sut er Sotaan Poa Sure rey of Ptr a Tae Department of Orarae Sure Lateral a it ah eon, Sut Te Paty PA 188 Seay ee yg Univer fsa Se ee atic ond Reet Sage FS i 0 ere Sire, atta PA E86“The sdvot farther teat in the important fl tuna sare should pram & rae craton the motives etre and tata, ht experienc nh $8i"Sod ther intettore in croting sucha wor Te rts eA be wep tear at measures the remts of nepal agate the send hae pr leo mt ben corm tern ena ‘Saeco ny manual outlining tho cing ere fe injured patent sel be «a aakeetS a Jt the futons of trauma core Recoil of the mul eee ae acd bea a emma cart fom prevention to ebaitin see eiere weamurernni ad he bare pep of teen aporck” rk ievvoen inate fe of de ah inten cy ee te le oe TURP! and ete tem andthe ee that ty fave ase to ‘npn he rou Meal Retna! reac we cn expect much rom thir fre Theta and author here ropmeet yun an! sirnt eae elintone who hae ber, etrenta eae eenaty the deton and pontine at an waco tran ce Fee ee ne whe psc ere aed ders and dreamer wh TaRy ea ecerd i the resect tal othe pel a eedage eft cmprchenste bt sorcc trurae mama conceived end tase up te gue! so made esr th pst daca he anager of nun th peken hour’‘Te tam azole ty the eto ha ben eee, ‘Blu Seis on vepresctingCinanne who Beth do and each rom began ‘the pacophy o's rte apread to the management of rue ae ie ‘Bbotene ef a cient yo caring ters apprach ar ever fae this ork ‘errant ven to te racgitom of ftteree of tpry ucts the cic ‘aprinc ofthe are of tbr ae ds the rpatzed agora to ios aa ‘eip'eciagemee All ue yesanced sip! hckground cf ape orto, Naess Ant aia conte Th prominence rd to peheal sey atSe i estima tte cad th iw and experi oe {5nd von eurent hanking sv Us ierncngy recon a cre, The etl Supt date review of ain meager roland fy Spec ef seri ited pata cial coe and rehabatnn arash rea Fite Teumo Monet and it wae wo cnc and stent aie Pet Mien aa iientions The euino Manuel rect throu & ct cadens ond nae ital levee of training ad expences. De Fre, Mansa demenctetes an ects fle thet iting fr the paca ‘ite dcp ote. eno sal echverert by er ‘Wb eur ots vnluc ef toning manual ithe achiserent of balance een Searuy an pteiy abe heat he sence of el ae, ‘hen te work valuable noo? tao evoke frm tudonts and eli ad thee er en the at cr autor at a see ya RU itfend ean sh nthe trams entero os the hin nasal iia thi testa ed with gt on ho ds ef the acai cr te ee (eet year ert fn the ate might hour 3 fa ih on cal nol D. Stewart, OC 8A Bux, MD, FRCDC FACE, Due Preser fBrergeny Medes nh Cima Heath on demos Dashouse insert Hai. Nove Sn, Cone “ind Adjunct Pfr Eergnny Medicine "Cnet of tober Phtabgh, Posen -¢ eka RenaBe-nownepenn MYCREM <0 apc bY >: 5 e 5 4 i i a a FOREWORD FOREWORD i woman spots fen et sunita eR ae aaa Sates ie cr ee ern Ste oer Cec arena e tri dec Spe nthe aetna adie gence sa gael Seneca mae ie velar Mi tae Mocacmdetrama ee ogni eke erate cae wt he hte rece se raed tenia Sievert nation Doral Tani, MD PACS “Frese and Chetan "parent of Surg ego Heath Stents Chive ‘Retard, Omenn-6 ena H emaBe-nonBepene YYCAHE 98 dpowe.py >-= ‘TWwTRODUGTION TO TRAUMA CARE ichae! D. Grossman ‘trauma ca be din terme tinny evar eh pee a threat 2 ie eae eae efi fet eed or mmta interven crane 2 8 cee rere rum care od trauma ions ty phi hasbeen eect |. Epidemiology The Scope of Taume as «Problem nthe United Sas Fre rion o dete rom rua rer fh oraren of reser men funn fie Fg 1) The hve peak of eth le eli cay and It, rit dh acne eee Fea ngrctraim trey. and marcato a eStart ut of hc potent ae weal ota ga eth ce an the fet fw ars Br tes Cm cena cette mon ary dain tetale tp mer Garin denser rapide hor lowing uur ees um cna HS RSET fe ete rpsene 0% fal i mpl eae fe see et fae so ees ant fer toa oe ‘ea erie ilnse, loweversadeguste a reunion oF ar Fipsewe the lina development as ie oes rns pic health robles the United Ste onde rea cag como reverb death persons wd! te ace eae nist pe Wht ina ont Teint ncor vei eases are tho leading cae wntntinal ce ated death fra US tens between Om sera of 3 sa .00 gel dn sary for tor weird 25S, Ma Ehao ome homie ents, However or the fart 30 ‘eis eden ome ort ESE SS Eat atnentn oremeve sued Ser te ed eel drier, ned epaic or sale vehi Tieton of ft pevetin regen on parody erat saree sarge ect Pegs, and inti ot ese haere en acho bby walls. 2. Buin elated Inoninthe Home are declining emer Pamy terme ef the viene eof elety vies rh m= ie Free Rime 00 cals ahs oeured nthe United Staten ‘Eat cence ight in bun areas. The serv rr ee MMe tectinpemaoenseliy nn aiarement Me A re aged fr preseeton incae thee who emake Pgh rah ee fel ile bd Eff edie these 7 i ca ite eeepc of fame rsa thing and SEGUE Ria securing oct oon the ere ery naling Tis hedets can bs tertile ‘Sopa he rm ca oly be proven by agente efit tp dasa al prox heron he tr nay he prevestad 1mocsed tom Scaniic American il 400 350 300 250 200 150 NUMBER OF DEATHS 100 50 (Hours) TIME AFTER INJURY Fo. 14. Te ima ition of sth fe jus ed with prin fen ‘Reokey Dh Tears Seni een wl ae Ne 3 haat tay ets a pretation aso on erin of len cme ata tie ‘Sie ard rok Some me shi cess sed brea {i ineadad‘weder this hence be tetera tema he ‘rite tse to ured by inrpemanal lens orrenty et ft Gere fear calls are unintentional fo abet 96 of aoe ‘early ft ole det doe nena en cen the rear asi shy ae ta flare Hon te Fon Se 2rd Geer ste death nd ny has rap incensed {ew Seats it span moter wehcercnos See he Ieeaing cause of jury and Seth tthe Uned Sten sew tree fs en sc int eof ear eke tena Fete teat an 15 yens doy te os dene 'Wlener frei ct alatiey an me te eft In Amer Seton arpa pee dite ws ripple cue ‘gees ths pe heat eare ake Caron lees ate on¢ ena H emaBe-ronsepenn YOCAHE 98 Gpewt.py >-= Inirodeton to Prana Care 3 fete ler fs por smear and Ik f'n Emus i he ting ene f abi ft Ua Sten nately 0 ice jars eer per et hal egg od {Ge stent OF thw naping med een, ey ere ‘Rac Tor rene einen Aimee 20 of pred eu ti gnin sone eyes ay a ‘Ekzdxtreuty eure nat erage Iain per Mi newlogipairene feta 000 Arson pr eae 0. Thoma! flan the Une State estrone Cot site pend remy cl te et eeomates of thee of ebwulrtvun thet ace, €7-$80 ton enn. Grea! te of gunhot Ment tt sea 112 talon pr ger “TBesownuc tein af rong numer rom a ect stand ‘roman eevee nee tre enter an fe ec Since mtd cone)" sns edentaces te tot of Nig ‘Si afer fect te clatter 1 The Roni or Stcying Trauma Pallets the Cina Sting ime aunty inure eau ptt ponents complex crea ehalenge to Ie signa thes thing bed olde tay, yt resect nine bay ise ele STi sod ste tetare x engeo, ll armies” esting ‘that te cae the jared ithe beet wey to ara mie itary experience rai fr my surerns andi te hi {esa doce eur suet rade rua Sete Career 1Setascal pine have evlvd ue tatleeldexpenene Fema of he bevery aed Peqeney a re. 2 Severly ued tema patos sre hailing they ave mle rls each eestng the ether Theve ule pode rena Endatieg somo eae toe teaching yest ergy SEPRHLAE A determining oer tee patent naongerest. ‘eventing thse ptire ogee «bred unr of asetery, Tibbits ef ack, pera nd parma a the sur (clistepecois ts Bash patents on fave leah interive cero unit ACU) aay Som Sade fire sara cordon aed compe Cita care of tec patios “iho” an earn hat ‘cota hee patent are goa ew el shane feta toa nr nd producti 1M. The Raton or Shucyin Trauma no Laborstory shui oyeensenflsmmatry repos spre (SIS) ate oortant iphone ei ye me fneton and dysfunction secondary Were ijur ad sheck 2 Bled tanta tt Bd subtte 3. Pathonhyiloy sat ens of HIS ng acute epetany de ‘eau syncrai (ARDS) os 5 Duhophystey fbn ryan oil of eer eer ‘ruin Systems ‘sae os nao! healt pobimn best deat wih ty dhe ovloent a Senta uta Rv ere cya hatin qual near of patients in eth orb and rural erwienments 2. Reduco death and isility2 Crate amar continu an aon ane a rehabilitation 4 Proide'a mechan fr continous qual improvereet othe F- + ig Sgn etn i et Injury and tomy ecur wih varying pore ly pce pop foie 2 Een dgeirtlcncer i ee i esa Eee (Hone septa eal Sern Ste et ees aca i sp eis ae toi by enh {ic nyred pleat Suc eepondr pre bate suppor LS) ‘Frost etblshitanens 1 ae aor pharma pcan and gern, cer splot erp tere ‘ec eeucs are done scr teabled prc or nd fagordre dred by eda ovina ES cena ay ctl ty te pan eee fre The well corsa ey oy be acted Rp ‘tourney departs andy be admin by (seat ‘ith eppreved praetor staning order “a Riage decrees scent of to mec by part, ‘yet comumstancs urandig the thchanir of ry td ‘Westin aps populations’ ctremen ge and pew ‘'nynicam sorted wedded, nd Gets Une Nahe esate ham iene ay sual 1 maneprt of thee ccaly jue patents sy the most expats tnt icant mens oe a ve ‘bared wo tne tn dietance cxmidrations pate tai, and feulale skis uf the chp presdcr Bechprnd’ ed ane ieualy herp moe oe ale 8. Acute howpitl ewe ‘T'Specationdcrprtnsie sete cre frit clle "ema cetera? ie desgated sting to ental eter ‘2 Speed perrl ders nl 28 tear ay {Q) Serger with pea sls to Went jd pants 2) Operating rat, svete, Hood tanks mpd tages ple (CT) senna ft ) Bruen plane ) rompay kalatle thin minster: reurmurcane,othope ‘Seeurpons and oer utp and mia peste (6) Continuous prtrmance teprovenent (CEI) prea te [pied wih compnenta fhe tauren ys (6) Evroitid dicated phyacinn, nurse nod niintrtve ‘ends firth toute prog 2 Each turn eter tw eo rte tar ciation stm which eopands te petro! age eters tat gl ot Ue pues ‘Spt have sore ijt an ensure th thy ste ety == Introduction to Tesuma Core 6 teau fe dvs o the tenant have defied rls nd evr Rd mun mean ac, with eerie ‘hens and tetient pc nese Creag om ny a ; 2, Ali nil seeps erp aly ha continua et ‘Stes tofetitatestuperitn ad febatataton ote tru pet iy ad ctrl erg it rk, nd ie 4 ah ep ae esha i ce or erating its prfasonale ‘teat tres cere Thsroco's ned fr eatin ‘The tou sytem ovate tai tho cme ui ©. Longer eae ane enantio PR sede le tempat rebttatin oracle care to ose sect nats te term rere ein as. 1 Regions 8 tect ystens av the tnt neue preeia povder agence and espa 15. ie replica in hat they wt determine New resourses ¢. They mat Sn ellowing ein te TL cureap medical cl, economia, pleat wsualy cated within a end matory each e Depart of Hlth 2 Cannas eter deveyment ad lense forthe tur 4 Legato: ine at nacre that the troupe sete fuesone a Tenia rt ofthe Eergency Bec! Service Str (IS), Bo ‘he's Lp corre totem to manage al epects O10 4. Fince llostion fyb unde) SRR ey eet iran og ce fot natal ru Tern F, Cnmonation (911, comunietion stems ace to eytom) Cia ee ened ty nee ect Tovew orpaniztonn ting cabled nations) eoielines ei, “Kmarioas Calle of Surpron Onl ors evi to ure capianee with equierents fr decgatan and neritic «.Gurnination wither met empoents to gure tho met of ‘savored pnt2A, PATTERNS OF BLUNT INJURY “Tint i iar and Andrew 8, Peteman Mechania of wry ‘Truna ton fry Oat fe there of pation of cay within te vin, ‘lg fo pence un can ny age een hah ‘ieee f the jr tod the ame fee iat Su ape pine expr na ene of rasta icine pers of iy ema sua ithe parce mechs oir become apparent eel oie pre ‘sci rm th ch soe the hues the rer ici al eee Pre Inge wl Soe vse are ound nh ptr jy Bt Yer [a pectin ital vow consondoel Hp erm vee {ion tent sh ion wile ten une esd penceang of Bu tau en tr wile cath, matory ty, patron vance 1A Ovcrace hal sf este fom pnintntinal eves red to met vehicle cen 1 Natl se bf ln hens rd er than 8. Gent rk of signet injury i whan te vis evapo dal ory aber by the vita O's poeeranaut, Male seen i ction tes the etic). 1 Chef major nary nereace 300% 1 SO fn 8 ah with tin, 2 Ral fein caus in 1 tn gael en ve Injures ae predued by rai desteae in eaaty over tort distance, Negi fine depend n vera vec change at varying neler tthe that een Garin heer A. Moar hie cnr ines tee part collin 1k itr vebic impact scar st tha ms ore spi othe visti, 1. Vn srw inte porate car Si dees verte eopgorng tractates of the bd ‘ Detrmeton cu by deeleraten cveer eet verent of ‘had wus sanaed prt nes shearing uy toe ao ee tonof thie 1 pect ors ofthe colicin Ie Steines by ‘Rilo ote ores 1. Detrmisd in party aren of ppt Duration of epptetion: sere ne clei one nee pect ores cute deerme within the vicinity tae tet Ina sher and camper Isr cm on orga exe i era de ‘pte eure ea pin) 1 Face fe cruh doting covery ory 2 Tory ek erly ratte and weight ar 8 Location o atm nine ear, inury pttern tary bacon nt sat vermu asst ve es CANE 98 Qpown.by >= o-< cna 1 SeaaBe- renee Patarns of Bt Injury 7 Type ot ra: tontlinpet tera Imps (Fn) rar Inpoct, rollover, eee 0, Useandtyp cl restraint devices Reet dvi re eines ween cor recy Wht etsine deena npopriy pled, injures ae dud its pgen scene ee re Mie rie eqpiy winctentcalnong Sn » Rarer ae tae emmen ‘SP Rel lenge ta Tine ci ince ier Fig, 2h. Creo fracture el injury Reprinted with perminion fos ‘Chistmnen Nl tr sa waco i aoa Prank DD Touma ‘managment oboe rouma, New Yok The, 682152)‘Tho Truma Manust » Lepbtinjutes nts wal ptr tases, clon ‘erotin mentee tgum shoud tort torres a) Chance rater othe hubs ope, (a) Fis sal towel tury approaches 20% in x patent with Chane nti fhe Raut sie 2 Stour bot ures fs ano ‘te, sucltien ere wrvalarercs Te sour Bal Penne gent ce fee San a et Seen mean cme eran {br mr etre, dtl ower extra eatee 39) ee Aad ij cori sic avr het recurs rulrery Sepa, vn rat, a aera open Ware of F Unsataine ont st passengers in frontal erates inp, the win ‘ind ducboar cr foe tard I cntast othe oveten! eines ‘teri wheal prsets fara upward station nthe tossed acenge Cras atl inet ecm neti as agers thn in vere thermic jury ire cnn we tr ‘entra sleds "ater rane repartee oe ener! ernie, exe tne jure rather the the ‘rleen Fg. 242. Uorvtrsned diver (Mode tum Rich NM, Specer FC: Vanulor ‘Downe Pudge WB Saunders 1730 oe cham ematooronepove MERE 7 GpoanenY o= ewe an poms eters of lon Inuey 6 6. Unrestraned reersat passengers ve tho sme rk fin a hae of ssa ts er Reel) BF cra injury pacing rahe ae rar impacts 2 Carn ijry ipl ry fe te ne on extent ad ese TPAD eet ahr cach nhac nro to the meta 0 2. Kine cnn of nar iofe sited over ng tance, wih ny ‘isunise ry tthe cecipat arly th van «. pedoatiorautomobie impo i 283) Fg. 289, Pudtrnnntintila iat (© Bayo Celle of Mati 1986 Mu ‘5 fs Flsano BN More BE, Noe Ke Burs, See Agony 0 LN, ‘sees4. Might tli, leery acd by in unprotetad pedetian. 