luohui961 wrote:
本帖好像出问题了，为了顶出上面的帖子，大家不要怪我灌水啊
先把有价值的帖子顶出来，回头再编辑这个帖子，也是不错的想法。
great translation. i'd like to point out those may not be accurate.
•肢体麻痹: it is paralysis, not paresthesia
•躯干、头部、颈部或四肢贯穿伤且脉搏短绌, loss of pulse, not fast pulse
•急诊内科医师判定, based on ER doctor's judgement.
白色（级别）创伤
•由其他科室: facility or hospital
•（受伤至）获救时间> 20分钟: extrication: free an entraped patient, such as trapped in car during car accident.
•由交通工具（汽车）飞出受伤者
•同一客舱有其他乘客死亡
•年龄> 65岁合并任何一种绿色创伤
•意识丧失> 2分钟
•急诊内科医师判定的其他创伤: should be any other injuries sorted by ER doctor to be trauma white.
绿色（级别）创伤
•“单纯机械（or器械？）伤”: mechanism: means the mechanism of injury or how patient got injuried, such as head on collision, fall from a ladder.....
中线包…: central line: means central venous catheterization.
thanks again for the translation.
great translation. i'd like to point out those may not be accurate.
•肢体麻痹: it is paralysis, not paresthesia
•躯干、头部、颈部或四肢贯穿伤且脉搏短绌, loss of pulse, not fast pulse
•急诊内科医师判定, based on ER doctor's judgement.
•由其他科室: facility or hospital
•（受伤至）获救时间> 20分钟: extrication: free an entraped patient, such as trapped in car during car accident.
•急诊内科医师判定的其他创伤: should be any other injuries sorted by ER doctor to be trauma white.
•“单纯机械（or器械？）伤”: mechanism: means the mechanism of injury or how patient got injuried, such as head on collision, fall from a ladder.....
中线包…: central line: means central venous catheterization.
thanks again for the translation.
great translation. i'd like to point out those may not be accurate.
•肢体麻痹: it is paralysis, not paresthesia
•躯干、头部、颈部或四肢贯穿伤且脉搏短绌, loss of pulse, not fast pulse
•急诊内科医师判定, based on ER doctor's judgement.
•由其他科室: facility or hospital
•（受伤至）获救时间> 20分钟: extrication: free an entraped patient, such as trapped in car during car accident.
•急诊内科医师判定的其他创伤: should be any other injuries sorted by ER doctor to be trauma white.
•“单纯机械（or器械？）伤”: mechanism: means the mechanism of injury or how patient got injuried, such as head on collision, fall from a ladder.....
中线包…: central line: means central venous catheterization.
thanks again for the translation.
不是学外科的，应道兄邀请也来翻译一部分，觉得这个活动很有意义，感谢Bo兄，有不恰当之处还请大家包涵~
认领第三部分（1）~（4）
再认领一部分，道兄分的第三部分太长了，偶只翻译前半部分吧，因为考试，时间真的很紧，可这里又实在太吸引人，匆匆译了下，有不对的请大家讨论指点。谢谢……
（1）trauma center
创伤中心
The trauma center serves to integrate the trauma care system by providing local or regional leadership. By providing a network of trauma care facilities within the system, an inclusive system can function to provide a range of care tomeet patient needs. Trauma centers are currently categorized by level, with Level I referring to those facilities with the greatest resources.
创伤中心通过其对地区或区域性的领导在创伤急救体系中起着集中协调作用。通过对体系内创伤急救设施提供一个网络平台，一个完整的（创伤急救）体系可以提供各种救助以满足伤员的需要。创伤急救中心现在被分成不同的级别，其中一级指那些具有最完善资源的机构。
（2）Level I Trauma Center. The Level I trauma center is a tertiary care hospital that demonstrates a leadership role in system development, optimal trauma care, quality improvement, education, and research. It serves as a regional resource for the provision of the most sophisticated trauma care, from resuscitation through rehabilitation. Level I trauma centers address public education and prevention issues on a regional basis and provide continuing education for all levels of trauma care providers.
