TRAUMA

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TRAUMA DE TÓRAX

TRAUMA DE ABDOMEN

ALGORITMOS

Alternate Text: The figure shows the revised field triage guidelines developed in 2006 for use by emergency medical services (EMS) providers to determine the most appropriate destination hospital for injured patients. The decision scheme has four steps: 1) assessing physiologic criteria, 2) assessing anatomic criteria, 3) assessing mechanism-of-injury criteria, and 4) assessing special considerations. Steps One and Two attempt to identify the most seriously injured patients. These patients should be transported preferentially to the highest level of care within the defined trauma system. For Step Three, persons meeting these criteria should be transported to a trauma center, which, depending upon the defined trauma system, need not be the highest level trauma center. Those meeting Step Four criteria should be transported to a trauma center or hospital capable of timely and thorough evaluation and initial management of potentially serious injuries, and consultation with EMS medical control should be considered.

The changes between the 2006 and 2011 guidelines are summarized as follows in a separate box:
Step One: Physiologic Criteria
Change Glasgow coma scale (GCS) <14 to GCS ≤13
Add «or need for ventilatory support» to respiratory criteria
Step Two: Anatomic Criteria
Changed «all penetrating injuries to head, neck, torso and extremities proximal to elbow and knee» to «all penetrating injuries to head, neck, torso and extremities proximal to elbow or knee»
Change «flail chest» to «chest wall instability or deformity (e.g. flail chest)»
Change «crushed, degloved, or mangled extremity» to «crushed, degloved, mangled, or pulseless extremity»
Change «amputation proximal to wrist and ankle» to «amputation proximal to wrist or ankle»
Step Three: Mechanism-of-Injury Criteria
Add «including roof» to intrusion criterion
Step Four: Special Considerations
Add the following to older adult criteriasystolic blood pressure <110 might represent shock after age 65 years
Low-impact mechanisms (e.g., ground-level falls) result in severe injury
Add “patients with head injury are at high risk for rapid deterioration” to anticoagulation and bleeding disorders criterion
Remove “end-stage renal disease requiring dialysis” and “time-sensitive extremity injury”

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