2 Sever of Injuries depen on sche oped an aati grt tt ci oth we oa 5 Adult ures comment ince ts iba ractres, thoracic ond ‘haem nts em tora act ih the eae eae Se “Z”Gencralysytient wth erent of Weds td {ote Bb femur frectre rei eon ry ecm gc tnt at le mod te Aiur ted eb etre inthe Ler les by tec gsi conta he ‘then ru under or tee oversea spect ont see FORCE TRANSMITTED. TOVERTEBRAE COMPRESSION = FRACTURE Sy FORCE TRANSMITS UP THE SKELETON FULL WEIGHT OF BODY TANDS ON HEELS: FALLS WHERE VICTIM TANDS ON HIS FEET ‘OFTEN FRACTURES THE COMBAR SPINE 4 Fig 284, Ij gute fo fle. epi wih perme (om ‘cal a) Bene aur fe spr Pete Hal 1868) --= Patterns of Blane Injury 11 rr un tor ht can hat tice jen trea epee rt the sat ea Fleet Canal njres aowunt we 7 etree death ak thet nips ht er Se Fae (iets ar sen ope orstvere wth gh ik bt oe 1 rans al ar esunnt pen dels wth arnt ae a {rear gut on ote The very young aod th elderly end ta IRE tse eldry fl wl ingen the Bowes ela (ral nec rte, hee wd ria pine mre rire cae ale dps om tare fal ure ruc and 2 Fee etc he psc of the tin weet ime tao On ppc, Kinet ergy in oigatd throughout the etn a ‘dacs of ae ein oR ew gi he tin toe) oie ‘rc try coer 1G) tase arr oer sorter ine icrzaes magnitude of ny 3 Fitts eure ernie every fury tena fied Testi nd tracer of ovary Yo the by oneree seu eat 13. Flt are common in eon unr 5 years of age Hed she hee ‘cou part ad tenet pon re. 4 Binet eat mae Rove a vee ifr pater Fg 280, ‘sy tle thsret wt ptr of rts that ince ‘eel fizctun lgwer extent tures hp fates sol weal ‘four ini the pin age rcture al wrens Whey {hey li the dp, te ejrien re predictable en ‘ictal rela tron, hid acd wrt fctures ad abdominal {nee veal sen arena ty 1M Asam fist bac et 09) ip aks ervey et ni tint 2 cap ngrtant in predicting covery ofan eogrpty er satan oi mine Coe Eo Da eros. Cae AM a Tater hg pet pet tari Ko Tone veld seupanta J Douna 2:8 158, Filling BV. Wal RO tee of nr i Neo EE Matton KI, Fbiae DY de, Tan: Norv Apple Linge, 1S88A1-6 sktsun i Yrge Corer ee eri trvtcenjice to ptints who “elfen and onthe nt Arve Bere Med AGT, 18 faye Riponate eri rab Ml Ky Ceeland HC, Sats GO, With OC a Advan fo trom, Chae: Yerba Meceal Poser, yer a‘28, MECHANISHES OF INJURY: PENETRATING TRAUMA 1 Christopher DiGiacomo hie tat penetrate the hurts body lnc, iar dt cont a. ‘Testers dkeusre are sed co wounding intruneit or weap wound Fe, ‘tae nce, ad dae of tse jar ARS ee eta tht phe ten be fara ith weapon ane tal, azn ef he Batre ay td ‘Batagemant of thee wounded structure are cen important. nes penatiting ip, jetory deiermination defines ona ry | Gunshot Wounds 1X Batiste, Panties sry dated ithe scene of metion of poder xo fled stjet in phe Hever in cotemparary ado fe ee 1 ‘eam the dy mundi of the buen a apn me mi of uous dae le habe onthe hinteenerg ofthe pret Staecteris of te tout denny lati) and ha Wa ney Sifted to tsin isan The eding peril of ne cn be Stood by tho cmt prune the wed pf Pg 2H ‘i! Peranent eo The permanent eit the mie tet ell re ‘tad tthe pce st ave thea the Thi erent {ie Incling nye dlr and fngmentaion ne pete ‘Reformation y Elastic Properties th Ts (3) |} pens eg \ aia po ae pe aaa rea Fe Sica {eile aces tht the tana, the permanent yi cene by rash. Toe ‘Seiad’ ral mound the pervuanent sty by necshing fw eureunding {un 2This ati pogety ofr Ge tc n les the wrporsy eas 3 ‘this eeu crongcnds Modid rom Mun NE: Blt tn au aoa a) Teteh of entting tena. Paes Wiha & Wi --= ©. Gun types “Table 21 Corpo Mechanisms of Ter: Pnctrating True 13 2 Tenpory coy. Masa bre len of i vy lle ‘kh da use ery oro ine see ola alc neue oe ‘tan stching facta ef tho rnd catty tho a, {eleeance to sretch, ad rat fener dit 1. Gabor Diametr oth bute gn rel, dengan hundedthe ‘an seh elle clr gerade ot crest skin ary ‘tone cnble 91 4. Mz veloc lect ofthe patie it eves the eur bare ESS fae enya =n ky tid, govern sgproniates the web of bullet hen ‘ears ft eae over popled precio ae general tele te'medir velcy’ mat Narapure ahd high velo eet ile) Fiabe «Fight eerotertis, Yow Devote ofthe ental sie ofthe ult fa ele of {agus sense yang win the tac the ene SG Mere nash te rte gh. ae Sie ad ht sa when 'b. Tumbling Rotation end over end through 180 which paint the 6 Ingtoal the wight se ef projects he of trast i fu ein at mel vost Sl chang In rte ety ‘nut nln cage in inc oncty ard hroe pant tacue Hendguns There se tw gener cater, Revolvers ave ciel Adtmotnidenrtngee Pitts ave lip at debe erg inte {2 22 car Lae mute vey Tru ie irae by dc rhe iSgerd'n gretuct whee th belt tatling sds ogersy csviaten nope ult weight ely, ie ener ad ay WipheVelooty KE Max. tengorary Contest (Grane) Um) Gulesy Cay em 126 Shtgun 4 sot (2 piles! © 10 20 126 Shotgun Ried Sag suo 10 162 am paco-sas0 170-280 2 1410-1000 110-140, a Mes 401 crossbows Chl ual hating Geese alt ice we rs gh ii hash 14. ‘The Trou Mat 38 spect rover. Conn revolver Produce met fe nse ‘etrectin Oy et ervshng sal npr et eccury t Sel arent ol op «Simm pia orale ican et Semindane atin ‘ites nn rapid ing of coguecl rund as pte op ‘n‘rcreneedmurmber f bullet wns or patente npr eae Wet dl sro Sa et Tanprtrporay evan, ering in tet iyi ne la. 6.35 conor ptt. Fumes mary edo arm. Largo bullet predasce tee decractios by tree ereshig 357 hogan.‘ tors toner refer othe ein of et ‘ayeener the cargo hablo inernne mul eet sie te tht ene eae aan {Eran set endewn bonis othe need Sor ens sreneth to ei te lrg capo on Long gu 2 Shotg. The sag ic ly og un tht fie mule poe ‘ctl tat cast al oun ls The song ean te ‘forte 8-10 tuned fv andre slid lg rer sag Sat fn puerate eerie ey tthe range of agh eo Std ery sesh he energy the set pls dips ‘anil tare Stace ecreane AL rare se the 1218 a aly tre sd hh gly ie wp ith ‘ent of shun dll curing, tel wing ar cari ao ‘smite th wad. Mont ea detract fo temporary cv ‘Eaton cere within 910. to sso, with dapat nary the reat ofa crac by the ples ened » io: Usui fee ner el wth cath ter pl ws Preecunanty for sport lt ult Ye fos ifs Call to @ Fer eke range praiingteporary cites an rh larger thm he peti ol jury he Seeing ef ee tp tae tnnperety tity tent tein natn 610 eof tae "ph and ay toe ie nn alan cm ented tm ep ‘a gus a pele on. Used ema fr pct sd ‘Folin cron tope tr ce, these weg Cn gerne sie ‘lots Separate hn pectic can poste eps Sih Sahin ater mee (3) Proumate Ae manually pumped ie tho prsere canbe. ‘When the eer pled capes ut th tral prepa hepatic Produce aleve oO 20 ee (2) Spring Wen tare i pul he spring vex a tn it femnpectr they roduee wel eos 8-0 mae. (2) Garson did earvidge. Corian Dir dente the patn She ope et to rt ty. ten oe TH Bt aly wade pres Wee 85 eran ) Pets 017 cite Cyndi icy o 6-8. me leven neva, etd koa meget MOCARL ot pcr py Do= one xan w Renate Mechanism of Injury: Penetrating Tran 15 Bowe. Archery an hunting tows een gerarte nro ets in ange of 7 te Arr ene na pie [edge lt erpe vere hig). Trew nan iyo 1v KSpamcdl ray ures fl ono pring lt los (ted en metiunryo peut tase une pao det p= ‘Sibyl and snl be removed te operating room ender “ec on oer oooh deta he weund act Con coined fy un ecru fen the flor by soenday inure renin fn Syme nde or sintioe! te ote kn et ‘ring tenner Ste wound, “Hand div” weapon cha nvr, else pik nd 29 Te Sia ype st are le volt feetratons with the ile pin pring ‘ewhde na ucucs dee My ve cy a i akin moun Bt fhe Sere ea tre eho eet ee 1, Sinan ype tow knee tro Tyealy ne aerate olny he fevedet Vd tend to sling cory wove irepectin of wound ab ©. knpement type enon acualypged into vet lang ng aif ade, ‘iuhrgin a in puncture moe urksown dcp Wm sie {Sp ope a wenpn test coraste to depth of wou or wou ree {2} frente sata wore prenie a)wtb car F WSpenc tl te veto aol ete retnet ity shoul et ‘pone stp nthe pertng rt, 1, The #2 otal ee isnt mounds primary coud by diet ary Tren vse tbe brat ‘Free rd und ene Rn th a wt eel de ‘Sencha cn bo ulpuens ty te sot, i oil tail und be eatciy cece! tes poe sed ljtne none ound nce al be omar nt cednatad and tetera reid to reaped sate [eeaerke,Drowigs ae cecal vt IR Gunahot wou. The diferent tence entrances et wounds fi unicng ti crn ren fem and boul, href ih frei eyerin nthe pesoer of sae than ene wound yore con Estos a squrte mace wounds or eracresig of tread tbegur aketrte ust be gidre_ tater st td Sd wppeelyiestiptes. amply dere the oe sz, en y= {Ea characte of ol sunpectea Set wounds. Sern: lle sn attr tcertty etme redigrphialh and 0 ‘tempest be ade wd ne can nover be eas tht ride ‘Sets halle wd nt tone erage! shaped Hees ble Towers ‘Etaneotstn of radiant ners nthe wil recor shoud ‘Seu ef teas ech serge bd or"blle shape eget «,Reweved but: Care cold be than otto daring th ballet i give or the markings onthe sir ef th tare the gan Rages ulcer tthe fu tht Gt Eutenct th aly soul Etytceniber shel reuerte to prnenscretehing Tn ble shuld be ‘Sit ow erent ages alloing cain fede t= ‘SLT cer te tl sh not be cts far tho sae ree ‘Sled une ever ny ogi range caret: cnet (stl igen cn se a eee. Teed Ee stswn wos ety Cnn Tock of rt ‘Peume, Pied Len & Pb, 106121 1 ‘n'y lly HE wa: Minardi rmererey WaF URE ‘Wethnpin, DC States Goverment ing Oe 15816 The Trane Mansel kler ML: Howto deni tllt ole, Av Bar Md 2886-987, 1 Fekler ML, ellany RE Mena ae woud pri tran he ee “clei intern, rena 2 (Sap ).SEt-S, 1988 -meCanigt Dy Colo Seu CX ot Ustream hamid ve one po pctv J True $652 58,103 ban NE Bale, tury RCuyten Co Teatbook of porting tous. lal Lea Feages pp. 109-10, 1 edo fe tna tecn tm f wmning ad wiih ok ogee BD, Selon Pred enya evi sie fom rd ure ‘Srewente in orinapee gelatin Towra 28(Suppt 186-8068 ‘ose DA Pater fstab und ee yar sty Med Sc La 7-71, 1004 Sn KG, Seas HC" Prnipo of talc apc the tose of pune Twounde Surg Cn Noh i 281-298, 180, “-<_cxave » Rexate-nowmepons MYCRRT 20 row py >-— ee ant pena {THE PHYSIOLOGIC RESPONSE TO INIURY Brian G. Harrectt ‘elt nbn a ina ry hrs he i al {nfo the bot reponse tom pica ono The pts vetoed there Vert i aa fet Spreng iter otopel, pei the gals itn the central servo te tnd generate often sgl nting pili rspunes denied tc ie oreniies ponte ty the infamy Oven The‘cod rect tho “aeet a in a itr we serencne east epee re ace aes seca ee eae enieatias io dtamonee mien etapa meee Sooo ae ee Saree ean teen cromee Seema Scot Sey aie rt enone priecestere reenact reed Pl eee eects bcc eee ae ee ewe eo oe ee areca iy panacea oe See rcsepatarn Ree gE AT went ein Rev tialte eaters coer ia ESE Mic anechestanachc Serine tne eerioeteaet earlier, ee tee nracteetenmevates seni pea tae poe Pear Soba ec eae bree eee ‘eat eee tata . tenia eet a hve Sriaraata deen Anamecn ah Src esata terrane cence ena o febeaterateh eadiiteenne meg Stan irtnerises game maar ah ee Series ines Tie aimee arya isi es meen se ematical Sherain aetna «pa ea een te a ae Src caremaatemennaeensa ee Sein tater cnt hc ce estan tatemngm ce ‘egies py eet wena cgi tr we See ee oer eee ree at a eee sete eter pees eames pecs Geom fuer cgaste ete Ei Siremsinergerencmen ons Ei caenetem16 The Trouna Manval 1. catecholamines Synge clsed rm the adrenel modell i etait eee ad weit «. Incense oltre peripheral vasoonteton & fimo rennin oe rte one entrain Inver hepa lpcopentys psaneceren nd ketogenceis {Intense alc! ace opel and decrease helt made “he Physictegie Revponee te Tajury 18 27 neu oles om pei let oly intend arene. ree onan leat levels plas sce lee ae Silo tain "S“jorerce pip and reopens Keep tiene ‘a Geass the too lengrn gun release entrust the TERIA" peantacenese and the intial Ropes fing fee wake st Et actor sh tbe ed 1g. Incrvace pancreatic glucagon secretin and decrease pancrestic ‘culating gluse | ‘et ilrokae spe ats ey cst in dabratin of « nue fps Msi fat ods 8, Honmenal responce ° hormone (ACTH. ACTH irked ra the pit ‘tay pad ster aimelataey by hypotalami ceracorps. reas ere (C1 "ST RETT coses sree rlese of coral which stimslatce hepa Pcorcopsnse ad instenge atl mare io el lens 2 wcities eo he Jester pissy ing irene to reno: asia xa ater Roti er tml) ed Siang eme ‘meses periph! vacation 3 nswares pote resorption nthe tal renal table 1 laces Roeticgusueess and phegeetle Decrace hepa algerie 1. Gromih hormone: Groton i released fn the ssteso it ‘Sey eand to vsyence to tyfdhalamie rele of goth horn ‘eittelng hormone CHD, wort arin ald Upae and pcein woth of hla mut fled hepa, 1 Degeasen hapa lens trnsper 4: Thyrnie {T4)reense fm tho thyrid onde creas in cee etncmeiaimaing mee Sito ment fee dcrenen : ners peas tel plconenpeness B: ncrens angen oenengion eras eppadte nero ster atity 5. feninlngitensinsdostrore sytem. Deseartd peripheral tare ‘Sr ilar mere Baton umn td en cae teem tate Mein came ea 0 Staion T thet i eolangntlysoerted Sa Ue plenary eral Berittetenin converting egte ACF) to anger ne sme pter restorers ‘lcears peripheral vrcentrton Incase Sianchne astro Decreases eal enroon eal sd wate 6 Aster Xi) Thc in adeno nna plete -<.enau n JensRornownepeonn MVCAEL 30 pon py > spe Rt re cri ne eect cactus Carer Senin cto etc ect alc noe tk Gere tear a nan omcoas onc er ea ey Sosy eee eae adr ste toenails ts irre ansegne anrert ‘Bee skeet aes men poor 12 pg Se ran poner rat retreat ete wri te furan fr a nea eee Te earn ae ee a Speicher ioe Biles Since pen Since Stet ath cede MoS Gs oa at Sts guinea RR aon one nen et i ert seem Soho is er etieer cea er Si wal ete gatr aceead acre clara ecient re ttt een ening rategatna Stewie acess Rem creraate ua at tee Hi ka ts Stans commis cy ite Ae Sie aera emer ‘pole tty cate tm es ee otc earned sete tating eset ce ehreeh sates ccna ee «eres ce ni. Se ar in eta ee “tect cts ee eee @ Increase deta ubusr Nav nnd CF Fearon (3 eee lee i metabo Response he stabi zon to sack nd tae nr se ap haat eh een aaa eeneaicnh meres am Eo tic pel ah a Tomponee har been previously divided inte an “ebb” phase and « “flow” phae, tn See gett enna rcrehaen fen i 2 ctl oe eos ea Soe ae a ey20 The Trouma Manet Sette ted aon nw Ce each sce nt ec Cae ‘eautoation, hypermetaote, and mutpe ergan eysluncen sors Sea ee ac ae see Seer lysine ead meget re Te ep eae rt nl ne nn ‘8. Resuscitation phase This hase nls civerrucain ef tbe tran rnin eee tt rae ievieeet recaatuas teresa ireaietiny aiteea cease iu at ANCA ayy Spare arrears SEP SgaE are ei eee Te Sita tt fay acre Seca aiae eras it corner ames, st ya ESeiagcteeeemnmeat tesa om o Ri Sty gg Seine nantes eee corer eect renaea aera re icc coat iRaned acetate nae So er en ya ae Eni seat te ip he mt ceroeaateeeedeaa x Snape OY EG wea on Soimactngoah mee cect omit iac unitie ae ae Soviet oa sa aetten core nme Spa pe ee a base ra ‘rain, leukocytes ———— Tee ancora een sain eva oan woe eric easteae creamer vem inherent GY manner os ere ere) ae precursors of the TCA eyee. ‘est «Rah tt a sean Se oo geg arian tart EXuGraici neni ancora © stm pen poets pg ielecen cereus atta Sacagawea kaa eo Tig Ss nese ee 2 ESSE cegtumntpanaepeumnnne + Hecate pemminnewennnaer genet Rage seitigeren ots seen cece Teese mms tn ents » GRAS Mra aoe ame aw Remao-nownepen MVCREL 20 poh by > ‘The Piolo Reponse to ljory 21 3: lnesed adrenal serton of etsholis, cert and abeterene {Siting eid rom he rer vt othe taal medal . tang. {MBany hrperenitaen predcing esiratry atkakais 2. ACE medied pruction aginst Sain and eel orous aster "Synthase serena inf odie multe repens 2. Shmuetc neve sptem chars 5, Neumeorine eoponse . Spimetiie epee "Mbecesot tne fw dor to shunting ood to the hart an ein, 2. Endy hrpatle yeeros Sa opens Co ate 4. Crm ef tmico as om alta me) and ty cis oom spel pace \, Summay i plage ft af he srs respons to rantainFnction ‘tilt tera tthe crn fete rene. ete ha Sielathentage Hovenerfarsaban the hermesal and leet el Man errs the patent muy develop a permetabale state wah oe (hiftsreti the patente mptonsfleraneory Feyone syadrome (SIRs) Posten fie lypemetahai eon natty fed to male ‘oman djfuncton syne ee Bares Cera F'The hrpermetbote mite nan aire yrs Chest 9 rene " 1 Es cago ana mn gmeee wae Met tere rT came mm eG re coene tee Te rcs re a eae a ts Bay een 2S Wh noma omen Ne sirea fee iy she ttaonana a st Sit =a rear EEE i cma gett wt Sega Ni hon a cer4 stock mechoelD, Pasquale 1 Detaton Shi condoning fom ished person of sues hat lez oxen var D0 tat adequate te muita he fio: td structural intgty ef cll This ea in cldar metabolic gence 1. Ghsstetin &t Sock eS mong su ttn he ‘her echmn yrs te et een o SS AST ae em mya cote nade myeemdal ache caaionyopedy, velvalar See o Seats we mynrgepmnnn sgn Sapo ohare taal RAG ctecnayaarkonte eemns Pena ert cet re o SERA oe genes nee upc Faecal ett enti Sheen teit anes tanactcaetaeartcs Seer oes ater « Kinerase te ey option oy at ears Solar mre onic « Spee mc tc Sas eae y incon memceeg acre eames ieecag mirhabmaine ia cee seahiockamantnchmeen ee easier ooo TERE ores retreat pace to the el In show elie alread to unenuping of etn othe ieageara ena ees ater cgeareaiar tacos Maas ‘Sencar Stsceaescmtute das fd water ll eli) a o SES ee enna gry Strain he power ef shea long inp ar eden o shee mun ra ce ree Set cate een ene See eae ett eee a Sates acter cen cose Secu ames tun fs ore et cguedetmemrarG caesar nes See recnowaiea tne © ia temerage nnd Cg ee a ese Peed tp te thu changer sn nial mints meng =< craw 1 emaBenonDopcns WOCRER on Qpomr.py So -< we man npoxsmt ‘able 41, Physica hart of he varius forme bod ‘Type Sho Septic ‘ramet Stock 28 1. Blood preseure This ie sormally itaingd by cara eu a ee rai estan, Whe th etac ctl Fede, etal Fer fice vsclar etn nereaes ea tempt te main ood rere Comersly whet vaca resistence dirnshed, boot 1 se can be rina sa longa orders 2, Pune nthe Sureterati eens techni vith the excep [cistron shaman efor creme carn ptt tng te mrt ent presi Rermanbortat cand ttn with fied tet rota or Fen oa thers ‘hajrljoveate erate taka espns ted se 2: vse hemes paramere The ary with the yp of shok Sahorn nb |v. Hypovetemis a amoniagl Shock. nthe trauma poplin, themes certs thok herbage, Hamever, ny freee tat contol to ‘BO Cesc veline deplete came ef rypnelene she exams ‘Sind cuectato ptt on rina ses, rome se Be eiscacaben: Cirse stage of norte hock have been rec Haeteth plume ct lod lst Tele £35 however bed es Ye ahaa’ dynam pense te pant ay any pease ‘ecw age toner The enter gtd tn Table 2 ar general Aiton rat hon ects 1 Blgncai he finsoei tod er ons mdcqunteebcrvan pic ee elncabec 9 enfant propor ofthe let lume tax och 8 CL cane et ion hog nae ram ee [ars iypencemis. As bested nt ll pts ponerate toch cli rte velupe td et, Betune of ethane Fe een sek will ve sli clnmmy entree its delayed ‘tia ing Urinary utp uate lndgtor of visceral Perf {Tittle hoc ig or reds wie wh ih, Tei ceaty led remure sbre a nacearate guide tthe wen HOSE OW ite ar hand, pete eat int bod hae wally [teat last on sero sett peste: 100 ry Ha 1 eval ic hyetecnte wile ruin, lol las mere an 0% 10307 of Tila wale 1.5 ins Oke pte Ove ef the wari Sigs esses nd annie Pants mya capi atta nd CSUN Tr Ue tent Bote agate sre hare fom bod ee ami dee compete has ot ber ae to sain Now toe iinet deeompencation ma be rut ‘Sate erlar evr end POWP —Cardine Output Rosetance Hopovaleni Ccenosense 1 1 t Tnerdymamic Hypo t + we t Necewene _ ‘Seuss owe SE Sa err it4 The Tranima Manual ‘Tble $2. ated id and Hed ess Bln pact iii resentatin Clas! Clastt ase tla tv sd Loum Upto 80780-1500 1500-2900 22000 Baal t= BY) Upto IB SOHO Sao Pe Rat estuinia) 2100100. 