一级创伤急救中心：一级创伤急救中心是一家三级医护医院，它在急救体系的发展、最佳创伤救治、诊断完善、教学和科研中都体现着领导角色。他作为区域资源提供最完善的创伤救助，从复苏到康复。一级中心承担着这个区域的大众教育和预防事务，并且给各级创伤急救人员提供继续教育。
（3）In level I trauma center, there is always a in-house trauma surgeon, 24-7(24 hours a day, seven days a week). Also it is required that the hospital has neurosurgeons, trauma orthopedic surgeons, plastic surgeons, hand surgeons, cardiothoracic surgeons available when needed. Besides trauma surgeons, there must be a surgical / trauma ICU run by trauma surgeons or anesthesiologists who had one year training of critical care and certified by critical care medicine. our trauma center is a level I trauma center
在一级急救中心，总有一位院内侯诊的创伤医师，24小时、7天（侯诊）。同样，当需要时医院内也有神经外科、创伤矫形、整形外科、手外科、胸心外科医师听诊。另外，除了创伤外科医师，还必须要有一个具有创伤外科医师或麻醉师参加的外科/创伤ICU运作，他们都具备一年的急救培训并且获得急救医学的资格。我们的创伤中心就是一级创伤急救中心。
（4）Level II Trauma Center. The Level II trauma center also provides definitive care to the injured and may be the principal hospital in the community. Its approach to trauma is generally not as comprehensive as the Level I facility, and graduate education and research are not required.
二级创伤中心：二级创伤中心也同样对伤员提供最终的救治并可能是一个社区的中心医院。它对创伤的处理一般没有一级机构的完善，并且不需要研究生学历或科研（水平）。
（5）Level III Trauma Center. A Level III trauma center serves a community that lacks Level I or II facilities. Maximum commitment is required to assess, resuscitate, and, when necessary, provide definitive operative therapy. For the major trauma patient, the principal role of the Level III center is to stabilize the injured patient and effect safe transfer to a higher level of care. Transfer agreements and protocols are essential in a Level III trauma center.
三级创伤中心：三级创伤中心为没有一、二级机构的社区服务。他们最大的责任在于评估（伤情）、复苏，如果必需的话也可以进行最终救治。对绝大多数伤患来说，三级中心的主要任务在于稳定伤员病情并且安全快速的转到上级机构。对于三级中心，转院同意书和协议是必须的。
（6）Level IV Trauma Center. A Level IV trauma center is expected to provide the initial care to an acutely injured patient despite limitations in resources. As with a Level III center, transfer agreements and protocols must be in place. Since definitive trauma care is usually not available at a Level IV center, a well-practiced mechanism must be in place to ensure prompt transfer to a higher level of care.
