Traumatology [antikvár]

' 2TRAUMATOLOGY (ORTHOPAEOIC SURGERY)Significance of traumaTrauma, called the "neglected disease" of modern society, is the principal cause of death in Americans between ages 1 and 44 and the fourth leading cause of death for all age groups. In the U.S. over 100,000 lives are lost per year because of accidental- injuries, and nearly 500,000 injured persons suffer some form of permanent disability.Some progress in preventing highway trauma has been made through improved automobile design, use of seat belts, and speed limit. However, prevention of injury has received much less scientific attention than the treatment of diseases of ^fa^ less consequence. Attention has been directed primarily to the role of human behavior - certainly an important factor - but the possibilities for preventing injury by modifying the environment have been largely ignored. The record suggests that the nation's health might benefit more by increased emphasis on environmental factors. Neither public education campaigns nor driver education programs appear to justify the large budgets accorded them. Indeed, the available studies suggest that such campaigns have little or no effect on the targeted groups.In contrast, the few efforts at environmental modification have produced significant results. The national speed limit reduced the death rate in the USA and European countries. In Australia, after seat belt use was required by law, a 20-25% decrease in automobile occupant deaths occurred. The required use of helmets by motorcycle riders resulted in a reduction of deaths from this activity of 30%.A second area vMhere major improvements can be made is the emergency care system. There is an extensive controversy aboui which therapies are beneficial and, indeed, about the entire concept of field stabilization. Continuing insistence on the delivery of accident_yK:tims to the nearest hospital is the gengral rule. The designation of selected hospitals as a regional trauma câîFë" centers would allow these hospitals to provide the necessary multispeciality coverage while providing a sufficient volume of patient to maintain clinical expertise.First aid and transportationFirst aid at the scene of the accident for a patient with an injured extremity includes control of haemorrhage, ^lacement.of sterile, dressing .on any npp.n-wound,'"and splinting of the injured part. Haemorrhage is controlled by direct pressure at the site of bleeding. Tourniquets are not used as first aid measures because of the jJ^k^ j3erj.pheral nerve injury or permanent damage distal to the site of application due to ischaemia. Clamps are not used because they damage. the .end of blood vessels,~ thereby precluding repair, and because of the risk that indiscriminate application would damage^other vitaLstructures.Sterile dressings are applied to open wounds to !protect them liom further contamination.