9120 Sue lot Pressne| ‘Normal Nermal arene eed Pale Psure [Normale Deceted Decree Deeeae ‘CxsiMertal Salus Sighty Maly Anos an) Conn or ‘oko —“onwiww “Conte luthare epee —— Sa Treatment. Specie trestint vary depen on the satogeeni the Inpovdenia: tower therapy slaps lead van teen te Selting to ve whe ating the sur of lu ee Cee ‘alti Sei cost te potent newest cpr Te amy she be cued and aera Sc cue os 2 inovenows acces. atts rae ka aelyiag wr epetion {Goon pate) shaud have tw laneere iin eaoeeae ‘ia hl be ae for fe sod rich at the Ue ee ‘ene cathe sen 2. Ives tle Insel oplarenet with ed salt ‘elite ner ate or trea scl nel ine Ge Sareea grirdat wre nada) eedernting te lan at fe eer 2 Le ean ‘id in aula te elves fase and defence ae tthe etre papi the aman offs sone ee eres £00 40m ethrini hd be prevent oy heed ae och ‘are te when lige our Di a rege ee impte i rere St ret \dtermnine eufosen here Pa) ‘Rapid reponae Tote erp aly othe itl tel nd erin sla Rae can Be decreed foe ners Acyl vn elution tcompleed Blt lb vale be ‘sdninered. Gena operate interven tt eed Snir cig neato sup Tani espn. sone piri an iia inprovenent vl be sn ne» fd bok, fllwed ty dereraton This econ ‘Seal be conateed ellen of onchng hemere ot ene ‘etatatay Thi gener sei patents nth ds MT oe ‘heck and tbo held mained et eae Sa ‘Seat infervetin tomo th sous Alhegh lye ‘auc god freemen staan Ge epee Er Ota fate her 3 fd ta ndpiistrationntestes ne fr ince ie tent contra erreurs nals {nt vom forthe stg tote cnele & & i i 4 A i Se nara ig. 1, Fld yesunstation in the tapi to agoreeee volume (0 ptr doe not eg we Some etal re oeeete etm! bt tate Foe amt th hn and als «eet a (6) The abcomen. Abdominal sltrasound or diagnostic peri Ee Ronn ee ter ees iced nied fea Pn saat Meencent eae mpc at ae 19 eee re rs ame Sos fap el onan aearhcmemen te prod te d ee yescesing patient response. Rewsseaament and asaurance of ade een et et Hoe eetaretamean ec ae tore Sp Seed cere eames Siesircees meee iS eereir enon cement cena SOE pe eucciiram sakes eee ee reo26 The Trav Manual iresta TBE ince cogent nines theta nea oer bd reg ait hn Eee aac meaner ee ceareeregeegeonens ae ats SERS coremerigeree FREES at tg ae Sete 4 history ana physical examination. ay history of achemie sytem, alule itan cr heart fare of Gagne yioe wh Ment Ea iy reir neti pry lacheatis, acy, yen evant acme apa 'ndhgure on ysical eamnaton Hale sn allege ony tte, a jierl ena may be Sempra in ce 4, Elcrocatogram. Evidence cl or new neem disease ‘loth an deca ampli shuald tein” 5 Chest adograph Dumcrtraten ot plsnty er efi, rca sisoely scl ate suspen seats cand euro choc 6 Th elo eva he psec ef cada me enema 7, Laboratory tete Cade cyan and eleinm tepenin levels ay roi eel ta dag meen ceri ud theyre ek Fomine tet Sear a 1. tarive emegyrame mentoring. If question rises about the tate the srk ary cemetary etheee shoal be doe. Thrapy ean be de ba nth ata Cte ©, estment Therapy i etd toward corti pur fire 1'Stpplemental oxygen. Intl heropy wih superna yg nthe fugmota ev ad ad ery ntti wit chal see rc he Worf bathing shuld be sory cadre 2 Homa Sis emep te 30 tH en shal te hither myer work we MOSHE em deers 2 Regia ited aie myer inert aga Ak Saran and aul be eapeaed, Sn RRS. sory ‘Rtg Din art acer hn ented ia ‘clare shoul be asnure pr te tin tery deed a 5 cunbinain of rts proka! euction, erin alata one Bian rd rn san td ete on ‘owed statin he epleye! eva sues ee fibootsrideaty increasing scar em on ours 6 lechaielaesitanoe, in misacory conan tre sre Peon one lerelgtkn ey ventrior sna device heal becomes ‘Mt Obsiuctve Shock. Thevery staid be Jnted at wehesie i eoyresing fee Both pericardial tamponade nl terson pacar can pool oe ‘yjeenion stciatd wth mek wn denon Pete abet a Tin scunis ed bert oneness odin te ieee --<_ onan RemaBi-nonepcnn MCR 7 Spon By >-— 1. Pericardial tmponsde This shold be relved promly by prio inten or puetonseing scnheteroventneede than: en Chap eae) 1, Teneion pneurothorar. ss pen cunethra shld beveled ya {ngs if cuge ange nthe ssa nto space Ue ean: ‘cata ite, Th shuld be lod iy pictmont fm eet Tube en the ‘ced ee Chapter 25) ©. Betive reste vein I alee ih me nay re esteem and veratrine comprotive ca wcll In oa [SSlnees rnative yntlary transfer il elume th Isher fcquens er ressure costal tore rte venta {DCIRVD, Mt Womr nyse fs ten denied sn mecccn with pal rd Iijors pul adhesin, ane severe he sry rey. With lation of Che ‘Stag iat icons Sut vos sotance ad cree ‘A Dagnoal Hypotension and tachycardia ry be presents however te xcs ant wa nl wal eran Ia the he igh meal cord Hee lst bara ery wt pene ay ea {hetero of he bra Gas ton ae dew are tenn Ta ‘not tance putts hac steiner rll eecdercinr ad pial anesthe 2 Volume nly, intravenous role shuld be supplement in he ‘Eira bgt dsl eur Contr venous presses tony ply wedge geseare te umaly deere ae tear Pata wil ape to expansion the nesses 3 Provoor: Pharmacol super early inlet homer, Selected instance ef turer ssh, an alpha adrenergic st ‘Ripley foe emi he nn i ane Soa ernest eae ‘Sout ares with onstent hemenrtag vlan ae tht mat et ‘nt iftemedyaanse tbl pers ae the wl rears, ‘Stine hat teense ot regen nd vette or eer ates 4 fii ees in ch pressor agents ae ede fro cre uid te payed Thun many dt ie eatin ‘ul lp present eum oro. hich ‘pile eras mnntrtin nang mop [Ut fedl nayfnchn tented be ove. th ere heed erin empty eon eel aly ad sera Taetlng ef engin stdin wth ct en de, eo ‘Samy towed sagan of tierra ls wm, septic Sak Sepia cst maya testy Ut deep a [omequenes ote meshes deus deangerants that aman ‘Rblagroi, iw tint prcetatins ar asad wih etches, ‘?Sfyperdymic sept sok ema by penal vcelitn ad Iperensed enn net Fr achpenni neta ad Woe 13h tre emman and velo th temic iDammatery rrp. Nal ‘Sst eft will Seaeared pergieral reson, ela ‘toccoatiction nd meroreustry hyperfine sen Cardia ‘Sip though lead dees nt prev eae dele fee Sots cape edn and meta eos nt eon28 The Tran Mama > fapotnari ene rk ca sw oct a ae eof epee rh “Thos yaks Sahin wih creme aries Pca tod toe el no oe ie aera is dept Typay posed fining ne tea (Guedwth hypovlene abc” He kportant fo tla tenes {ese picts an alten we iceae adie eft ad ore [evden Neutropenia may cep ltcuchengetean shat ea ihe dterentl to mow innate ove eee eine pee Sure, antrum lactate kt unl elevated Mera oe herr att in pny nic shack an then ne dari tec ©. Tate. Fal und were sprrt may preert the devehpmant of Ipod sete shocked mile gan ftanion ade Te ‘ed wef a mints the soar of sep 1, Wome he pattent in septic he shi he tated with are sNevelume caplonertaton wie the cus eres bang Se flnidvate mentor ental tne aber pets econ i mcd mpuearl dst, sre tae Inara rasr spot egies Aeubloes.Hrdspctam eri antbtic hevay is nicatnd ‘the pti with spc hee the she atte salt be a To the prevalent cer sees wh he ad ‘nai, Chote oft aco rcs ch cma aco {te pet, pital preven nd Wty ture the pao, rot sting antihtic, rigr arch shook! te pe er tetas an props Grass scales {han Abies can en be ed wen the aloo ies snd weno te ear 2. Monediond therapy. variety moose] antibalieeheve been developed a ae euronty ing taco dates eonhioe improvement in utome hake mentale th he ss ‘nd heir wei rently restricted to rete ented oy 1% traumatic Shock Traumatic shack inclesyenemie sek eaten tn mth Be llormatry spun that we act ahem tel epee ‘testes ty etn sept rete ato ‘achat fats thot prelate the Ssatry repre ec a [Bele Mt iatratory suis have shown spate fers he te, {ep revente wo hemoriage pl injury amped with heme le ironangepulorary tale afer motes hrc heck ree bat play afnetion after trai sch with tendon ong bee 9 setSoeue injury common, Further, tnrw ifr) withed ere ha prestae many men ems Te prone mena ae ‘Goa forthe Resuscitation of Sock ‘8 Seurce contol. "This eer to een the cae of the sek; tha i, emershage out be opp, ature rimobied, uses di Inetona wcne, Sune costly ot octets et sa stale nome enstny ‘8, Resusctiatin Th elf rrwctation shuld et ines eagyen de {23th anios Ths notes prove fefiion uch thet enn diy pment apn datand: Cre Uns mars ql by earns Taetent fed aration sf srm ntaty an eye Extsheu be to prve itv enn Spee Saearae® the ‘waar aio rousers (aS Ss Chior Gono! ee Whisorea perspective. itary antibod towers (MAST), sone tne feted ts the pon athe pert PASC, wa ak cam w Remato-ncnnepons MERI op QpowraEy == me a8 mponamn Shock 29 pecan ii wr ps ro ep ol a ma ua Cet ee Fao sop mcr hPa es i i et Papereecion nts use im inhospital manage Hees mrcape ennai a Se a rie ma Farnoprysll “The gnrment increases systalic blood pressure by 2 Fab, um ose a ecient ste i lb a hae EEE myemes sore npn ei (en a ee ie si Suet State "eet teat am i at Tie gaah eer tari 7 isis areata fami i ae ee ascitic’ ‘ees ra ay en hee 2s Se or te cat aan eee nett Sir gated acucaoma ee et ol cman ect anal fe ee eMIASt may be ured as a valuable adjunct. In these institutions tee aed ea ea ‘Shoemart chair Se Here ncn eeteg sce rte snaicatione blue eee ee ae PEs ceed gt naw td ia cian tnakins ane 22 inadequate ie ene, potted ree ‘Poneto ced hy ab “Palate of ae eguetly mask theses ad symptoms of bik atin of yivleis ae amcstny90 The Trauma Manual bograpy PEST na tt on Regence een teers oe a ee, itd warez wat apc yao nora WHEE RATA ca mena nmgunnoonrasreee MAST i pos raumatc byieteanon J reuma 2679-76, 1986 7 ae enna eae a BT ensmen AB lie 1 86, al: Hemera shoe Curr Pro Sur oH< cx ematnensnmepcns MEANT oF dpontupy 9== : i : 5 MEASUREMENTS OF INJURY SEVERITY “Thecdore A Debidge Ieitroducton, Rieency medical service (EMS) ates are charged with Iain apd ter scents tna scence to fle appropriate le Free hel personel net deteroe extort firs nee nian ‘cia ores eauaty uations to maximise rerum lation hed cn! cutee: Underage ore mhcn pliers ih vee ines re {ree fasta rer te Se ‘apd srs ben tients mth ess sere nn cule opp ‘Sel fra aw reunite cin, re anpored to ai tors Sen oe spate tyes oe ele tng eo pet te let 1 Theirs tity ns tne an ate thn deci ang rece severl ruin seer scorn yee tuot Seeriy sea shoul any tote aed requ ol Fadi ‘SiMe des. Wen pie the Sid ew ve bon timate UY ‘Sey and saa tered ete al se rng spend Prove 2 more ejectve bis fo comping pint pring cy lngronement tee prem [ifr aczinonnts Bene ery pane se ena our abi To regi (Abin nares ected with segment Une peptone {heir facto Sener sees can be curacy tbe ye etm EST enive te b saluted Curent neorng techies are Ded Pe ‘donates azatomir sina at, 1. Physio Scores Reeser Spend on chang in Hed preasure, heart ate respiratory fate novel eleenscxss that carr the presence frou re Inferntion rere to clelte soc ree erate to kd [eran in Cary ple sees sre wel fer pst oore= Sescenjny sesey and hip dure tage decrees *Wbleagon coma scale: The gop Coma Sale (G8) intend Toe lial ade or sexeming the degre of inp eecass, ‘RCE aay ri ta a ee an ee opening response Tale 5). he peters ret {eft ef the sorta aroun atm (CNS) edge fe gtr drat fuser apt Keres arg ean 918 (6 = ray icrensing a the level fe ‘Somes oe inlgration capabilities grove Rey dese the OCS int ateoun! fr the patent who ‘vo inflated or pemecsaely payed The pallet ith ‘GES fr ahead ory ny he yr rent fom te atest iy parle fr combate fetbated (a pharmaco pled «There com et et ein a te GS. The GCs ha price vale at ‘Semin with he teal GS of 30 = 2. champlon ran score The Chapin True Score (7S) babe ‘Siemens ef arty vate and eet pte lod Freroe ei ia el el ha GOS Scene rary neva te 1B ct rend injure. Sante th OCS toe TS wee dee oy a82 The Traum Manual ‘ue. Gang come le ye Opening Spontaneous Vow Response rented Contest Toapopeinte eras Pa Whew) Fusion Eaten (in) Kone (Gag Coma Sue Total Sse Mote Reset ee Soe = {o limi thence to sean crits niga feng ted ite TS, in particular respiratory expansion and espillary refill, Furthermere, Deck aneisneniaiee aes nes sor innocence ite seliererisgeray meaner eniame reed a Senco arenes ome See omuseem saben mre ‘oe 038 ota Bede values 0208 pry rate codec) — on ‘Tble 62 Roved tra re Gasser Coma Syed © Coie Sa’ Preaure mm He) Reopiratery ate Yale C¥) ras oo 0 ‘ oy woo a a oe 0-75 9 2 a 18 1 1 2 o o ° sows IERIE on Spang >= o< cna ema Meacurements of Injury Severity $8 4. Otter sanes such the CRAM sale (Gclstn, sepia cco spss, Prep inden, ed the Tun Tage ‘ite ard un ied nse ares the cot 5: fhe Rare numa Se bean ne Cato Te 1m. Anson Seaies, Anstonlly ted eins, arene injury severity a aeons ncdully er cli The ee commonly TEES cnc the abba Iry wee (AIS}, ich unix SSRGPTEARE Tat tyre an the nury seve score 085), [7 Tes rm mln the Ais Hoth rrr ono rien, ‘Tig tfns tur ae yarn only afer deft evaluation, nh aereee nara sno tr enorme so ‘ithe ABS lta several hundred injures, which are categorie according to ce et injury tated en a teal om 1 (nr to en rh al re A et ee ea predate the extent af the ionic Te ATS ‘havens wry ef eh ir ltl wd orn net provide & te faligees prendre pase! thie Pea .Inry severly Sear The ng Seerity Score 18) sri mide a et gle pati 1 value rong ten nice ra a RNS prety mrvival tt er igri eat ralty dani) The TSS cael by summing theses of he thee Misc Al cece in orent tc fetone had och, iw ores, "Dealer pecan sean ore agente ie REPT cle tthe toe ages A ces wer Ue fc, ora [ShVancmen re enh fone ores read enue a ue sae ie IR atonal W any AIS scar i 6 emt a al SUS, hase 16 inufomatcly Yon Se 206 we to neat ie da atten nj tae warrant ce at trauma centr, 7 icaune te E eed on AUS ororn aie on rtetione in Beste mcs wih ich cos be deed, Furthermore, ‘BETES sunt ev ey te est ere or ea oly regi and (its a A serene eqal saver Tha he HS vale ‘Secs io sli ombenasora uly aterm mma ean ens 0) hare Cos, Ue Detae Sh eri OD a) nteaacany tern apple wo msey Sepa patent Usted Sater The [CD cles ave eupnoeic ora oe nw Tei ralor en digest ede NCD cade are assigned athe eof ‘aca he hota © ene Soon cago the ate pe PAT aera eect cba ea more; meh re eluted or Eu ope ty meting the cry imate or ech nga 0-5) ‘Some ak cer ory toa ‘Matate eta hese neue penetrating ris to the head, eh, ter, muscle pronto the bow and ke, fal chet obser a sr an nh hur tee or mre prose ee be tre: pe satis ene and arts penn tthe wrt ad are 1 Appts of Seeing rus Cue Fetter coe nice serait f soi chains, eine Pen jy fever et prceopal ing rere Poe i When seventy ser ae based et wee gure he data reid ‘aha te are titan sali yt ae een eal SGUR' lg ers hae Hed ensign rrediing UEfex crane Tne soning stone ans ier opened Serco th ei dv ater ha = Mog es 8. Outcome evaluation, Mor secure preitions of utcame can be re by Soh sot ni Tm ies sumtin ce TS A mechan ryan age. ‘Probab of outa fr ary gen poten ean be pedi, Hire t “THIS prvtes sm cece wenn pel hy RIS at ee a ro 1 eet of oral a per he Sr Pe Uae) where bt bE BSS gs) ty ts ody ae ofidnts died Gn the Walker Dunes ‘great apse om Uhm eu ptt ened 2 Asovertyenoractaraion of vauma (ASCOT ASCOT vee dina wo {prow on the prec sity ef ISS ASCOT combs the RIS xan FexaBi-xonnepcus YEAH 29 dpowr.ey >= Meaeuraments of Injury Severity 3 tit gard» orale antic proewih ales fr bead and rai yd eto te nec (ther repens with SEE eld eter oponewah AS 12D ogaehy Fac gery Sele—1960 Revision, Des Paine, Ameren Aseation nei STP ONeI Be Hdon Wo The inury acverity sore & method for desert ae gah ae we iki or Prue ‘past WO, berry CC, Rpperscn MD, ct a: The failure of prehsital trauma prediction rig cat atm patent scart Art Kner led 181-8, 1088 nee) Sues orlage esa tage ae ne, rere hase spre tie pe ms isn Bar He vag a A, any Ws Eng mn re: THES met chy CG, Sch WAL ure JG.