Practical General Surgery Handbook

Author: Chief Editor: Yang Jizhen
Publisher:
Publish Date: 1998-02-01
Features: Synopsis This book is written by clinical general surgery experts with many years of experience. It is divided into four chapters, introducing basic knowledge of surgery, diagnostic methods, treatment points, and precautions for common general surgery diseases. It also provides concise anatomical and physiological summaries for each system disease. The book covers recent advances in general surgery, such as laparoscopic techniques, laser, cryotherapy, and non-surgical biliary drainage. Additionally, it compiles essential guidelines for the use of antimicrobial drugs, hormones, chemotherapy, and normal values of common clinical laboratory tests, along with over 130 illustrations. The text is concise, comprehensive, up-to-date, scientific, and practical. It serves as a valuable reference for improving clinical general surgery skills and is an ideal portable reference book for general surgeons and grassroots surgeons, offering easy access and quick consultation. Excerpt: Chapter Trauma Trauma is the third leading cause of death in the population, after cardiovascular diseases and cancer, and is the primary cause of death among middle-aged and young adults. It devastates the lives of young people just beginning to contribute to society, imposing a heavy burden on the nation, society, and individuals. In peacetime, injuries caused by accidents (industry, agriculture, transportation), social violence, and natural disasters (floods, earthquakes, avalanches, landslides, etc.) are common. In war, combat injuries are the main type of trauma treated.
I. Basic Concepts of Trauma
(1) Classification
1. Open trauma includes abrasions, lacerations, puncture wounds, incisions,, and gunshot wounds.
2. Closed trauma includes contusions, crush injuries, sprains, internal injuries, fractures, and dislocations.
(2) Terminology
1. Compound trauma refers to injuries caused by two or more injuring factors acting simultaneously or successively on the human body. For example, during a nuclear explosion, the impact and blast wave, thermal effects, and radioactive contamination all cause damage to the body. Alternatively, in a vehicle collision and fire, impact injuries and burns may occur simultaneously.
2. Multiple trauma refers to injuries caused by the same injuring factor affecting different parts or organs of the body, such as a traffic accident injuring an individual's limbs, chest, or abdominal organs.
3. Multiple injuries refer to multiple injuries caused by an injuring factor acting on the same organ, such as a gunshot wound causing multiple perforations in the intestines.
4. Penetrating trauma is usually caused by firearms or projectiles that penetrate the body surface into body cavities, such as sharp objects piercing or bullets entering the abdominal cavity. Based on severity, it can be classified as:
(1) Transverse trauma: The injuring factor enters the body from one side and exits from the other, with or without organ damage.
(2) Blind trauma: The injuring factor enters the tissue and remains lodged.
5. Contrecoup injury primarily refers to traumatic brain injury. When the body is in motion, the external force acts on one side of the skull and brain, while the opposite side, due to the formation of a cavity in the brain, experiences a sudden drop in pressure, creating negative pressure and causing injury on the opposite side.
6. Whiplash injury occurs when a person's back is suddenly struck by a moving object, while their head snaps into hyperflexion, then hyperextension in an instant. This can cause muscle and ligament tears in the neck, cervical spine fractures or dislocations, and even damage to the medulla oblongata and high cervical spinal cord at the junction of the brain.
(3) Characteristics of Various Types of Trauma
1. Gunshot wounds are caused by weapons like guns and cannons, classified as bullet wounds and shrapnel wounds. The extent of damage to the body depends on the kinetic energy and shape of the projectile, which can result in transverse or blind trauma. The wound entrance is small, while the exit is large. The high speed of the projectile can create a temporary cavity around the wound track, which is dozens of times larger than the original injury, causing widespread damage beyond the wound.
2. Fall injuries result from falling from a height. The nature of the injury, the affected tissues, locations, and organs depend on the body's position during the fall, the point of impact, the direction of force transmission, whether there are obstacles to slow the fall, and the ground conditions (mud, sand, grass, concrete, or whether there are piles of debris). If the impact is on the head, it can cause traumatic brain injury. If the impact is on the lower limbs, it may result in comminuted fractures of the calcaneus, hip joint dislocation, spinal injuries, and spinal cord damage due to force transmission.