多発外傷の初期診療

Initial Treatment of Multiple Trauma

Point

・「重症度」よりも「緊急度」を，「解剖学的異常」よりも「生理学的異常」を重視した対応を行う．

・多発外傷はどんなに優れていても一人の医師では対応が困難であり，多職種による外傷診療チームによる診療が必要である．

・防ぎ得た外傷死の回避と二次性脳損傷の回避あるいは軽減のために，気道管理，呼吸管理，循環管理が重要である．

　Head trauma is a common neurosurgical complication. It is encountered daily at neurosurgical outpatient departments or after-hour emergency outpatient departments. In addition, most cases of patients with trauma transported by ambulance involve those with head trauma. Head trauma is a common and unavoidable neurosurgical injury.

　In case of a head injury, the neurosurgeon should verify the level of consciousness and perform a proper neurological examination. A head computed tomography should be performed immediately for any abnormalities. However, currently, severe trauma is often complicated by head trauma and various other injuries. When medical examinations and treatments focus only on head trauma, preventable trauma death cannot be avoided. Functional prognosis due to secondary brain injury may be exacerbated. This article presents a standardized procedure for the initial care of patients with multiple trauma and head injuries.