¢ ab Latonso he TRIS method fr iter Tera soya eaten tay J Tou 3) 47 101 crete im Sc Carman hea Testun sore Cn Cre Med 672-618, chion 1, Saco Wi, Copex WS: A revision ofthe trum mere Tete "py 0,1. Caton FR Sue 8, Cope WS roar sci: More EE, Maton KP "SEE Dede round Ba NwaeApcton & Cane, 193 cen OM i las eat: Ar et Korkir Bocr Lt Maa SA a: Petal index: scoring sate for eld IMs ornate. An Per Me 16.1718, 190. ae et Sean Wea Petating sonia trauma ine “fume Bab 4,181 se ips bts Lt a: Ef preinjury lle on trams pate serial ‘tea Tou 38888, 1981 Mead hesmert fcr nd impaired cnsionon: ratis) "ae Lancet a 84, 1078,6. PREHOSPITAL TRIAGE AND TRAUMATIC ARREST FonaldN. Rot ana Vincent N. Moses, Jc pn ee et ey Sieg cea acter, ESA coccaea like recor omens Fee apaitatereas Metmoranemmncneay Sede aen cies eee acer soils Carina oar Seatac ae eieiay ices Goma meena: heating ip capes ame ceoereatte SEED aoa race eens reactor fa eae Fecha tt ern ree sect aa acter aon eer ep oe ce aie eke oR Re ay mu om tel te See eae tr anne ara ce ce cie iranabctre ey there cee oo eee etaaiaeare ae Sa ‘ane Se eh re oes are A i i tr foment rae » Het eget pak tern iceaw ae 2 ment mcr ete Seoemaeiy eaters tae Seems te rapes mates ie ce eect Sooeanere + Rago ede Sy one a ere Segoe akin, + Si Se aps nh el * mee eit tat Ee ve ag ieee creme oe okt Seer memes Fs el warmer ete SUR ege gooeenacurbemmrmeon SRSA ny taste ears on< cnn 4 Henabe-nowmepcnn MYCREL oF Spon EY >= Proll Taye and Trwmetic Ames 7 ‘ube 61. Fi age iin Patent Ascent Prt re <0 10s Repay at cen Sec tet pane 0 mee Caney coms ee cl ered me lt ecg injuries to bead, neck, tore, cr extremities proximal to the elbow or ‘ee ‘ora with 1b sve rea, carey ave rarer Paesain echanior ot ry ection tte Death ef tin in the ame purer carga ars20 fee aller mien Higher ei rash ‘cto vem pean 35 xh Metre rsh 920 mph repro er rm ike ‘Age or 358 youre Crtiac or roirterydisese Dioetes mei ses Hug insaio) Giri tier dane ‘aie cane or aligasey Mab lei Hetero teeing order or antral ‘Aeaiabity ees ec and tel fain Egelpnent ard super "Danaert eis genders) ‘Turn tine fr ehiee ol ies ed ed evel “Al od eae ren eters (ther spec cre centers (c azadea eecuredeontamiten ‘etc peysnt) Preece of oging hard orem dare‘88 The Trauma Banal Comsat cor sy has Naga ron vera [e} ae ; S09) Sane tng coetnn Mitac ies Reenter Santon m= TF an he ei sh ingnecaon “LE snore reo ‘Satie deat tne scene beseteraa ome sep Fig. 61. sty in measuring vital ean lvl ef conan Fre: Arai lige ef Sure aur or he optimal sore of he are pone Cease ‘ssetian Calpe ct Sareea, 2, o-< cxat RamaBo-xowsepon MYCAHE st apown.py >=— Prehospital Triage and Trauma Ast 39 compensa physic suchanians masking mar ijarien Troume Se eat combiner fh now © angen esiel emanate at carpe nnd or ‘Eitped pea based onthe selon the preter vrai fertuio tederalstat Asari wil an ee para ces {eras an he tnmacite rapt eatery Hei provider egment Vita ema trina wcring techies, eld Feri jodgnent hee en show ft mnaie but nt pec met dentin parents wire 1. tage tug Ysage tas ate ont tc ams that we then rv cierto tne enna ic eit “Probie tht en cc ath age angst flowing ie equation othe ta to iim 1 Content by Nxt or oy Be Limi pace cement 2. Gor ces eit ctegeriatin by ry seve nd eed Seer 1 Rods rly inure M inl patete wth ae ire {iia head thre, and alone fr wich imnedte sural seca cr eared Yow le tcl nun 1 cde tents who ar ee er i injre nd wh si eure sort ogee bt at ‘See Pls have noe Hinton (Sto dod Tt ar dea oh bent al er Linton to Tapes Ay arrearage pre tage eal Co ‘ae Ses S07 yt moan to neo rece TR ovrtage curs when eld num neonate the evry of patente Freeney td igi th et ie 2. Greg can oven pats wth aroun fom rcrving Stren ere ‘8 Unceisage esr wen th eld team urdeertitin the svi of @ TM nertrng can eauze dey in restent and rans tint with ior hin tester ree 2. Underrige can nape pln with Methrestoning er compli ‘eps be set to holes nag apres “eaumatic Arete rm ea team est were th ea ul cf 2 ue Zaub Alinta ic term ensoneol defo oul sree within ‘igo ener pic! ference in proton Prowse ted el re Styles ined traurn ee shld prea trauma ptt eo Fc rt rs eon ees ae ea 'A eedogies:Swucesf resuscitation ofthe patent in crdopulmensry arrest shim ere nan a toca ree a ‘Tartan fed fo cordtplimonay elu afer trauma,1. Away Lee of pte airy thet came een fre ‘uss a Seer (i) tose of tone ME speinian coud by ead ou, teres du sre 7 ’ ‘rsctre hen > ain by rn bay opal ser ed eth Dect raumatecerption(urngeal facture, trata ellogs) 2. Grething. Even in the fe fa yt upper ey nee ps ‘hance an lend to api dnc rent athe ong ef vrntaery dlc ene of the loving @) Severe bead vary (2) Heh sant ert darption (prec nerve mc ent Co) wee i et a Sa i) Resin intra fr or tilted pen curators eucingchest wed (3 Fal det rene » {G) There ereh or compression {8} Duphrasmate ripe (8) Large hematoma other (1) Desig (2) Systeme toxins inching drugs alec, eaten moni end “Gunes sue ian) 8 Cheulatory. Impaired livery forested Md to vital organs will siti che ap el Gttnatin Th on ec ren te a Sta nomcrage Gy Haceral (2) Intrathoracie nts erin of great vel (9) Inte abn (9) Rovio cr rupert pee fata) Mel ate ‘No nena children ag ear) 8 Coatneton of loo How prevents enna ao hort) “G) Tension pocunathara ) Perce tamponade & Myocsrata ystuneton iQ) cestaien ) Repaire (8) Intrctien ood chon (6) Dror (0) Pei shac (©) Gonna re high enrgy bw cst) {6 Hype or lobe! sehen ag, beverage he) 4 vider stl eae recognize the treo mat eonon Wet racer Seca nner 5 Hypeventiaton or hypoxemia © Taneon pnoomernort ©. caution of ay " Lthoed of sur Reser om tis ope often ise wisare fine endows making nerreation cul The dude both ret puto hr ENE re sane eee a ‘he hospital snd patente with vatiable peesone e ther sign of Me, sat Tenato-nownepcs MYEART 20 youn -py >= mc we nnn pena, such on ppl eponte racine eer acy Alda al ste ‘Ser tal pope mana te BE) oly ‘ls can be grad rns tho sabe date * 1 Viens ef peretating aura hae reir Nein of sea Trap cri rest ht cn of oe rs 3) Sunde more lity afer sta wee 1 to 40%) than ther gunthot won (to 1) Somalis wah rane seat alg Hb wont he het gence (2) Rest pie EMS ariel sigicmtly nares the Bk Kolar » (9) Prem cf rgpind and quel tested pred eanpon isin poe Pogo fctor ected il peed 1 vue of ut tne who er crpumenary anesthe 3 netted of surat (tr Ti) These end by prebopiapersnne ob in area with no tite ou taoeneopencnss ovement or rape, ‘Sats fac velo citing papa) aod ee ‘eal aaiiy in the veeoardogram (C0) hes nglhle ‘han feursral Prep weston not ba (2) Stn it ia oye movernt pop resctn, crn! res suariae cre thn tn palo, nbn patient Sea ihalnad of rail of abt to 9 Beene Sreutentretan sha nut etn eee Sfemsn rocumcthre, sn vlume rection Ff Sccasceal "lngters "sure reasciaton shold be Simple hice fleeces opcly cyt wert ry lo ga Beet ie (2) Deaton re cnn are fer ERS arial bt price to Apia arab fe dma procs ut Rl ceive ‘te ah be unaraten, Soe nhs tut no ene te Emermeney Dernentthrctony for en nt . caters to atempring esuseiaton, Heuston should be ttm fo Stpetente mre beoure of mar Hato penetra oles nj bwin cept wih i cheap lation viscera of thcieatert)| 2 Abcet sigs I (no respira fr, mo poplar respnse eye foverea reponse to dep pa) ah ECU ts of eetle 4 Decumentd unrcatel plsleenes tn apse lenge thn 10 ‘ar eg prong entropaven, heads cen n't neretbertic 44 Ricormetc © specie! eonaions W"Blcial shock and fighting, csi sa in uly ced by 8 ‘Grin: fyigthnia sil de sable nape sacle SEO ie samen nll pti When wile catne ccc oman cata iedo theo br ret shouldbe gen ie prc 2. Droming aed hanging. Art uvaly ese spn these cnt. Although appropriate trauma cre such se apna ‘sin should be atte detest esusct anfa ced {ctr fr medi sete: Noythermis sal te sree42 The Trauma Manus 2 typo rin one eae <0 al ‘Shes fife Patents wh re severely hypathrm dare active cre ‘sping pret cane eames nos ure ar ‘Tenfycempatise wh he Herta Chgset the ‘Godin nd etic 4 tet ebeenday oa medal cause Cin shalt akon ome ive patente who ma hve ner atest hc ol a (itn tack othe ever on ne eno etree sft cig ee os ne management potocots the sone, Noe: ne oa scene (nei een Plated ect shald he se an te ip Decrmine whdher ini etn ie Sci HD). B Aawes or presen of spc nin ouch per tay esc th ig eS ea ee {Maltin aru spina irmobataaten. 5 Gem tyne head ns el ei 5: Ven te ieint ase mae) a xm {ero cest compressions saat i0minut. {© Datwmire Eco ym ‘Paine up oe ince (030,560 fr venti Rote presence ofan ogni ryt (ces eta tit IWHUAD artis contr earecter taint ofa reeable con 8. auaige to pert emda zn ero Chaps bet tere per tbe ron ane sere 2 TF unable oper intabin, ermine elven of vei tn gb fecha {abe venkat hat ie ad fh, csi (2) Wale Wo veninte ndsqestaly and rescuoe ic properly nr and quale pute recy thre a fester adie to ge nts ith 10 Chg eine ‘Sip fintere rhea ecesedboath soho were faire lor carpe epcily wih eine tsar el {Sit acl deviation, et atecenneee emp yean ifsc perm aa ecompreian 1. Inpeblp plete eg ard i rap, xvid el, ‘ie tse ee on 12. Tranter patient rp to eb ad nt tsar. Maem rotors anfute o hoe ‘Tecate ie cent and bye vena 4 Cnt mt aman aden ity bed en bel prt 4 Coir tary nteek tose 5 Inne btrovonos Verena distr cated Vid wie ‘Tiseapectore WE cep rida xan FexaBi-onnepous EAI 29 dpowr-py >= i Pecunia Tage and Traumatic Arrest . Managoment protects: svanced ntarvertion. Tse ray Be inte Ite prams cra thr evan proces nate stunts copes ‘hte transport tune eater 1 20 inte Sue say ‘Cnectretomy ‘a Dylans et veraion 2 Poreaneovs puncture of conta vein roo ni a Ree Serre ny pds ne rab loner, 1h Dicement of tern dt tues abcd be stray considered fr to tame oy tn! fis ering rans E50 moe fom sere to tran cv ol pales ee axioms 2 The mast tly ioe pant te rape 1 Rw seem aie acu rtd wi igh ike + Overt ae much a 0S marry to ace seep aes of wer ape + Let away fe the mast cram cae fr cerepisary amet ae ‘Chun flawed ty Rypevenntan or hypomania and mn pecan cranny ‘pean ©, Darts JC ‘Thenyon HO, tT aria ert: Spe of Pred scric Ann Ermer Md 1-886 18, [BEAU WC, Jona Gy fertage 12 The dou, tage le! A new eocare bed ‘toprech to th fren ldentson of aye tama vine Ann Kr Heh tae,E. Carat en Tour Ameren Calo Sarco leaned aura Ii sepprt ‘manuel Chechen Cale of Sarr 168 Durham LA, Kcr fo Wal She: Eeeeney enter Urs: Tact ‘rial recain )Tnara 1 F 1 ipo Ole Fi rkeveh Gt: Dy prep eam enter ge ‘rm dent ger esumnvtin Arch Surg IBOLT FI-TO wee Gta Len iho a Amp copra porn Sips, ne ij GP Modes BA, Overton: Multi caualty oidants I: Kuhl AK Pr Teper nd maven crt St Ln: hay, ‘ore Snmats By icersan dea Energy throm. Svea co ina with pyre sats Towra S10, 780-784 OE Misia AN Senge es Ue Bel ers Mel Cin Neth Ae Tita, Ft i Cog hr capone amt: Cal Bogle Ci re tt i ewer AS Nas PA. Olen St a: rebel trauma cndne eet The on ef ity roam B08, 1087. PREHOSPITAL THERAPY Katty J. Rnnert and Kevin S. OToole 1 ay taragement A ftocuctos Suse irray managenent ee mee important lt tutered ty fle proven ream pation catene Speia e Slants untied ty rebel prover cont to the che iene coasting aera elaing vers cvirorben oes {inst dares rtd ate sentry of ative fem! ale sed toto prise eer or avi ney {eluding cernn sary mancer) ampere with fll tech Ist fe r acute nce ench fwhah nerce ens Pant atsessmart he siray a ase ty spunea eeltion of pee sence es then eo cet 1 Lovet sconseouanoss The aint genera codon af wanes |e tho best pricier of the sity to pled he airway fry aspirin ‘een Spc simp ese mah Tote patient nae, ‘je open nd oer? athe att reac cero sin ‘Royale tmunble only opanfd er msn Sl? epi Unepente®Abmorsaliee fmt stator nab ndtv of many {tinge hypeventation er fypoumin ar wo commen ann ef tre ‘nsinan, slang wth nvoperfsin, dro lead intone, ‘Sele guy the patios sity olin gure eye in wml or ry ate pct ey ire ae 2, Pinal fining. A sere er fndne ndtv cf por eae ae evo sen hich oul fm dered velco {FSpmin pre teed omyeneonent renee) ce fe livery tf anpeted Hd Opin and oh acide paleo met Lela opi ail 2 second ond ney obser Uns es fan ot ow, ier physical findings mee pee Lo a pure tepirtey abooely inde symantec ahi chet ‘cure eres ear scr nse Ting, saene muele ‘ey rina ethig rsubentlreraten ‘2. Vt ign, Agora wil sme mot sen be ese and apo Poms ln ec eps road et ld proses itwadabl sc onnetry To epertat tome thot nrmel dings do ot uranic ada vention we ire Protec pnts tay equ sinry stevens to ssare sia ‘ire Forename «ple exitry rag oO i oun nti sl eee inttasn oemare ary proton ©. eoiciatian ey rsucation encompass ening td ing een dry of petal ag ae of ea oe “7 Bosloning the sioy, Manu! teshgues to onen te crway inate ‘rehabilitate ht ack ale to marly {lice eyhgipealalesesand h Lng omy an the panier [retorts that thereby ling upper sure Fence Te the {fsa tient avid spine ny avg be steed hte {mth food ican oro’ in and tema patents (ide fe he wih aed entrees. --<_ cxai H emati-nonepcnn MCRL 0 pour py =~ i A B t Probusptal Therapy 5 ‘The ow ust ccpihd by pang ro Rand tthe ans of the marae pt fn the jv ferwra The aw i peru ‘lng huh maine sth the mandala cer a serif techn Te jw a itr tached et toe are {i hited forward: Semsomscis ec cate paints may te ng tae af hei Others when prone ith cists ja rt and alr ok al ed tle sonedwetlton td thea itn 2. Supplrtotat cng. Teme sear open concetrlin sp plctetal ype shud mitre to if ear pelts Ts Ey ie scored hy numero devices Cocrenponding fon als {Sed dcinered HO. re thoen in able 71 igh Te dees tning he pri and non rebreather mks, ‘rt tet fr werng enn te eae, ane Fallen santos tthe neal tapla i wc td Hid by Bed er asin them fo tie anon nal ena aye ‘estate shoul ot be we pce high Dow mak devi way adjuncts These ar devices manewers ha in sin Tagine cen uc ae pie Cid te oublch gem siry pate, alagh earying the Sprite pwn optic ha aon ere Oe ‘Mura mont te rem Src ered wth ea ‘lange poring nce ee ate tral pt a ‘Sat roe ah dg ve Hae ‘Gy ite be use to ar he airy of debris. Care st be ited to {vad nding encore oreharyuelHecding hen us ‘Sip natn dice Smal bore dvi eae fees! Br ‘etme patents ‘Hapa avy, hia ai inti iwey ut be ud in ejuncien with mana! pening of the airy Tae he ee ee fe Xion The ary nul ae rer tbe th [ele tp smi fred shad top Te device meted ot the fc tenga the mee to he hmopharya coming et “Table 74, Batted delivered onan enero of various der deve Device Hw rate Win 03) Nasal nue 2 2% — 5.10 ass Bia with ame 105 wo ont mane 4 2 adotrchal ube anne to demand valve NA 0-00 ‘vic nd og46 The Trauma Mauat teed the sng tt Manas f be nse Sea tara Ma ay a iiss seer oe ‘eked pls cl gt cer Sha et se Siege ca cy eee wes se ict « Sopa sy Ms a mie ed etn hon tenes Onna Se aa ed Egan nih earal palsttey se ary Ree hg mah ng tre a ong oe Seed int aged ee re ey Sainmsbt wSitgn ene ae emma ast? ‘rl, withthe tip rae mth the atures corer ec hay mi of a a Pose hale tye parte nae Teicha ene fon thelpsoneoeae oe siltation orig ees ea see Sincnehcoepel ate meee a scarea ms Sfresinie tinge we nicaeaticeor arise Stns pete ney i i pend Al ek Aecth and nab to ole the tracen a Hrphtporsal Seti 16} 1. tices decree Shecuptigal cnn easbphemtsc tee ite ir a co dal ee BQMEGTA dovcon wheres te bat enopentneSene ost Eerg 1h Siero HONEA he PRC i pad Uh be th ‘hat et prc ele vob Rak iilvte tp nadernet a tophan wc kai oxaBenouepus MVEA 27 fpowT-Ey = lac we nan nponemt Probe Therpy «7 ‘eg nating tbat cate he No se a he ‘cage wee Prt nti Gets SS Rie the coor elon aa dre he ‘Ree denc top veh ROWER See) teed he eRe rll wes eed he in wh cst ea sods and apie COs (2) hpi 0 Te oer gt el the Aetirtg ateed atr ta h er enaee e {RE happte cphageal por entre mo eat ‘at eth stan Tie rst recone ne ‘Shain, Se Sand prt stu te potted Sim tt ‘Minded