四级创伤中心：对于四级中心希望其能够对急发的伤患做最初步的处理，即使其资源有限。如同三级中心一样，转院同意书和协议也是必不可少的。因为对伤员的最终救治在四级中心是达不到的，所以一个确保向上级机构转送的有效机制也是必不可少的。
melody2007 wrote:
不是学外科的，应道兄邀请也来翻译一部分，觉得这个活动很有意义，感谢Bo兄，有不恰当之处还请大家包涵~
认领第三部分（1）~（4）
谢谢melody2007 友情帮助！
普外版里基本都是男子汉，现在有PLMM加入了，大家积极加油啊！
根据道兄的要求把上面的改了，下面是全文：
创伤中心
创伤中心通过其对地区或区域性的领导在创伤急救体系中起着集中协调作用。通过对体系内创伤急救设施提供一个网络平台，一个完整的（创伤急救）体系可以提供各种救助以满足伤员的需要。创伤急救中心现在被分成不同的级别，其中一级指那些具有最完善资源的机构。
一级创伤急救中心：一级创伤急救中心是一家三级医护医院，它在急救体系的发展、最佳创伤救治、诊断完善、教学和科研中都体现着领导角色。他作为区域资源提供最完善的创伤救助，从复苏到康复。一级中心承担着这个区域的大众教育和预防事务，并且给各级创伤急救人员提供继续教育。
在一级急救中心，总有一位院内侯诊的创伤医师，24小时、7天（侯诊）。同样，当需要时医院内也有神经外科、创伤矫形、整形外科、手外科、胸心外科医师听诊。另外，除了创伤外科医师，还必须要有一个具有创伤外科医师或麻醉师参加的外科/创伤ICU运作，他们都具备一年的急救培训并且获得急救医学的资格。我们的创伤中心就是一级创伤急救中心。
二级创伤中心：二级创伤中心也同样对伤员提供最终的救治并可能是一个社区的中心医院。它对创伤的处理一般没有一级机构的完善，并且不需要研究生学历或科研（水平）。
三级创伤中心：三级创伤中心为没有一、二级机构的社区服务。他们最大的责任在于评估（伤情）、复苏，如果必需的话也可以进行最终救治。对绝大多数伤患来说，三级中心的主要任务在于稳定伤员病情并且安全快速的转到上级机构。对于三级中心，转院同意书和协议是必须的。
四级创伤中心：对于四级中心希望其能够对急发的伤患做最初步的处理，即使其资源有限。如同三级中心一样，转院同意书和协议也是必不可少的。因为对伤员的最终救治在四级中心是达不到的，所以一个确保向上级机构转送的有效机制也是必不可少的。
tongdour wrote:
再认领一部分，道兄分的第三部分太长了，偶只翻译前半部分吧。
谢谢铜豆，辛苦了！
每一个部分都分各个小部分，大家可以选择认领。
请大家认领前看一看前面的回帖，避免重复劳动！
呵呵，翻译了大半，发现了铜豆的帖子，那我就接着翻译第三部分的后半段吧~
（7）trauma surgeon: team leader
创伤外科医生：组长
trauma chief resident: primary assessment, putting central lines, Arterial line, chest tubes, emergent surgery: thoracotomy, stop bleeding
创伤住院总医师：初步评估，中心静脉置管，建立动脉通路，放置胸管，急诊手术：开胸，止血
trauma senior/ junior resident: support trauma chief, expose the patient body....document the finding.
创伤高年资/低年资住院医师：辅助创伤住院总医师，暴露患者身体...及记录检查结果
other member:
ER doctor (1-2): intubation
trauma bay nurse: give medication
technician: peripheral IV, FOLEY, NGT, find surgical instruments
respiratory therapist: ventilator management
X-ray technician
OR nurse: trying to find out what surgery to do and set up the room
Anesthesia: help intubation, set up the room
其他成员：
急诊室医生（1-2）：气管插管
创伤室护士：给药
技师：准备外周静脉输液针、Foley导管、鼻胃管，及手术器械
呼吸治疗师：通气管理
X线技师
手术室护士：尽力弄清要做什么手术，并准备手术室
麻醉师：帮助插管，准备手术室
as shown in the graph, others should stand out side the line except the key players of the trauma team.
如图中所示，除创伤小组的重要成员外，其他人应该站在线外。
now you know why the picture i showed before was a bad organization. if you have too many people around the bed, they will be just in your way.
