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Trauma Ans

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  Ans.1      Massive patients admission    Dependence of the volume of surgical aid from the battle and medical situation     Necessity of Triage and evacuation    Unity of treatment process of and evacuation    5 Levels of medical care 1. Staged treatment of wounded, ie, providing injured surgical tool , where in this manual was need (Oppel). Despite the fact that staged treatment of certain surgical procedures and manipulations of the wounded are made at different stages and different doctors, all of them should be an orderly system of surgical interventions, united military surgical doctrine. With this system, all pre-medical and surgical interventions in injuries to determine accurately certain activities at the following stages and follow-up actions must flow from pre-made at the previous stages. 2. Massive losses, giving good reason to compare the war, with traumatic epidemic, when hundreds and thousands of people directly affected severe and multiple injuries. 3. The exceptional severity of injuries, causing fatal on the battlefield, on average 20% of the total number of casualties - the so-called deadweight loss - and the next stages of the number of so-called health losses from certain types of injuries to 60-70% of cases . 4. Unfavorable conditions for creating aseptic conditions at the front to provide surgical help  because of an almost complete lack of fighting near the line of any premises has been, the danger of destruction by artillery fire and enemy aircraft, the need for burrowing and hospital operating rooms in the ground, hide them, protect against, attack opponent, etc. 5. To the evacuation of most of the wounded at a considerable distance in the rear for treatment and inability to carry out this treatment on the spot. 6. The instability of advanced care facilities and the close relationship of their work on the general nature of military operations, forcing surgeons and health chiefs to be always ready to clot, transfer and deployment of their units at a new place to meet new challenges to resolve questions about the premises for operating and for placing the wounded about their nutrition, warming and further evacuation to the rear. 7. The extreme variability of the volume and nature of surgical care in phases due to variability in the overall tactical situation and the significant fluctuation of the number affected and severity of lesions.  8. Linked to this is the need to concentrate reserves surgical training, health and transport equipment in the hands of health chiefs to maneuver. And these funds in places the greatest losses. Despite the difficulties of full and complete implementation by the war of the modern  principles of first aid and operate the wounded, the military surgeon should not make allowances for field conditions and should not depart from firmly established in a peaceful surgery aseptic and antiseptic. On the contrary, the rules of asepsis and antisepsis, surgical operating discipline must be observed in a war even stricter than in a peaceful manner, as a wartime injury accompanied by even more severe complications than injuries and diseases of the peace-time, requiring surgical intervention. Ans.3  Military doctrine    It supports an integrated health services system to triage, treat, evacuate, and return soldiers to duty in the most time efficient manner.    It begins with the soldier on the battlefield and ends in hospitals.    Care begins with first aid (self-aid/ buddy aid), rapidly progresses through emergency medical care (EMT) and advanced trauma management (ATM) to stabilizing surgery, and is followed by critical care transport to a level where more sophisticated treatment can be rendered. Ans.4 Medical support is an important part of military operations. The aim of war surgery is to achieve the return of the greatest number of injured to combat and the preservation of life, limb, and eyesight. War surgery is different from current traumatology because of many reasons. Because hemorrhage is the most common cause of death in military trauma, airway preservation and effective control of bleeding represent the highest priorities in war injuries. Wound excision (the so-called debridement) is a significant part in the management of war injuries. It involves excision of all foreign objects and contaminants and dead/nonviable tissue that--if not removed--would become a medium for infection. Broad-spectrum antibiotics should be administered and tetanus prophylaxis measures should be taken, as indicated. Delayed wound closure (usually after 4-5 days) is the standard procedure after wound excision. Recently, changes in the dogma of war necessitated significant changes in the organization schema of military services supporting modern military operations. The concept of highly mobile, easily deployed, forward surgical facilities is the most important change in the philosophy of modern war injury. Military surgeons are now facing new challenges; appropriate education is required to achieve success in their mission. Ans.5 ,6,7  RANEVOY PROCESS. MORPHOLOGY AND pathomorphology.   The structure of any gunshot wounds can be traced to a number- ing morphological traits. (e) The mechanism of injury tissues in wounds are distinguished: a zone of direct action hurt the  projectile (the wound defect, wound channel); area contusion (bruise) or primary traumatic necrosis due to direct and side impacts and runway; zone concussion (concussion) or zone can- molecular tremors caused by side impacts. Wound defect may be true (because of the pull-out textiles - minus tissue) or false, due to retraction of the disconnector- United tissues. Depending on the nature of the wound tissue defect can- Jette manifest in the form of the wound cavity (walls and bottom), wound channel (depth greater than the diameter) or the wound surface.   The walls of the wound defect covered, usually in the dead time of tissue damage, forming a zone of primary trauma kinetic necrosis. Wound cavity and the wound channel is usually filled are satisfied by blood clots, shreds crush tissue, often  bone fragments and foreign bodies. Accumulates in the wound cavity blood, increasing intralyuminarnoe pressure, promotes spontaneous hemostasis. The walls of the wound defect covered by the convolution nuvsheysya blood coagulated fibrin is fixed to the wound surface. Microbes that fall into the wound, serve further research source of infection. In the area of contusion revealed foci of hemorrhages, diffuse
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