cette es the ld poi det en {et eaten and pode sete Mewh Sumi CO ‘Stee, qn param Beemse he yye fealell or ban pres fir ec mane ‘easery Chal detec thn evi sopra ee EGRET ne of ace end acerny of cee ley ‘idly he ck plo dedi he De tore, Naor theta nce ck tren ee Teeth tent tes ane ely the ae ih he tue Ecard entatign hrgh cre a «ope! otrtr sry (COR and enoshoogmc be ie oye) Tes ae heels ated tee hte ce Tne wth a ca heh the moth, cng fo et te ‘Sophia They are Sneed to tau the tophagus Wah th i enceurtred in he EnergereyDepainet eau Cee, immagenan cenit of aig osc te le the EONEGTA deo rmoiein ce Asrthe arene EQMbGta cue enone wh ore ste racine pliner ef ie dvs cna ethene rar ends MEBSRECER doe dnl nee en ptt nd ‘Sinaia ytd pment ea iSryaea mac ny ta) 7 Th ki ee, ‘ea dr hae! phen ntte h ‘Troma elon ee Senna laced eg te ctor nen sope the got wp thee ‘Raia ee me eye eel SESS hd an fe TA cde "gu ane of cameo igh ue eo i rat ‘Slncname cin tne corel prtain uring aver sa ‘Serre stent eset et ‘ie meee hsp, ngirement f'n uncemented ‘ethene be ocd wei {8S ana wl py ihe une sl halen enon chest crey apagent - Soteta monomer Cente puree Hed on the aid cat ty cece te phage ht dey eh Wen ‘SGypetr, ced penuh ees opr ty Tepe treatin an nce ened ri troiypetary and ps apt Sew TO bel abe cane ination ty Gop etre large stare in vi r= thle Crease rnd respi trinomit fore to thundering eerie spne, Othurvne, th ‘Benen fers ite rk and brat pte benef. One commen ‘Bake ta pt pram the hg erg athe ae ig. 7-4. Eeophagtrachcalcambitube (PC) (Melfi fom the Shri Catheter Corpinon Ree 8)48 The Trauma Marne) {g.72. Yard oaks LA ai rm Arche E418, gee catng; thi don mit ler he snk of erating Cite tio a er da arya | Aavancedaitey sii inthe ‘Al nvnce wcsqs, rr ctrl abaton Lo uric i Severe an invetnent Iya equipments retrhne {ata ei, Fac il tS pred fy gees Hes ee ney tatty one provider et tem wl mtr al ‘ions Mere npertants ple wilt att en ade ‘lle tobe implementa Chapter dnc general tsa ‘ena lebct here we hight these pei tothe etna se , Endotrachea! intubation. This prise the pacment of an ‘pee eae exept or Sous the fa be techs, [roving diel ote or ong wotlation id rene re a ining he loin pretation rr aprcin, Ort acne i baton th mated fchoee fe nt patient nth neaotaches Frtuaon ‘a slernive ia cra apontancucy teste Tallnte vith tench oth er ialiy to sath the Ft the scat rae of nan Inttaion ewes then wih ol {etude oth are dc n aredta in Char Ye Dita nuttin The ecg anal wth hie sve tthe ‘eter ornaiy to dieaty sulin the ern crc tthe Fel ted uti copies tne haa ents ott fr ‘shined jwise Digitol intubation rogues an ucnsd Fatt all a eek ar tte dae te pete ‘ntndiatvaeiothetaneehe tgs wil scandogaees mea =< can W Howaornowsepcnin MERI ot Qyoun-py >= tee (cgi) commuter. Wile puting the tne dre sear with he lng ager snd eating he epi he den Tiger the endcrachea abe bts Waly between the Fingers {nt th te opening. thas the sens feng este les wher injury er rv serial mt ect vention of the alts Hever, teTehiqu require eran deters ey ‘er the pdr tonnes ura at oe er €.Tansiuminain ight sty) intubation. Ney developed it Toten dec take avenge of iter ecg Yo ad ‘eal intcbotao A brgh pt treed ne te ges re the te mitre neck ooh sues levine opr t ttle erect ge png dl sbaagn eared nbs (@) Te prose eal placing a ma, plate costed yet ith daa hgnteniy tino the nda tbe ‘These tute arent nt nahoekey mick tape a the Iie 3-4 em yah gh atthe tip (bt nt rerun Using toning nd rin whl the nner hd folly vuln the tongue fervart, the nlc tbe ised ‘ea the math and ine the hypeparys od tin When {he bret maine pw the teaches Che aye eld {n'pnion whe the tube advanced its the ethos the ‘oping entered no ie in inte ln it Sense sete marly ewithdrm an entation ‘tteapted.Gncatay intubation of Val teal ‘prepara ar gs ote ie po. (2) Atvontgeo of trnetuminaion iotutain cide ably to Bera tte org ata rae sedan tient mpi, adage lad aie in ring platen n igh amish gh, ae ian sd muta lt ious [line led aaa none Ue patents wth ncmplee upper sway citron tit en led th sta ford maneare Gecnsed in Copter 1. Grcetryolcetony, Paramedic ght nurses nd other providers 5 Aas dows Praxptl pers! provide vetty asst {mile rd ce hate ae tage vet, dee 3 Baga devices The gee io clang seleting aber teeth tw teeny vate The bag he nConan 18 ere ton at ea tach ce mano ngs ae or ea {ten Whore with roe dled Og 5 ih Day ‘ye at 12-15 Lin presided by weupplemeatal een tt vat ‘eee ba an dlr to 00 to 89 oe he bag ask ‘etc tn te edt sat pentane tsps fa wena Ss patent 1, Demand lve dees. "he dena vale nous rgee!e- fermions breathing dei lv 10% ys hgh fa ‘Bc 0-80 Liman A pa atten niall pen to owt te atin Adtages le eae ef toed High eancentrden ot {inered aggen Dianna inde hung eer bi ise anspor psi tenon, slit to oe0 "The Troma Banus dine patois aceon af the denratngs, demand v ‘eedgounied enon gto ing eed ceria « Riomate venistors are trey costa as pened ‘even They are porate sod urly Hav se ee wo cn oe fer veiatry none ne or td wae: tad 16 a ‘Mapes oa with an edna ae . Field confirmation ‘ef racoa! tube Placement Canfrmaton of proper thea uation seemed by mips et, no Gat ‘aod eis ig. 31 a Pyscl sasestment las iselstion of he vc cae sata ‘ae ding lub sd soni fate eth cunt ag i te, ack cry sondern ep ‘Demied cotter mothe e mont potecte eee eE 2. End earn once detector ln sn slrimetrc deve) pean ea he eh eth nt ese ‘hos dtc en expire CO wth levine 2 teresting Sere pncement: Semsguanative CO, kattrs ay se fe ‘urate in iw plenary ero tes uch ance ore mae seein ea re xe ann ee ih ns capred COy sot to anim corel fib a nse dons cat tol rhe end the cnr {natty hea vraag at wk pe iia Inceten eral esto sin 5 aloe oxmety tay caturion mentoring ean est tosses ‘eprtary adeanss however trl ean ce tse fd Ingin espe fare Thin eared ith tec! ties with aig inthe le poetry wih yea pt a he Fig. 7-8 Confirmation of rahe tate placerat, (Prom Copal Ed; Base ‘noun ife support, Se Bagewsed Ci 8 Pree ial oe) on< cxaM H RemaBe-ronmepenn YOCAHE 98 Gpowt.py >= Prehospital Therapy 51 uty of sn rapid eimai of tree abe plat oh be Rade atin eon ster oxen 1 Other Procedures Thera Si wmverousaceust ard eld erapy, rar a ee emma feels ad frac, a na earn of trauma fall are a et time lg tee data cupping proce ei erat peop oust th inten (WN) ag eecepied wit dayne traeport wd aber ile ae ae agacaly srw anager net emergent To Famigs ecal tera stomps che! be made ring etre im ling, eter een rote to te hort Ds LR 1: SE i eer sare pti fo a hry 2 Te pe emertred that paramedics are 0 werking Fala. stern a 1 et emai patent in he bod Scot ence rogues grok eal ofall ber cf Cm eee iid TY sce enue oar Sen ita dats, uncnoertve pti the er. Sy " 5. Fate herp Inthe Held. Contry existe vee the compan, ter cl gl of ia nrg in teva tient aera are undshi sod the spec heat Teal the amount fd ore por, a a au dat mt pene cnter en Tu 9 ee ied mmc, pen beta, rat a eased ere Sse dei (Chapter) These princes ar sce im dal Cpe east Scr wt ge US ttre anmer n cers SPUD Stone dl the Vcnam Wer id demented i a ere sige eee ae thera inated wml el 2 Be Fo mm te rt ie Se nes Me, Bea cen on oe telecaster oe ea ‘ee eich at tae ae ener arharaide te iat incr 2 ah nan a ae be Bethy cares anid estab the tree Secret + EE na inmate a SHERRIE Glin nd othr whose la ee ead sae tanincn sma82 The Trauma Maal Prehospital Morapy 58 ed ppc tot ino 8 4. pad hing MAST trv Rn ey ‘ema aye pl pa te hn te Etre sieiaerae tre tetecemter rca cerry pel eget ater ob rte pe hee ne MA a a ee ee Un betel nce nd tae ih Pecea gie e Ma = = Seer ea teeter Seater reamneescertccmrat Stree trek totem mayen fe ee ir caine pal pn at oe 1 Bold ren geemetregann ame eee lent ise te ser tleh rem cgegses arcana, Sener ce ntabans 2 ee ental aaoa et tg Re ey era rae en. scat ie eee teehee soared ge aecrnantctaanes Or tn i at Seo Gafeacantgebecr cette Seinen acne cere mecleteiaraareeiaiaitccmeictece Eo uaesatarerrasy itera iiGransiewrtghanm cinta sac eon oor Rapiecina nding coe Guiraceiaaa eae Setters cegeeen Genrgca eas Le Eee eectesuenaraaricete saris mm iaicpacmeaeh tie sae iitag ae raurcaeamere Seco rey ee os ate oes ceppaceie ie ina sare SSeWe core lgorieresicaatirs iam aetaworsicgrmaewas Boev telacan ee acer eee Seance eho sateen is acum ua eect Eieetorrene peered « sepia eeacai GP er Sete gecmanartncenc Nac amonnimenes Satie mp ioe me aoe ie toad ean W DenaBoenonmepcnn MOCARL ot cinpy Do= Micletions, Nel recon shad be pafrmed hen enon [euthanased or ape Thc can led to are ‘ratory Stes shou be moneda steed et elon ra Imothorax Dagan ne el wnat te tcateprrto sie ot {be'Traune Cente Tesin poeumetier shoal be sped ithe {gute ve ect ffeaharbyeerae tcc fe Deca eth ode B Trahal eae er the inte ie) © Dit nck sin his mayne be sn the patent who be Iyer tiny be the eas ale f Cel tee renner 2 roe, rine hal re apy he ie Freeda neat eee Irefecerepeer ond ig. 74, dig er ae act (Maed omy Chae 1, Ea {Std death Th ac aoe cent See eho Pea Rc sper eb Sho iFotmiaga 18 gmge nse cer age he sombre ewethat eaten: Theoret haul be pint in anatamie poston ‘th the ent exending above sm blo the facta nite ot [sto Ib ptiot rise rarest etaghning presen into putin enor Drs she be pil oa ope 2. Spin ypon Many warts ne depoe of sophisticated slats appear fr tens bret to the True Center oe Einegeny Department They may teas sng aen ld up pemgagr or never ab see ‘ta ation spit A perl pits lowe, ‘2 Carew spin These splints remind fe heyy ode ‘Rnd are mest fr singe vas ont 1. Boo spins "see eon il dure, sd ae made of sgh pce weed eto sot cat ara ge crepes Thes eile the ifr atrenaty and ae tated ‘st eto pert fos They tre wus ert elle oul ‘lm he under sree 4 Nacuur spins Toe se cred the injure nb Ite fie Irae blown nt them, then and vcs ie pred thot sen the tint «Traction pa Tene re ee fr fer ete. Tas al ing ‘ne np iar tection op are he tc eA ‘atc fs its nares ei teng firproper cern + Ep dy ie ‘ape They ew toch fr sling etme that cant iniphtne, Secu they ar ena tere pint cen be shape {e'mttc the extremity ality unig to hes, 2. cCompleaone though linings sl a ete a most patents, ‘Simple can derdep, incu te flrs ‘a heurovasetercompromies, Whtchver split i used, itd neu frvtuelor matte must te thecked beled fer spine spe {i Rly eeonmine the eneerty if ay pest ert hes fecerihe pen cpr more pin o eee te ieyanic of heats inal the spin Ii onda ‘evoakly chek the eearoratlar stata evn ett any of he ‘Biv oaning When iopezed neural sett set Stl {efEeigy he plished be ized nd the eure st Pai: Whun ident, crc fr nears sapromice mal ftening shuld be underaton Gene repottening should Axial sine mcbiaaion. ‘is Pronoeptalieeatore. This performed whenever the mechanism, "i eterno pmol naan ne te jy apa Shrtel te precoiaceey npc of pd mieten drs Unk dts inl ol redigreghicexamnaton eh be erred ‘nthe eepengy Deportnent Pants with evs ysl gt (cp, keny cepence’ palate step) or thee wi nur inp eg parrthene eahons polei cent ith pio ed {ejry shuld age copitl mmeilae pe ete. 2 Cinial elerng ofthe pine sen cannes snd shuld at be pe Seamed ¥y eld perenne tecsze cf tina, space, Serctng ry. ‘tered ‘cnwelousnae, nd ther concer Yes aren, Bld Cotrl, vascl secre ean pele ndeguate afield eeluaion 1 ‘le i prebeptal cri einain high es spn fe Sch norer ond empbcis i placed om the ier spiieation of ‘inal mien son MCRD a0 pou. py >= onc ean 4 Mesatonsone Preheepital Therapy 6 2 manatee mgm en tee ee osnttyetrare sen ameortce ae et ees teams SES behiaay Soribwn Serene SETS RS BE nme Rese ani Se rt ant ra ‘ual clas cried train eva spe bars wl be Haier Seedscantehsg ny tage ete Setiicrie acne mane Sua ienaerasaartned mats ie Crraanire ate at adamant cia ignacceta ta acter Zaire one ean SO ace narca fe ieee emanate lorena pnrngaeart te In eonjunetion with a cervical imeailization device (CID) a pine Titel haere earn Griieces sccontutenar giz Fumaifignesteecaraean arena . Coral i (CIDe) are of plastic, ear Sie ne So eager ising erent siti cGaramenaereemoas Seika cern eres Sicha arta sober ene ot es Se Ra erarenra hee Sees ee ireem Suhre ruses deci seg mate eae in et eto . Beeman mere sie aromas eeteraen kas eeuteetaiar meaner set ave ei oe at sacs Parte teacoean aae gion pee meets Seuhouecurheitnnetccirt Sao Sooiee eae iirinsactloremparmarcisi ti ingests cen ihe cae mei gers (Stave the ea It hon ben aed neu tele exe froin toee pee ie naman ane Ee Ste ee eater aemmurnberkeusnaness "BBS mam me hn on maemooor, oie headache nd, bck, eats mandible FiSuMgpiosinn of etal fnmchtiets Govan tea {ecm patente Ping hind tne cap ne ime ars ‘rt nd lpia ue autre stead se epee Inger nth poet hy psi ge hair Beer et es ee Sz + Tnlmeowu sce shoul te ten el nl tio injured patent in the + MAST iieee ee penetrating tos trou and ite oe in treum care + Salt cevied' ad mia tilization should be done with sli Alvis ina pint with astspeted jury sneer ar feet sneer REE aca iden et siete Rae fg a pee cr sea Reva hate saan eet septa RE a pty weet mee eet “Sea mas CHa a at nt to eee a pane tie wat te mene rien genre cerpeNE actin nna sg mca nar niga foetatanent its tae ee Sa arent tg ate ee nea Fe a sehr ar aia red Sat a ees ces ae Seer Pais Fn pn ott Sak iat ayn ga Se eee bee aera ee acm SEES te cde tan aura ase SRE tant nonin a SE he eh cance ie Beha onaH H JeRaBO-xoHDOpoHN MCARE of QgoH EY >= men T Tyrer ee __ {ELD TEAMS: COMPOSITION, DIRECTION, AND COMMUNICATION {Writ THe TRAUMA CENTER ‘mvs rp cr ie a we ih el pre a era th car the ro pn ce so MS) lennon hey improve ese ere eth cy a ica acon Io acta care a ert tet ral ran Mee ent wih th tens toa member. Toe jest and sper tbe ees proves and 1. Ei Prowtee Se rte ited States Dato ranean DT a ta pe ht te em le ch ee Be et ef raed Set erie sti an eet ed oe Me md, es rite fn pr fe cre Te ES een ade nasi aa ee kan eserng cave toc cng 0 scents Ea ane pe See eceessis Stic ease ee Fo a teat oe ce go ene Tne termnuley used to refer to hese certifestians cam “FEeugeney nee ccna oS ETA, Ear ee ee cea Sn ie orn the fo dc Face or ety se it ate el ee mig ENO has rsd aprecmoely 100 hus ck Set cr Seda ea eet Ne a ring hye cnn than! Ses COP ond ot = o Soctey rude erin narod PR Te Srey pee errr he sate Bh cnr ittor toe ac Se ace ly ent on Sesto Ae case ICA se See ee ee te cet catia ie ‘Stoel Sem a in nen cee Se ne cane ae Keer casei cieuneanarbe Aa EMT es rol ny ekg my oe ae SERRE RSE SS ORCAS eending of asta 0 ps han dacs he reviuly 2 omer heath dre proteslonaia. In some seems, ered nurses ‘Spaphyacns serve a EIS prvirs They are et Hey ob Yor ‘Fat sued temper oe I eda! Contl of Held Providers IR Metal ent i tpl defined othe eecton of pint cae by a Boric who id fica ot te Keates the patie ae fe BREE cal entre a tae fe general erm ite wee. PMS ye ems nen intone lth to diet poten care Bic ar ne in no dnt {ject ete ty gsion or 4 pyitansarpas Dee meh ‘Snipa Grvkled rao em oat emerfeney Soper, ‘here erereny getins de! the ear ef ptt wi wl ie een ct er tA common lame te us cet oe ‘Sm wher: in in cpt fr sea fies Ta fw EMS pete pyre rep to Ce Feat ft energy ind provi en Seen mice nna © ct medal orto Tha the us ff inact Ik ar se LUteatine of ENS ponders, dovelpment ftom pers me ge lnc inate pou ce slit ay |W. tnt ftietion ofthe Trane Team by Field Provisers FNM nail eels ‘oul stempt these nlp ama ak Kiet 2 jet ‘test eter retrain wen shh ‘8 Important ita! nformaton Tis shuld neue the mechan of ir, ‘onber fated, ny reuse sonal ence EN fre Plo ‘tpt ie hd pcre can peor 1. Cocrdinaion of resources This wil lo the ENS cimamuncaton center teecrtinate tho meron reopens ad eaten zorens od n ‘tion ofthe oa aterm Tie pinay opr: ay hl the ‘tava team bce the herp based ere egy aie sd epee cerned peta arth is sieve . Types fcommunlaton doves. Sever! cman devise sah ‘mit apie by EARS set "st wanamasion his the mont widely wed! meth becouse oie fe fue nd con. Spec CHF anal VIP ra erase fe ‘ems mde or mui un Ahh dio commun werk ‘el, signal ually may te poor Suntan enioroen mad eee moles erm Rae gb do mpc thr meal wale Tene fnd’ mason nen = lied umber of tgs ‘rant: Coucotity eid ty the whosptad wads oF 2 Lelie tans Pre lhe i he xsi ‘Glphone utes nated by Inka ptt and ily neat ‘ith part tenors (HOU unis what sda es 2. Eien thie oes