7/9/2023 0 Comments Barotrauma bite woundsTriad of immediately life-threatening complications following gunshot and blast injuries There is a lack of uniform treatment recommendations in the sense of standards or guidelines for the prehospital or hospital treatment of gunshot and blast injuries, especially for major events.Īpart from the clinical trigger factors ( box 1) for the adoption of the DCS strategy, the tactical situation, the number of casualties, and shortage of resources, e.g., lack of material and personnel or technical problems, may require restriction of care procedures to maximize survival under exceptional conditions. In the case of a mass injury event, a gun rampage, or a terror attack, departure from the standards of individual medical care may be required. Treatment following DCS principles concentrates exclusively on survival and preservation of function, to minimize the additional (systemic) strain on the physiology of the severely injured persons ( 8, e2). If certain criteria are fulfilled or the clinical condition of the patients is critical, the therapeutic modus operandi according to the principles of damage control surgery (DCS), developed for the management of gunshot and blast injuries in the military context, can be recommended for the care of civilian victims ( 6, 7, e1). The management and treatment of this class of injuries is resource-intensive and afflicted by complications ( 4, 5). Most publications on the outcome quality of the treatment of gunshot and blast injuries are, as one would expect, retrospective cohort studies ( 1– 3). Because of the low incidence, there are no robust study data on these injuries in this country. They usually result from accidents involving guns, violent crime, careless handling of explosives, or industrial accidents. Gunshot and blast injuries are rare occurrences in Germany. Depending on the resources available, a transition can be made afterward to individualized treatment. The main considerations in initial surgical stabilization are control of bleeding, control of contamination and lavage, avoidance of further consequences of injury, and prevention of ischemia. In-hospital care must often be oriented to the principles of “damage control surgery,” with the highest priority assigned to the treatment of life-threatening conditions such as hemodynamic instability, penetrating wounds, or overt coagulopathy. Patients with bleeding into body cavities or from the trunk must be given priority in transport hemorrhage from the limbs can be adequately stabilized with a tourniquet. In a mass-casualty event, all initial measures are directed toward the survival of the greatest possible number of patients, in accordance with the concept of “tactical abbreviated surgical care.” Typical complications such as airway obstruction, tension pneumothorax, and hemorrhage must be treated within the first 10 minutes.
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