he es ef aie he are te ws oe parts ecru {eletety how i Stanley to asain: Arges a be ‘ae wi eal euler to rane EMS wt ory se ‘che 4 Tolomety EG data can be trina vin ra tin topo, eclr cle: copty i a stan pn ot --< ena H emsBe-nonBepene YYCAHE 98 dpowe.py >= Field Toame 5D nyt er tr ming ve eit sae sgn BO ea ge yee oiewranige nn, 2 de Tae era hata hn aga secre ce int Si ett ool Mtanopor rte wel conta nine medial coraiand Si cae tat et de ms senate ‘ped at ce oe ld mera tee a rie hice vai he ne er sxc i th a ae ae oa TEE mee abc cn Fe ee ag eco ar one Tea pace echt, exetaton Une, so etal ee ERS Iraint eicindeainen gee a ce ri eS ae aren eet ia la ae soe 1. at Meco story This es sgiieantrnjor past medical sry, tens hz i ance Sele * BEES ccna figs. hie oie arinin roe rte ig i ene Fe Only ptinent postves an sect pet an a ete Sab peck Reiter Soe ‘Therapeutic ierventone: This fntn specific interventions ven aod Teepe ree eng Se mel am a nn ty cn adage in at hence 7 ‘ecehing station "hes names the receiving facility and estimated rhe a ER ras yd ot teat cr en eee tr a ls ms olan a ce Sa an pcan evi s ney peice ose ie sn nner vies sie es ence fie pen 2 ements Sateen al Sa ct a en an a SER ied eld wate ae nea wit mel ih Ck com tn le eng Se ‘pee erent en gata set eerste see ht ne th cy Sin ac at Soar eee uma tales sould be aia wath tho map and bi of fei roi ndtv ptt to Uv rau Conte60 Toe Traume Manual *+ Physicians fom all dcipioes eve a trauma care sho be inv EN techn despa Impress 2 AM ive wth + Conmtieatin, rin cc tld rated and evant ore Ciena Pe br : ra cae pecenationsI Tensnor OT: Cran PR, Rail Stratmeie Dandie, Piast €5 Din Lars on? Te The ‘te il Devine 8 Chaney Onin Sede Ta ther ad prc ten Are eg td neo 188 ‘elt Ace Pepe PE: Me cota I: Setar Gt Cayten CC, Man feline Princip and pte of emerseny mean ee Flt 8 ge tosica-sist Se ee w< cant x RemsBo-nonseponn MYCN ae Qpanespy >= estes pes 5. AIR MEDICAL TRANSPORT Etc A. Davis and Michael Rhodes 1 Genera Sx sr on the experience ofthe Korea and Vietnam Vrs air moda rae prs poy bette ae pr arte ar In th Ute tates, Sele rao mee tec ‘enero pay 6000 peste any, eo om are rue ual plas Tv hrs in tempt ave ners, wheres ee ‘Sinton tray dey fom the seme Pty even the ics ‘exuding ht four of darkens 1 exuipment ethan tracaprt dey done with rin engine tngters pei as esau er avenced io sper. Mont siren wp too ‘eda tanepre and tg retry olan Wo the pt 1. Bact fh the enviroment eae, rederng aelaton of Hood fescue ee eat suds dal Therefor nal epee vine ered oy pation er etaated eed psc afl). Next ‘Eeecports are Ping sryrenmately 200 fet sve the grand, trthend amueringacton peers chines sch ab exocrine Whores tue te iar) antabeck trounce (IAS itlaton Fhe cew cma wth ach ther vai nts nd maybe ince ik te meting taped ame penn ot farts ows the cng an Cntr be tee Pe fare rape R Elta trmport by tte wae det once teeters Sea Ses ve sae at Set matic tener fr ute oben tee slot tha {Shc alert wh spared’ hea gt ay ‘Site ailosuon Horeca genapiccpei ana lot ‘Taohun i cet Nepal wr tng rte foe end be SHE Cet teen shui be sped ty el ee ostigti ed cco tin, fare ptt ly a to's her lea of care Map stuces have shown that te al othe “able 91, Onoene Rept ise “Trae center candidate bse om tage vein >i minutes to he teu eter by round {eel ambulance to service Wilderness ee digi veins ‘Nendvancet fe sport ovaiabeniles oa ieee Se on mee wer 0 Ne geren matenie nto tare ‘hs rosotumanded tinge guidelines br erecane helcopnr trnopet (Table oe beammapeptnigmentermness mana sve {geen merece pe vas Tee ea rig ee Se a cara ee ae det ce ee te saarresynn wae thet decompression, ttrvenoas OV) acon, te externa eta tem. Sincrarice greta 1: Na feats ie eed ©: IV anal ston, nde prtn ll ain of ‘ences an bl padre dia he ssn Fl. 8-1. (A) Air view and ground view of safe apc 2 i | ‘Air Medical Transport 63 otis most te under sre mal cot or predetermined approve ota. Helped Recess Team A Roce ean trun in Mele sfety i sully devigntel te sia ‘height eet oding und anaprtny the patient ue hatter tne emergency doprtnnt Yah hips elie pity othe roa ‘ation ee, tho ned fr thrapete eterno the hal nh 0, ls eid remie om the renuetaton area fe wih eetar tr errr rasp! asta thraptti nterveatio, th Se tah Algom srmey a omprced ptt, ay te required o the bled tthe deacon tal pos mad . Enis rst number of entcitative pacdure soul be performed Ahe'htiped teas lag to he eergeny te true depertent Fes thould tein senifing the need fr eects esa pect ‘re; esablekinent fa sreaydyreting eon poeumetires, ‘Seiving dest pres to an open ceding woud or adtumateatin of ‘eee tres ond emt ry” three [tt erred inte eegency Dyprtsnnt ornne Center lcs he Fen frat ate prof danas tat cul mpc hw maces of these peceres satay 1m tranmort i primi en aviation event wth ze! ey tent Ae matical sty an abanialy proved over the pot cede eon, Infevra 60. ing na 2 vnbilty ore roid ih. Tie tobe warariscspeciie depentang cn the presence ef ecm td ect ee ‘ible 92 Salty rou the eller "The we softy strane boul be pected whether he helo: engin are ‘ao stad Tena theses operation, go hash te ‘Sted for working round the ols ‘De nt approach the biter fer nding les ignated todos by ight ‘cm member eran ear of tho Blt ot lines une sccm ya ight tn ‘When apprncing the copter always approzch fm the rtf the aera tod eo nay ini cme eto When approaching the hep ona lope ever epprech fem the pil ‘ie Kgs speach othe dowel sce Cece the Yt to he [found chorus imac pester Aung be aware a the ede dearance Set Never walk wound the a ror are (See Fie 8-0. [Nowruteraed personnel wits 200 et the ara. ‘Nounokigg with 100 fc he sie [oleae within 10 fe of the sera No mbes win 0 ft othe sera. Ne Ve rather eject ld cr above the band, and lng chet shal ie ean parle othe round6 The Trauma Manual © Te lated to compete a miso shold be haa on sation tare 12. Campetoue Stainon pega fer grou pre fr hte ‘oautunieation tte ip lang soc Pte paranoid ‘und the arr are oneself my FG har ena ent £.TutleeZoutines tatty conduct are! the ptr eer at hee na boa helipad The utc sir medial tanaor fr trae pati i depen on app hate age an the si of te fight eens Atal uansport primary eton eet with medial eampnent. 1 Névrapprath atop witout he sntance othe tht see A-< ena H emsBe-nonepene YYCAHE 98 Qpowe.py >= 10. INTERHOSPITAL TRANSPORT Hector Mt Alonso-Sena Sm ty te neti a ern ee cee Sieh igus pee eneeeme scans souvent Eva nena, elite cer nai ental heen pi oe ni et Eine nat eh es Sess eg ep aa eer hee ac ees oh ae ae rae Seer aay iuie femeeeiia donates aed Seah anos anise Ce nant prttysamet en ee ‘Pra ace areas eare eater Soran reaneetey tira ete ics Soi mensuatan tema ataetetnare Spee reson ca ereteemte fey Se eaten ie et eae Trot aktay ell Koo) tothe ney ecaiats: Pr ean oe ses ES hoor ratty Soa caer Sara mena maa ote: Re on wy nin tena ns Repeal Giese ae racaeeconfaae Eee cammunnmaaran ten marie fee piece emer romero 1. Fema creumetanes proce wh wil cr fr he att ring ta eater crirac tame ratemtcstrta fiseetteesmnmn mae emma: EES cers er a ec Soma nett ticemror ce mo eis nt ey ema Soe acme 3 Hong End nn a ieesh nee cinerea res ‘5, Portnon physica examination nang, pest ptint edition, nd (6. Potente complications to be expected during eanirat.©. The tramgot tran stud then germ thir own diet evaluation, ‘unseat iomprnary survey eit tray tren The Shige Ltr the loin "Bocumént espatory saute ination of transport i ech te ny ts leq penton tsa «Check tor appropriat functioning ot ventlatery equprent. ‘heck or pace tegen epee spain unde device ee, thera) g, cure peor 1 navn catheters Scr aces spe See atin er vee eal odin Bn a examiner ard Giasgon Cn ele Recnoneelbaee = ; » SEC eee inte ene etme 1, grep BREE ematn tae nite of tne wt lt he fit i ee tin rae te se [aise ttre uns amas ae rl ta TREN crestor re, nen i alg oe aa ae TicSiete the ata meat oan ae ent Sane tne deen ape apr Ene ech hn ahentage aad pce ey mc HevS Sh daraePactamseewering yee heehee ‘Tee i St chp seme oh ich es emp ee Wt Sea ln Telia te Be wt pln perth eae ee ected ca Sanat SEEEs aa ee Tt eae eae a a Soe hie alse caters Seti Saison cri aie 0 ey A ie apatite tee crue Woy tpi nd ed a a ee Co Poi ear ae eas ‘Srenkeadiypovate ptt ten ens Comma Scores ics aimee See cee He Sanita pn So as ee Ee Wm die See se oe a a Ei Tie atin wat ne li saa he Ey ope URS tpn waning EET he ching iy he tmepar cm must do ete {Sia Nnry nat lone yr ayats say anges ee rene ‘ed interventions In ain al documeneation fom the eer ns --<_cxane » Remationonnepcun MOCARR oF Gponn-py >—— 4 : 5 z Intetanptal Taree 67 ost be delieed 10 the seeing te leader The tenor team shuld ‘rnin wth the patie aml caret pul cured the reselng Proven he pulent should remain eid ad merely th ras Rivne am vil eprops anaeran be dn toe eqavalen hp A irapensihlity hae not bon eeu during tanga, teary eng tothe napling ttton eed phys oh ariel tho pie as teense or sagnase procure th tote trated tack to ht ‘ginal imitans thet elation ply no the eine ope {GiFtPageatie procedures ceva ner eee neve of peel ketal als het nit be tera tac thot propiate {AeTemer of pnts Goes oe fly to aor i elated by feat ‘atte The legion dat created the pen stablation ee eer ‘inners fr hantale and ign the Conca Orbe Bu (9 Fecoctation et (COBRA) of ts aso ww ao the atari ee ‘The resuontecesealy applied ony to that fet eee log Hepa {tha ben cere ern oe and unto the caret lpn senda ‘Gono he mae stv of src wen to gararee equ coe © “rene treaty tol atinererparce oft ebay 1 py ‘R's acumen of he CODE reson eter he scope of ie hapten tat tierce ral pias and ines eligi {rit startin se arate of na pete be far ith ie {i CORA ates responsi forthe pan’ vant to the Fler. fing heaptal and physician isons can tout meena. Nidicare pvp far bth nad fs of wt $0000 per cach spect Infncton Reopensies rte raraering ton na he etn be filled pynatane are ts dient yt aes ‘tography [ners Cole of Sugvone (ACS): Saiiontion ap! tranaprt Ine Adare trouve if oppo (ATES) nade mona, he Chia: Knericn Coleg at ‘Seana em Gay hee a ri nti te manger [Frew 8A: Find trancfere: How to comply with the law, 2nd ed. Dllus: American "Ces af Emengtcy Phyeiians (ACE, 1 ‘Swan HO Storer Dc Demir He ta Berges lial Serie EBS) Commitee "hey fenare and Basetion Paper treaty Defer. Dales: Arca Co Iege Energy Physicians ACE)1 TRAUMA TEAM ACTIVATION ‘Theedowe R Deloridge \ tnrodction. Healthcare fie designated 4 Tass Cones botte the ‘ree fo roid ial fave ere rope fis seventy ‘AC dept bythe Aree Calle of Surgeon, eve 1 Tena Con {er pons the eapebiies and pial ueurse nesta) fcr Tei aura eae nang eecarch ucaten preven, and ei Aston components evel if centers panes nals al tetures ‘itu eqn the research and eduction erent Lave Ul cnere ‘aay panes lied satan recurs fr el ct, odin cer tran ptiens and ening thee wth ove sro mee who are et fereretod ato level or I cetee 1. Tea am not i rn Cone ri, Mining {cable quale ra ers eernnt only ivetrarl ty a Tan Center nating te comnasert proving quay tau cae te 1 Aetiveton ree ‘Rte trae toss ia renouron that in aval to all Tena Center en lowe nr ta th tr an sae Fe tents owe spectrum ours ae pte by emergency me ser ENE) fa re By a abr age 1. Tomi depres Gering”arpeding el epee cri al lie tat ‘are fr tru patietn banner erin a tere by {ie eum eee enter fcturen Nonctlnybet ateh ‘sourer tian an eed rts west varying eels of reper ‘eyepiece epee baed en recur age. tie and net ©, Naty level and rum Centre curently enpey rage criteria to eile the a evasion freuen meme deploy pre Sl equipment Devdopsento rach era fons resto Tht ‘ory tro caegoe of patents eve at thetsure Cater, "t"Thee patter hove in ste spyorly severe al demand an "meat meltidernay appro el for wham the frau ea ‘hotld be actted oar te ther sera atthe enter Tce patents Fave lear einer oie teste nary vend by aba lily etal seme antenna erating irc jy ‘irate: pti wise eee opr boing a term mc hcl mcr woul be oer ar pad 2 These ptinta he inure, pot ir nr ny ot sae Inurl ie threaten. bat dateraion e ce They ay rot require the imate stein ofthe ett ey bat ‘Se tt sppreintely walatedimedotly by tual Boer (enc Departnen staf opti with ori tefl te eat Somber’ snd ated here such ldsaplinery resource are ‘halla. Thee ve fen pent th sean Schama ef ‘pte th minal or hoes ease 5: The pas who euld te managed st most est efits with {elled emergency Deprtmne raft with onset mi her Forder ae neds. This epee the et reared core ey w= --< we aan mponae, ‘Trauma Team tivation 6 the same rcoucee awd or not eer ace entaune a a webb mover gee Rc ew rt ‘Echame: As rtd, pigs ad anton fein ae song presi iseatthe nd ir eiuacare rear eration. laine ny ted tp ier soi enaioemat rama 2 ee cae a Ba ae ce eget aac ons eae cee eth Eos ea ae tear Scacnuc ate eases aor ae ee 3, Anoramyle rue eam. activate criteria i eed in Table 1-1 Rechte ncn inet iecciie siemens enat Bb cs ay sen ene a rang aetna Sere Pere orne minccno ccc Te arta regen be pode to» fl ems i eed 4, Reso ot tire responaes. Level rman exter ing Swed Se aries tare ig tt {il ae nd i Be ety meine fie sien tert ine oar nekarter pects es Succes eterna ermtans So cere ma raat ieew inter arly eos Siccg see weer een elieimnantenmes ', Rewation crria and wie at thor tra centers. Fr vel 1 Sree ae {Gis aco mpartat Hecarr ncn nid merge my piihewausymmresi eens ia eile aap nar aoc ee Seine tha eens. idesseteta te esata tn incre sige Se Geer er ucmiatrhceertae Seiaarisieteeaecmnaias i sceeyper ion ue cae oe Fave bear todo difleences were found between cheered de 1. sunmery he onus ua ring ie cmptemine iia Saha aa meena Sorrae sain eae Srcnasi unmbahdateercias aie deteableresouce ie appropriate ae tnncard era eit tau tam at ‘aio important fr ll centre t evant ther tment eg ‘ent quality tnd svsaley ef reorom, snd prepoaivay rate nua ‘eam adation cider that re adegutly diapered and evel on a ‘ging Sach eet enc he een) of eta patent ere, ‘Tle 114. Sample toa lam setitin eitaie ‘ll pone: Emergency medi and trauma tenting, rama follow c sxior ‘ral rend, to oer resent ern care wr anes atoning oF feos radile tecnica, reptor fochntsan three mire Physic Tespttry strat Intel er queen of airy seit Syed prssue 100 a Ht any ine Tensening want the Bed es chet, hae, extrait proxi “he ne er to Apolo or delving sry proximal eka cr lbow ‘Muli jars Fateiet Suspect pina cedar Stipe pve actare ‘Teo mot og bone fates itp patients wih sean ijn Meant ‘Peder track by vehi meng 20 mp Partial eapone: Bmergney edn tong tna fell senior seca ‘eee nr reset twe Daren ody thm bee cle Seated Nr ptints witout iio nen Decanin fijuryint meting evel eerie) Tall>15 het Mayor vice deformity Vein pescengr emer inten Death anther ete cesupast ale vei cath etexptr ene fight ENS personel vequct ct mecing level rte) <-< cea 7 nemnte-nonmepov NYCRR on gpown-By >= apices SELEY ae Nowe FT inoue run ren pam ore: Gn Finan eaten ate ae vig Ji Siig tentang er x on sottney Ca Bench Trou tam stvton “median fury” nt ea fe et Sgt ora See sr ett wey gr rane i ier eesti fauna signee Spee tea am rao emery menage ata imam Pins Sa tk os sn aa Se Coy atl sen cer Son ie ch 5 a12. ORGANIZATION PRIOR TO TRAUMA PATIENT ARRIVAL Witiacn Hot ere Wlenee! Rrodes Lhe Touma Response TR iatutonal apatity. The kl ar neous that a nen byt ha {tet trun pts vary widely The Amertan Cleo Surgeons Con ites on Trauma haw developed neal etre fr trun entre Ta ‘ary sate a frm eater of strdtation ae ten ebb et {G5 tum center Altea ares ne fequcrly serve by ts entre her inured patents ae managed by organ rare tr In Stal ral etal rat patina sana emerge oF ‘ay ore pyetaane Trauma Centers redefine mews "Lael Provides» har moun cma tex wih cote rene Satie, operative, eriical care, and rehabiative capa Te {fanaa ta stall led ty on aleding etme contom ements Bgecan, train flor cen seen redent avel Ueetere femenctateentment fo eucatinthough pyesenn ring ‘ecch and etmunty outreach and preverion peg 2 Levelt Comment wo thecare ofthe pti suman to vl Teo tee However imal nscavee nch treating, pont ‘iwmsolar surgery ar forth ty sary event cation, a ‘ele teaching jhe regu tran en hn (Srey towne 2 four pr day Bet tint be ane a et the reas that ar insceesble 1 @ evel center In-house eurgieal coverage not required ce & “Y¢hour basis, but its evalale in ately fashion, Proper functioning equres formal transfer agreements te higher lvls care when nee ‘Most howptal in the Urite States are not designated trauma ce tera Many injured patients wll serve af nontrouna hasta acd ‘euie rap tial evulution, retin, ad, psentay aster {oa Traunta Center Altnough i unlhey at fl rau tear can toe nila, s refed emusiaton team with pedetreined guide ines should exist to provide initial staan. els of espore, carly the eel 0 total eet Ssinpletired trauma response, the tnunia teat is activated based cn {nforaion provided by prebonpial perc! Ge, eld riage criteria) ee {Chapters 6, 1).The proces of tringir the pate lowing arial the Emergency Department eliminates, sl the tine to define care ee ‘ily eine “Many Trauma Contre ue toed levels of trauma reeponse based en fein rr. sppeeaed oy prt sie dey {iw Tm generah mtr trate reponse cof ilo ‘& Pull response tic "trauma code” ene ed level troune pose) ie deed fer he patent wh hcl untae or een [purshot wound (GSWD; the patient will eie inet evalu {lor by a fll rau enn tra surgeon, athe, ne 9 forth eesti oie rie thretecing inure o-€_ exam w Rewane-nownepons MYCART 97 Qponn.y == Organisation Prior to'Trauma Psent Ava 72 bb Mesiied responte (eran let evel I trauma page it theiged fo the pater wih he ital forsee jy tne Cir the mechan f joy aa the inal yea ag, bot ‘Thc pylori rae era debating» hf heen iret guy Te compotion of he ta ea al ‘ary acordng fo inp aur aun conestaton evel tur page deviated fr patent ‘aged fo Tesume Cntr tad en mechani of mary erteie ‘eat ebviour signe er pts rberesingsgieant irs Pent te eal evated by enererey eran on eter {othe tener or appeprte supa errs ed TR General arte considerations. In hospitals caring «sient Sumber of tretna patents or were gure patents artive with a replied rans reusltin sr shag be slate ihe Energy Departs In cet inion nln acon tote ‘aut recat ten tmpracca hut every ef shld emt the dein pres to eure thet tuna recuacaien ta pace Sway {rom the general Bimergrory Department taf tn aden, the tan ‘aunts aren unt fe secure Sonmediel percel og tay, ‘Ee wide pera tnreai e i aout tne Operating Res (OR), Radiology Sue fen URS GEL and stat cl lores ther hoyotiant sideration in te mama recuctaton area mst be lang euough to comfortably ‘iommadate all embers ef te rau tae approctay 8-10 Prep) while pemiting al reusing any merce {tecire insvng the abdomen, thors or head al Mek. sa Ihe tlewine 2 Raped ntattion Re tl tes © ubeterseatany 9. Remedatiethomectomy FE Diageste perttnel levege DPL) Spliting fects Emergency bar olen® E Tetestenal mooterng Series® I Pacman of pel enteral isin devic* 2 Suen ging operant, tat the ight source tallow fee enero the flict ned osy miner throug hte ete Slaton aes emo provision fo prevent of hypothe eg es ‘tual wom thermostat contol oerhead honing lesen so be ‘ude the dpe Instenl guideline fr handling mule atints i the tour renueateten ee should te oertoral os Erp ea nn drag esac lig os 2, These erm should be salable in Gengrated are nfacent to the tteua rensctaion som ear ve of tna masa sonmultene who tay eter the rane reeweaton rea tht ition se ape me te74 Te Trane Maal {austen that camenty cca eh ptt arve wien jet Suto ene ee nai ere {ited wh hee net had th eporupt eden peste trv, 6. Equipment and’ placement A mime amour of ect sald be ‘ite inthe ama seo re. though een resto may {encom slimming superfuour equioent omic Msueaon ‘Se sol fittest fear Tova sqapst tu aul conta nly hoe istrarent ed ‘eur sively neat topo » fartlr preesare:The {tne shoul be caly noble openly Sglayed nd arty sen. ‘hed ith simp bldfaced Ie Huipment aed rye soul be lore fo minis was ext daring renaton Alogi “yea to armnye apne in "head eonlgatien, sh {HRT eme used pet head the patente erica re “fired ner he a of the stab thence aye store tear {he msdprti fhe steetcher aed eliting equipment stored 2 he 2. Renton ste cl with fury retrars,sould be felt teh ener fic nevesation pee faving em re etre ume each tech Bins) Urinary eathte iets tear Stall on tanker tranoprt {Nee and etree Aa ied pee ct Pace oan ea 2 dpm peasy to adéree immediately e-shreteing end {i cull te lw sect e121 in preniaty t the {tau fe rer st Moly ose aed ot “Giprent far airway managers itl fltpleerdstrmbeal tee mith sits egpen ucuen deve, ‘ral end rel ara, Amb bag leroy fay #1 eouiment fr intrevenaus UN) see Wood dain Irenoucr 1V tabingerotnyedetmy et Teaye #2 a 9: than tn het bes 96 P40 Fo, ak ‘voqrote sure aerial othe ote streteer aad 4. fui: erystalod satin shold be delved frm the warmer nga bath asl ese fw te hod won ad ‘una in nies, Staequenty need een Hd ‘ei etm pied ed comes 1 Chet eatin eat eg lear) 4: he ume ee ost salt ste ag he Srila he rewsitaten ace. Lanse, peta equipenent tb ee Uy vole and acai alert can be sted theless {Eko detente aye Cabins erent recomended deed ere ite sna re hese aon ‘ak 9 RemaBo-noHREpOHN YOCRRK 99 QpoHD.BY Do =< we ant mona Organization Price to Trauma Patient Arrival 75 = SS Her 7 Poa | | Fa i i r & I Be f 7 bg iiaaeaaag i @ SES resales 1124, Layout of dhe tran renunciation are, Prom Camntiee on True, ‘AatZc Clog of Surgeon, Furs for the pial eave of te inured patent ‘ticge Aamsan Collage of Senger «Fd warmer stcad wth ental ston Rapid iron deve 1 Citta venus etter pulmonary artery (PAI catheter inertia tom 1. Sat intruent res eg, thrnctny rch ape. vt Image, reyroitony tsi surge se) ¢. Ierste mont, Suture ere 1 ron van ex atin li) [. Stutdeng oaecaty te i Gade cart 1 Sey ew one with “bi5: Ant inning pacity ed terre ‘eigen Re eS oe tate aly «Roun sae veh peor hot on teh ae nas sae some ree tiatmetcg nny StriCO ie oa cn sed iamuceasea ‘kind ey, ie Mik f Sisigrataaty 2 Aegan a meningiren. & Beer teas 4 hitched emu hose int ee 1 Synge, aod 10m. ese heen 1 Stra a ot ‘Mediate retnciative paralytic analgesic and weave dr) Mitte" webcast yn on et o, Bind cnintn rm Eicetglnganirar , ‘est nored ins separate “pene trauma car The art shoul be econ ce al tne ss [Har engint te eel coat eco athe cain nw wna entation ae flat cnmunaten Seta ma tanec tn te ei ‘Suunto fra ss a acd he ‘eae en rds sone for ten cet he eset Cratrunettentt tarde dokomesetkscpane inte cif r yncin rt EESTASSeSa Shatner ieee hy Syst ang, Sanity taincae issuer arene arene as 2. Rimmer board shu pay pager and tepne nner fm all ‘otete see pre) cw tate ten mero 4 Rap crue vif rosette er areas ‘tthe nettion eel epic managed ofthe patient = Organization Prieto Trou Paton Arts. teh videocumarn.Vietpes must be seared ee cit td cco {eiectapes shuld be iad to ids egnt apes the ‘cape revon pss A poly tating tet the rita sre eed ely er ‘ay provera and hatte ae nk ocarercle whey 2 Riva otifleaos of paint eral iota fr peter, 1 Unita pects shld be cnpyed rl etl Sel prvier pti ‘pain inte ee rect + ulpen and yore! i the torn estan aren shel bse tal ploed + Dura the cone of renectain, sel commaniction shoud be Rept to + Trott team eer shoo mista a peecaic view of tna rensctaton, ‘Bograsty (Centre for Diese Conta. Recommends or prevention of HV termine Sn eatery ene MR SSep 2 96 Clean 1 Nite trou enter esp atx KL, Mane EE, Flan ‘ide Treumo. Neral: Apt a sp 981 Lay DE, Shcklord SK Helimgomerth af Vio ein tran att. ‘ons a elective teaching tga JTree 2845 THER Meo HE, ucstazon spd elon ofthe injure! pn. Ls Zar GD, ‘Bert Bling Wd he mangement of ron. Pian WE Morn Herr Land ts Tau center sa the OR AORN 44:46, 066 ‘Scie GW Hessian fn: Aercan Clog of Surgorn Comte on Tea ‘Bor fro there! pat 188 Chie hen Ca “Tonmend HS, Car R Rent Mo a ATLS tad ita tr ee ‘atin vie Haran an onto) Tre 3.8, 1962 ‘Teun hr Te hn te Ce Hg i 164 Chet pint tin tina ec isn uneven. Phe iUnera af Pea Medel Co ter Hopital fn veto ora, 14 “Anercn Cale of Surpcna Como on Tel Resures foretinal arc ef he ied pen, Cages Amora Clg Supa, 18"13, TRAUWA RESUSCITATION Michael Phedes a period of medical which initial anc Tes nice ements ieee mark gogeungs commenter ctagerneactcarene meaty ak ees aes et wat eee bese ae a toca Se mere aS gee se Ere eee ing ge cogteee SST pict Sait etal es Speen cieemenrace Re oe Ie et ie es ae as eben tise ceca Sees et amen See aetna ae eee ig tn ne eter Sat SoHE ec cerca renner Stee SE Re asin trates tear Boras airesereanie git Eecegetnean chaperone snag CE ithe tcc reek ‘etic fe amare ears tee A eerste reagents mc pi Eneieces aentirtame tee camara ea netsh inp crema tak ig ita Riccar er aetaneses (Oe eee Se sete eee i epun a a narei aet 2 REESE etmeuereaam cio mee Sma + Peat’ ainmy dancin 2 seasonal’ rey detanton iste or an “ag a a pen en : EEE yet aor ES re et LEER eee 1 ena sen nae on ae CE ee ats -n< ona Remab-nowmenonie MYCRIL ov opounspy 3 ‘Trauma Resuscitation ‘able 19, Phases itil norent Pray Survey (15 econ) "Arey with Capre control ‘as i enhengs, potency: ceric! nmebiitian Breathing rea randy, best wel, ek eins ‘cirlion Meratn, skin coer, Hood seu ck vein enteral ding Dud carl Pupil exroity moveent tp and ie AVPU (A alr. V = resp to ‘eral aus eens pin U = unespenine) pen the pti Reauestation| (Gener -BCG les ple ont IV; ro abe (Consuret with ie entning indie on rimaty srvep Incl atric and wethval eater or err wt xd SOY Seconaany Survey lett toe nanan nlading sine) AMPLE hstny (A= Drees, M= mucatons currently taken, pa illnes, Tilt mel Eevee eat oy Taine Maye deed vel far peratog rom in unstable patient pti in Dette Core “Srgory (ay be in rerscitaton pe) Solsting estates As: analgesics, thin ntietanoe Conatante Taner ‘erry Suey Repent primary wd secoay srs within 24 hours far elt or ise hh Crcti ofijrySblenHat with pei Weta fps Rening ‘die tm neva Clee carne Geto Tar: Ahad our fe perntome Gtag sta Cg arrose «taut amt § Set ees stent i Spoccemmoeermse ie TEES nem ttn daearia tice gan 1 toner rary eater if pant uuble ovo pele reste. iis veaceietesamet Cee Emma tot "Gat ray (esa rote)A The True Nema Meghan ———— ZS ZN Fig. 4. Inia emarseny department 2 ype nosy ao mga ses ace Chose 21) 3 Ritoras trap Seo glen erage Area Pystieny ‘bien Fangs ‘Gang Coma Sent (GCS) se 14 Pole or > 12 eatin ‘Bod presur <100 or > 100 mH yeteie Reaprtry rte <12 ort treathnnte ‘Tenpertore @2F GC) Sujectine Figs Poraie or yas exchange eg, Ses <9) Sever pain store hemorrhage ste) Cmbatee "Severe drmiun pi, ac, het etemiten Penetrating wou rom bea opp a — ‘cetacean es ete i -€. oxaie x RomaBinoneRcHn YOCARE 9m rou ‘Trauma Resuscitation 85 Iv. Reauscitetion Steps nthe Urata Blt Tsun Patient BAseae ayn Cape trian Seg tytn Iecertins, Ox arson 2 Treat aera ace Chap for ne ets) ‘Mitac Osby ink) Chi it Orley eter *, Radtrachest tation ama AeeeEeTemwcce,daph an oaity of empiri, okin cola or ‘nein acon) mee 2. athe Peck yesh wan chest eyrmety, etary at, ‘ental one Oy staan 2 TR Seine cee Chapter 1 fr spec iets) tt Entries tobe Re domo oferta & Senter nano! teh Mero ‘Angee . Assets eeviaton, en ‘Pin clr mare, pls pal Eek ef pele, od pate colar rfl pega cyan kin Geeta exter hemsrhage ett. eetenigrophie {ECU merterng Os stration ae rset tens oe Chater x specimen) eit are are pred 1Vs, drow unstable putt” ekrstry BE hin peripheral acme unorateeobeuvinn a foe ESOL tnd ger cate am fat poe ortor <4 Wily prefound or persistent hypetnsion > url Hoe transom Wage hype tea thine, base deity, taceardiy 0 Hale) Sek rss dt non a x es ma ok uns drt i © chet ten (@) Absboinal envi plptie, agestic yertnesl vars {Drv ates elroy taney ei il ences vrs ma, te (oy Enver! octane parties tera for {8 Sobetenccsve tntues with hemnrtage ba 1 eee ting t nmreveling ber ences ef hyetesion Mehul. {2 Tesin pematores & Cana opto tapenade etna hk tara pil ed er) os nm gts roth i a la ry mr) Tere ee einen arnt rede examination or Chote 20 Refs plete pnt inc an ares Cpe Cha eae {GCS a ene rs sen a i 2. elu ee ne ine ine nal 5 tet es 20 ot 21 foie)Manoa Beetle fe Mac pl cr ry Winer 4, Haare snes hain der ine @: Vererelotamy ne ewes 2 fapte pe Deper 3 ar ound mtr a ener eatin hea 1. Roan gras daring Apply dive prnerete contra enor Sin ©. Appl rein er ature -. Pragoriwogastc or rogatetube and urinary catheter crt oper ‘ty i nat entranced or nertorg nt seat orto teary testing arta, or nage dtanten <.Imocing inthe unease sunt ours potent | Suggest etme an creat station pera reusctcn aes) ‘SGhest raj comet er pater peter tee fh er Geral spine ara! re tps ery nl) ey fll eased elit) delay Piss oeroposterir (A) 2 Seeetve (owed on easesarst) 2h general aging Sheu be delayed unt seway, resting, or hcomoryoetcton has been sized, Exel sur when {Bisco orpeocrey send ety aaa Hed ce oe 4. EF sean ttt hemafsmamislly). CT sean done ian unetble tdemy tet doerpranen, cin to operate eiesewcese 1 Chest i snpeted castsin cr medion antrny wncurtany Alone te ao sopra ruben Spe unptied by an Se or acl emia oman ip Sle Pretg a Pater ‘ecumenism ee Os Determine Weoctony- te an determining enstomi tricres at i 2. A teast oe pergheral IV 5 Reece poeta cette and wrinay caller 6 o> ‘rnin tre won 4 Sebi pte” aerator ston . Aneas the ate fr ipo ‘amination a abt la ‘ied Chess peding on ijry tex piel sod Cr at cent a n-6 ena H emaBe-nowepene YYCAHE 98 dpowe.py >= 2 Nick: A a eal xo tet eal ay, te a het chest “erays a traremediastinsl, englasraphy, bronchoscopy, Ciphageel contre CP sen sate warden ecerurgy 4. blowers tok aril lal won exlratin, DP, tetoun CT ss, Exremiuce: puis nar ead sensory exapination, ankle bre Mi Dupk lircound sreropran,peratve certs Vt eswelaton step in Untabie Pencrtng Tourn Pate Tikes tent or tna, aust ge exchange culty er Serpe Sesh 2, Reamer ad tes of poncrting woud : Dearra wefshny “the itl in Staring anemic trucos Pak om soma 1. Treatment opis ee Chapter 14 fr spel nteatons) ‘Tareoy oo B Sete © chin i Opa ary atta) 4 Soar ita Saga sway (er shaun wound fo fae) Groam rel decopruntin of che, nibteral iar Chest het water! or iateral Neato mal or mecha Etec rete vector Ta, unatabe ptont Inbratory stun, ‘Sie aetre sek hing 23 Lt awed Tigers state 1, ike rent wl pin ert reat Avid parent sh that Ue bullet wound is beeen the TY site Aas hysovtemi eu (. eta ean, itor Jenin ores. thr base dt, ahem ‘rhppetonton) sere for aie blood fos. tte rane deity rk wi, tera al ‘ous ct sy cette teal pecs = Sitar ath (2) Mbit ea exlorstryIpactamy lesen, oF DL ‘Glan wend, (0) Wgpetenstn centinues, ok ero tamponade, tense Ei spl er iar: 4. rhe pauper nei ake and urinary eather stat Neots pti wth enetrting wen oh dock ptt heal mt er et aes peri he 8: EN a eat fae md fisted o ramets ling ne Chapter 2, hom pram falc ‘Perera win Bakerton trarathorocie or trnseorugel) © heroes Tronic 1 Haogoged Stet etyThe homeynameally untebe patent with a penetrating wound tothe ‘nce, or ekramity mers contre Remorebage nthe Oe 1 Revelation Stope for Pann trams ‘Rte peter tn exeremis presents wth anata o hile inns tat ‘sl rent ath snthin minute nee fey sree These eth as ae ch oe ps pre rent wth profs tock orp faire Ts egies wet heh fy fugue ite ebtai @ sel aay. © peony. aot enter 153), 1 Dive gta pesur expanding hemetama a sctive Heding BN and Mood a earnietio {2 font eed, ee pte pressure 360m Hg unin Alrveay + Head Chest Neck ‘Abdomen Extremity Pressure Bilateral Pressure on chest tubes om aT | Wound Fluid Thoracotomy OR | Cerebral function OR lin! cas Pronounce CT'sean orconsider 4g. ores narvest oR Fig. 192. Perteatgtrums pit in extrem at RenaBe-nonmepene MCRL ot apou py D== Moet 0 somatic rl within the cist oboe iy et tarsomeres he dt fon Sofas and eae pres ee art eter control of te ere thou» Hie 4. Groin sn exten lenin Sap renee apanding humors or ative ble EWP and a Oreting a 5 Ma Pere en tiv Hei & Birt dat rater Pee tranny (ee Abdur ahve) 1. hunt inary, pao in enters e123) "hep reesre te etre herorhaoe 2 Whnidana bead 4 Butera st bee one bat like do Oller rausciave erate: 4 opt er virmeound (US) ose SPSS pater US miso rf Mi vay pie ge oe > 150 nl insertion of ces Airway \ Apply pressure to ‘external hemorrhage [ED thoracotomy oF IVs—fhaidblood OR thoracotomy Bilateral chest —» Ongoing hemorrhage tubes cor> 1500 ml Distended abdomen DPLorUS oR iaparotomy fsbdomen a | Xeray pelvis Fig. 199, lot ere patent in tree.90 Tho Troua Manual ‘ube 19, Rogue labrtary ston the usta patent ‘lot type and eres atch Arterial lg medline ‘Prareshistine, art thmtplatin ine platelet oat Urine ager Wend HCG for ore cldbexring age Se a tt eng tt ete ee claret Saegs dreamrenage oe 6 ries with mip ates nn” SET ae Pee ES cara 2 Soe rence ae {koe eae Se ey sm reed CES pee et ett mp a ea ta Se etter Unie dail fr Hl Rona hore aos CO) 2 Urabe patont Tae 1 Soper sect larry tts hae ital pc (HR AC Em de no Ut (Sein rete, pase (3 Scrum ero Mtge Vins When several ume victims sien th rnin es ‘Simultaneous, erty should be went tne utter vai ‘AVTrau eum leader nes ror pps) should yas se {ents areas Snes dil eee rat 18, Theron an leer hc rat a pte te pate tere ar stent, prize ae uel serie sts oni tastes Tht sha cet aed for ray titan alin ‘iter lan when dd ott immedi ecies The rarer ‘oul oon the ie fling fr adel secs +The until wou polenta dled otal ruitenent fr sure) {Poe TCU ta wells apna dtc + The raion patent erro ry rege teste ir gi + he mame ptt me sale hil oman. sully ‘Rett Ces of Surgeons C "Tram: Adsnee ‘manual Chega: Ameren Calg of Sarena ne Pret alr Bel FW Tra the oI Aarcan Coll Surgcne Se ‘ie Rnertan Surgery Seton IV11-80 lot Rew Sok See ere, =< ons m Romate-nonsepoxa MCRAE 98 QpowT.BY Do -< we an mponat Ta TRAUWA AIRWAY MANAGEMENT Re 8. Vk, Katy J Finneran James W Krogh Aden apa, vlan at ptt em aig he tt Seen supreme wns of ol oem he ‘Aiogd sony ice fro the mechs of tin, ay a ee i or ee mie St ee 7 gti ng iat mcs fre mi te 2 Spisaiene ee brati ramon shrank ara wer ane me See gieaetoeatea numer pxpaceeraaicry eae 2 Anais are wieder of exophagetacheal airway (Cmbitube, Se oieee Rep eae ce 4 aes ner apd coi cae “a seein cee, Seow « Sea pnrenakeoce cine ern x chaaornraranata se oat Ea erg nme with) eeorece Le ee rete vata fae betsy ICs eam nomen cri ae th et Beran wisi tonite ch fa He oe cinta ete face Sacer coat cnes rhe aaS “A Apel insiations for eda emergency intubation eee PISESSESS co emsnentsonen mtr 4. Sin earlier epee crsciousnens fea ei ot Sermvtitans oretorieonanmatts pon Se cn ighenatoo92 The Trauma Manual 2 tent rn) ssn cy eet ee 2 SET aan wih detinion ee mt hel omc ay er bn ‘iS hia ak oie sl a pues chests Ie yeegewast tess Soienont eesti «: eer a ten £ foie ngeding apt fre Sno Roget eps oat nee Tien np fo ors Rll ec lie haa ee toe sie 0. Te lt eit msi af ie gh ay Pisemat wth ate fed trae satay ts Sie Cli he hatte dened y el tne Sse rte! ye mt rine tal Seuvuniemas ecmerenoace mem Siacy Tr ietiee atime ena an ta ne SSS ati mS oy hy lt {Stree tke, Alert a cued sey eas ESUIERSTS istveeia eee ie ater eats SESS dig ee ae Fig. 1441. Thre pra tachi fr nation, -€ onaie H RomaBnoneRcHn YOCARE 9m oH Trnuime Airway Management 98 seein SEDER pect a aay evar maa pics eect ‘Shou occur while inition is being attempted, Other activites cin Search ence © Ceonara chs tates as isan tea en the lnwestequeng of complicate, Orel intobatin eqs thee perl iets cemirerucaetroree ia seenre Lager rst euton devo must realy eit setae sae er eth Epstein lation etabote sly Joe Soaesn ee arener tr tanita sea cen enna Shake ener eusiey ameeer ee Toulon igetsecinen see aha inecihrine eceecereeeec Siac ce eer maar ieee ete oe mec ee Shewinanfia tamosemsewane ae o mat mt ee ate i oie reese eae falas of those win misoca nos, basi eu ectre. Niel aioe ieg gen een tee to Grosse Sitentatstettamee rach sh anu gre te ememee cea shear uta endaaacen furs tay Site mtn or wt ee iShares nc iin iainadoarancac Remet tonal TT ‘Urgent and Erergeney Oban later Ortrachel intubation cari sine ‘vith iinestaiation ‘i est | Orca ntbtion white ‘sbizaon or note etsation method) 4-142, Alri fr sexy rename yaa intubation "0 165 em ptt fede ca stn94 ‘The Troume Manvel {ea veniaingor Ant te Ose Sr psn hogar wil ‘ceaary to povent ln of educa ee ee ie ‘cl the mal to face nth tre hase Shey ae Ue onc, ing he he nt neck in ete estan Th ster pane bes he Ian on Sears A sea nM orc ey ‘esc rut batter go aca Inmet esas n popes sea the illo este erry escheat option snd ot ‘Sie aerate I td pats why rela natal ttn ‘re steel ier infubten atade mayhem ten er ae {airway perfor Tacte onan, and. corsinelon {sppreaces se ll esrb each eaues pros ht ae ele ar ‘trouy vita Ue sed to vnatoe Ue Bt ety. eye i oe fubatn over ale breshcecape non ete {iin that oes cl eget an oe Surgical armaya The se rue ven bse atarventons ad nt {seve ah toss ce sevre ey ey tara rn leo incr aca esa or hae fa Cyrene ter nd ra fier tcbgu toe pyecirs Telemed J slain ist aoa tm alteratie technqo to scp at ‘etry Hath protest be cet srt ily rept Scrap ath endy nyt Try rary ‘tog a patents with Iarmgel canes nau Sn ‘Ercole, the rai pet tion [eenate of fairy, any ane the iy te pase otal ose ‘lon from eaten et pice a ogee ray ae! i. 149, Crichton techigus (Fra Trunkey DD), Guerney INE Crs {Seca tn Hat FN, Tuy BD ls Serna pcos n rca management New rk Thieme ens) oe chant» Rematooronnepone MEANT or Gpouneny 9 we a0 poms ‘rau Aienny Management 8 ‘8 Teenngue (Pie 14.2 The operat palpate the tyr carslage Unie cout fegrened ected membre A'S ine itr the tr lndarks are et arly pees ot Novara Gn the ign eck: wih cor snare lnm) shi Incr permed ever the memtrae, The abn ered, at dm ar ete ctr emia) ar ea [hey palpation As to em tuners ies mace thn te eran. Te prac perforata tee Input tthe ema cna be me, ice where he sf em {me jl Areca ae edtncnl abe o et ‘Somme diamssr bat ons ener than ha wuld be ch ‘reenable ints a ‘Stina: Adoqrtaexyenetion ue! ett te ensure fy ‘Sendardteclque Svcning shea cerur ser adequate tn (enti nd vention ate ered 1, Scmpleatene: imrrhags oly contol wth eal preure ‘ant awd by hig these ofl incon), spaced, ‘ima sendy to plod recede ine, cphinge fern "marys! aur; ne sutetasenss empiaetna te pet ‘poets ene terme alee en if [Sse mv aed enliaed ameter ees ee Feit contrition ila ary tru oat oo (ethan to tls yee ce Pecwtneeun bean kits ge able hat fr erg tre ean ob pieced Mongh ce rey rembane, The fukt hen vente tin ncpesed sures Cully Etgenee der) Phone tse ite edvantage rel thy + Sifechmgue: The rastvay aveser crtigred membrane i Itt bive ued cri she ‘iylctee ine sage rca carts large ere (12-14 ue (elroy died rth reer ad nits schol) overt ish caer with swe rg eed cde. ‘esi im eal ine sy eet roar anging ntrateschea pacraca eden ree Ea it ‘Tvl an the ning) Thal ore to racing rene aygete ao renlte te plone Bor ering definitive iy which al require. Ti) Gee onchange exce vn ate tos jet inslliing Alevce dlrs ightiowanggen at npriatly #0 5 Iho Cpt = 10 om HO Tse can ba ciple [ir peonere one sey wave innit ao wh ach rt ‘al causing) ers ser slaboateventitr ws le love! stag) he hey pot that thw dace must be ‘Senties andrea for we btore the apa procedure Tether than spt tagtber en the spot" snte the Iter fe ‘Gem fa deter equate asbes ve Witand the (2) enon ewe pss port fr exalation becuse of {Ene ony able coreimeietion ie compte si) ‘Sbairucon snr cnet) yan the peeing aera ‘Soeen sume confit ll vlomes ef 101000 ce per Sind timp are ace Lt eatin er sre tection en sprain nine pron he etd [xis eed, clearing te pyr sg) aad am exelent ‘ote ar alela deter eel(2) Acanston mistaken pereing jt iwition tenting {eset ih e's bao doar re dese hier soap ome eure ht eps ‘Seen ware il et los or adaae amc aaa omelet hte xypnation nay escur Contrny te i rns tien we ah resource 0-80 fet not the same aso ta li se) wt note of 18 second feet oes ‘also adauate to superna cgeratn sel vest, {wih no CO, secumlony The carmen ture ye ples, tifa Shoah etn wnderotae a geen eet se ‘ral cut 0 to 60 yt oe are’ ttre the unl dewalt dans ht ow st A Complications of et vention ie hare, hence ‘um hypetnscn om everett ees eens ‘in eat pn oh nein haan ee ‘tcl eohyseoa, typotia Ryfercrn td Set Fo sgn np he Pequot are 1, Phamecologic Assistance During tation 12 Rime ptent en entail emits rin ste eget, whereas sors ean te teed wih tel el thesthtce toll er succes or srg sey acer, inves toet patient mut env atresia masa seul rl fo ensure that itn ects slely art rly A ‘vere “alvaye™ appre tothe tae ef parwaclgs ane ‘Mog door, se ech prec pen pets to sabi Stra Poeexample mil tsar wate pellets maybe teeter of waning nd opti prong hyp sad hyper, nd ISowescsicenoplctins ten opps parce ae ‘sta mont taste thd ene ttn sy to ‘ra vente I nypeeopy way be tcl even ih ‘ti cts mile etapa enone Sr nr fetes he suo sth Sd fe in ‘rl eal wih fat note ond as ett at ere Ser cent he mer ges ring tr ©. Chasing agents entirety) Pawar most cose fm 8 weit af sedate, anges, bypmt sed meretmscloe Decne ric Ia ttn pt ats ‘seu thet beth hyperlemasaat e ptmay col mens seen ‘Rho gecen sor ype Sn he sna infty, snc ether cndicnco be ltl tn the Oe ‘Rite fr ariel ‘ee tits ith vain cri we rr ag chat ing inductive agent ttn nearanancoe hocking spat Ths wil ot fe lntubting codons i opi rey reser t {est emo neers acm eel 2 Basen the prceing principe, we retemend sogereicta| tet th eocivenss ara lyre nt teu ent Fee ‘sneha er replant loners nd ence Wren scans mts hea ay mesa ‘eer es ted eran co oan --< cna RemaBe-ronsepotie MCA 97 Qpen.By > vf ere ecg tt ae serfs tat nepry ohla fata ‘Eecurate thne enn hee fond ad Pn ere occas aa re oe re eee ee recat sat er cocaine simrirsuen te prev fut Socom eden i eucinie re Ape Al weoonin 28 anti sept et eouettineganctecrmtacts BeenSente toe aeons ce eee enaimett renee ata fora eee ogg bot goma cect sn ee a na a coresiesh cats See ce aie ee papain aenerad carat hime Serie enetatacge sc: aaa Sher Ped onstage camara a te at eco at aed hip Se fer ie ona tee ce ey caine Sopa tanttccois ieee tne ‘recta monfering, Obserse fer signs of ce eu echange: yer. 1 rece a ie FS a a eres eta ae eee ee ira cet t Sceecesih meng ats ame Deoanmemoeunametae heretic = emma 2. Nidbnogh fen unrecenind a declining rental status sould roe Mice mama sete o eogtan at n narpe a Se eee ely starts ofS shale agi eS gr seer eae epi emcrmamrantn puta ie ieee anime se aetna sera i ue eae cel (ae igo teraeicnaateen 2. Capmogropy the mnseureren of expired COs cnet, with Sera hearers open see amie ctnpeamareeae Een neeceepdaneromcartee ‘any ahowe excl coreatin with abel and srteral CO coscott wot eo, mere at oi meteorite aire tee em Seer rie ee eae Erocieanaaiommne tenes peice eraaere oar ane ire ciscnyearreiee foe urea a petite Etta um esoren men guamene gemma nee hacia Sacer irae eich ame cee Seep dee eens meetin ee See iowas geen mrt « guleeaeear ee Beet epee Shere anaiedaeacmareums eee 2. Grygenate with 100% Os ant ssat venison for 3 to 4 inate Gf pos Spree Set ait cp nine mocks ee ieewa we oammaaas Sagan te or esrvouanny Wome oe 2 ee ce cae eemeemenarnnel Saeco: imei ena ean Homey Es pe meen pe prea Soret eat ee tei oe sos aensenanins aren ne eee 1 Re a oor env oa ieee + BE Sea amen aceatenneme Sor ecnan somata ata et eee = Se FTES oe re et 1 etre ecoreamane mange erage di igmaeunaant ce os ae ae = ‘Trouna Airmy Management $8 {. Communication nelps vert conc; however, the lire decision to ‘ute ests it he tau tears fag sc veto sould ae 8 tuliey apa oven ct nrg at ae ‘Stern wil soda ty it prccpents Thine oad tas ‘StSeenntn drug eptmens oupcn strats ache Sagi ol tng po es ht Seat a a ehicmic aban _ EES Spee er pce tte Pennie pacar erea aes + Nbane tat reuia print ere hypoeemi hs hed wd crv spine Soe hese cree in ESTES Tae cae certs oom Aiba tat all iru topos il db ered te ar es + SIRE name mt pte in eit ieee tats ecient int cetoen a ‘iogrerhy Fret ly Seller 6-Te portance ef ranted et vention in the Tmonagest ote dieal sry: Anstelgy 117671 108. plan i ford Harman of heehee econ during aro “eal inktion he trun wt ih an abe cereal pine An Fr ‘a3 1 Raton BM. Moga BD, Sewn CW, ea: Ure parse and inti ‘Gnum nt it ah J enn 94902248 Toe Soaith DA, oun: Probe rayrtemy” An vestigation of nto, Teciques erica an patient ote Sm Ben Me 19792, 180. ‘Waar, Wold Ai fag BL: Pete AB Homo fsa emi fer rpldZaquncs intabtin GSD in esergency depron ta pent ‘cd Be lt, 88, ea Dat Pars PA, Rea sdnese in sry managed, Ener Med Clin “Nor a 89-8 108 ‘ily DM, Pea A; Sera RD: As eatin of eno oon sures or ‘eae ventin An Boy ed 9028, 181 Flow rough a catetr ie determine by Pelee i oemxah aL ‘where Qn cen roi AP i pene eran is ety {dn veces the bestow etna en de, war deter ‘ary id eran tre abet wide Cheer wer eure The ‘Sarscter oft ethers te mat ment fc 1. cess tothe wasulr system dnl should te csc enmate to the {espa or eanedent sath the primary trey. Chace there fora Initnchns ge thud eae enc of pot vaca ny A fntenerae (1 ne should at be poe wil nwt ijry ete Nan guncor cua ithe pp igh ct’ wee ee ih nt tay exewrtte Heding for ubclowian we nes 6. Wane access obined in allteane penta ni Mad soi, Mot entation an injection of ope 1. Patigher cease 1 Non nese walt btn ergy ere cnsderaton fe gn to acme conta 2. Monsees ‘lott to largebere (Mer 16g) intone cbtert ‘ould placed in ge ar vine Slr einige shal ered nea’ the urgency ef theaters Meat yoripher hs bbe fer reructaton i te poke sting the ete ny depart shad be rene itin tte 46 hos se Stier te sod ta i mere hr complications yortear sows ot "Surgical utdouns ar ei neque is tea pit buat ‘embec greet al stance ie nema, a tery frchicren, +. The coneet achieve fore wens culdown eset proc ‘Mecafl rman. Hoc cudnt sh eve Re ‘SS ein saath unc of ned er ene see Te Spice Win pr hte wine vane me snd) Wet cutduns or uma he basal ftom te od {hese iner abut remoned when rts sees eve <4. Genera acre prince () The sitdoc ste shad be ambi prep, and drape 3 Appuprt leh od rues shold fe matte, 6) Slate hema ed's Ne Bade ere aged Inthe fal wins cd mam) renour wal ert and ators cane ‘peat bene (@) Rite mesthtzng the sin with ea anesthe ‘es hin nese uevaly ngs af ch te ‘etascou eeu ae spead ns oat ston can 4 SexaBo-rownepots MYCAKE 92 Gpown.By >— oscar Acces 101 slang th eure the win A cond Maar oe fey et oc orm Kee ptare ree laced ue the wins lings © Fetal anal he foil eng enc ue jc eon Shomarar suet oy belt te Sa es ae Sateen ical cancers (© ined pth ny nt te the en sed reese aoe co melee ARS et nano mais «eet BS me ce tn soe iooes cen iene Fin. 161, Sophenoe vin edn athe soe: (Pru Meare HE, Bisa B, van NG; CW is Cea desna im trotme” St Tons: Mews, EL)he Trauma Manual fo) Locator 1 cm antr nd to prnia e the metal ‘ates p16 Blesventgee, ) seal See er te tl ate peecly toeeeale dts io iowaveg Snctra, utopia tary ante enacts AST) (2 roma spies ve re ovation cm inlere Wt guia erent a ‘eile he ener ple ors es meme eisai a» ple pater Fe fo ‘ster ni oie nh en at ‘rubleolaatice diets thesia ot inthe en ihe ee (@) Aowningse {In eet ean ee eapdly ae a ree ‘ce si iene gpa ng the Femoral Vola Lecton SLE /) [ ema Ary Fig. 122. Saphenous win clown nthe yin (Prom Cie ata erica (are ad Halabi opin 1 6) a A : : i i i i : rei Wigh on suey can be mbised by [gui tyeing tthe hemtt urer the ‘eine the nde ig of te ter hand Bh tn shal omen ad slang ever 8 evi ihc fem he wen th (0 La etre en ter it et (a Te odio geist enous etter (8 oF 88 Toscan dive tpl flowin he in en (0) Avalon rive, No.1 ee 1 edit ‘vos twit rr ev enn be ed Ie the are en evn ete noe ela” ming he eh eect _ (eae tyes in pint wit 9 be (G3 Nitec in nae and oman hen nes case innate (© Pipe expres an fury wih tbe mst: (B10 etic tute and ewe de tote poe eee yn (0) Ao ie pena eto rn eeu, (2) anced region Ar anodic es seca he (Oeste hi re (ave denied ste src fa thi re re ‘Set ower san pris att len Traci frog and econ nerve can omer Tope ics ee ute ei dosed 3 em poate? teal te ol pce th ct) ate tlre ep ofthe Deri) Fig. 153) The te feof sodomy. and placement soar to tht (istrant forthe ste (anni prety en Se pte (6 Biasdurtage: Som variable Sn eto and comet ‘mee fens Un taphenoat vin te sa hr Ue acces r Mth tral veo ee lly was ror fr petro ‘em stato sapertnce a mang eau ener aw ed otcteted ess errata of untae rere atic Wh {te'nionca.on he Sedo eo dom though tee Iona ty cater ver quinn cee renctaten ntetre 8 t IEF alse er tor arti heve become emerge. Test ‘thes ni soy bigh ew tee Cece ef ere mrs {Bat chic eeily calor rps anon devi ‘adenine “ey Poe cose ond prvi immediate Eig of the ert or the yet ena cr (©) lw manures fhe contra venus peta sd ‘neo ke tunequon’ placement e's plenary ey104 The Trauma Marl esi eso! 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