现在大家知道，为什么我开始展示的图片是一个不好的团队。如果有很多的人围在床旁，也应该是按你的方式（井然有序地排列）。
（7）创伤外科医生：组长
创伤住院总医师：初步评估，中心静脉置管，建立动脉通路，放置胸管，急诊手术：开胸，止血
创伤高年资/低年资住院医师：辅助创伤住院总医师，暴露患者身体...及记录检查结果
其他成员：
急诊室医生（1-2）：气管插管
创伤室护士：给药
技术员：准备外周静脉输液针、Foley导管、鼻胃管，及手术器械
呼吸治疗师：通气管理
X线技师
手术室护士：尽力弄清要做什么手术，并准备手术室
麻醉师：帮助插管，准备手术室
如图中所示，除创伤小组的重要成员外，其他人应该站在线外。
现在大家知道，为什么我开始展示的图片是一个不好的团队。如果有很多的人围在床旁，也应该是按你的方式（井然有序地排列）。
you guys are awesome. thanks again for the hard work. one thing i want remind everybody is please dont' forget to answer the questions i posted. it will help me know more about you guys and better prepare next discussion.
thanks again, esp. Melody,
Bo
chest tube, central line kits 胸腔引流管 中心静脉穿刺包
各位站友，BoYang1998兄提了几个问题，希望大家积极回复。小弟在这方面实在没啥经验，请各位有经验的站友顶一下，也有利于BoYang1998的授课计划。
questions for today: please do answer. i want to know if i need talk about those procedures.
1. how many chest tubes have you put in? how do you do it?
2. how many central lines have you done, including internal jugular vein, subclavian vein, femoral vein? how many arterial lines have you done? how many pulmonary artery catheter(SWAN catheter) have you done?
3. how many emergent cricothyoidectomy or tracheostomy have you done?
as a trauma chief resident or trauma surgeon, cental lines or chest tubes should be done in 1-2 minutes, tracheostomy should be within 5 minutes.
Hi, Guys,
am i going too fast? if i am, i can slow down.
i really appreciate your answers to the questions i asked. they will help me plan the discussion. thanks
Bo
这次的问题如下，请大家务必回答，（根据你们的答案）我才能知道是否需要讲解相关的过程。
1、你们做过多少次胸腔置管术？是怎么做的？
2、你们做过多少次中央静脉置管术，包括颈内静脉、锁骨下静脉、股静脉？你们做过多少次中央动脉置管术？你们做过多少次肺动脉导管（SWAN导管）置入术？
3、你们做过多少次环甲膜切开术或气管造口术？
作为一名创伤住院总医师或创伤（专科）医师，中央动静脉置管术和胸腔置管术应该在1-2分钟内完成，气管造口术应该在5分钟内完成。
这两天从BO兄的讲座中真的学到了不少，不论专业知识还是英语水平，相信大家能坚持下来对参与进来的站友都会有所收获的。应道兄要求，也看了fish0220站友的贴子，觉得既然是讲座，和“老师”的互动还是相当重要的，大家的翻译工作做得很出色了，可也别光忙着翻译而忘了我们的初衷是为了学习TRAUMA的，觉得界面有点乱，偶搜集了下原贴中有关大家和BO兄互动的内容，集中整理到下面，也算是个习题集吧，偶会不定期的更新，但最主要的是希望大家对BO兄的问题能及时回应，也可以提出自己的疑问，请将回答或疑问发在英文原贴，也好让BO兄及时调整我们的学习内容……
偶也来当回短途搬运工吧，呵呵
以下BO兄的回贴用红字，大家的提问或回答用蓝字吧，方便阅读
（1）BO:
interesting case this time:
62 year old male attempted suicide:stab wound to the left chest. stable
what you want to do:
Pull the knife?
Call a psychiatrist?
Give him antibiotics?
Sent him to the CT scan?
Upper GI with SBFU?
Open cardiac massage
fish0220:
1、从图片上看，该患者伤后已存在生命体征不稳，考虑是否存在心脏及大血管的损伤？是否有心包填塞的症状？另外从刀刺入的方向看，考虑是否存在胸腹的联合伤？此时急需做的应该是急诊开胸手术探查，明确损伤情况，积极争取最好的手术时机，诸如CT检查及心理治疗都应该是后期的工作。
2、对于异物刺入体内，在情况不明的时候是禁忌随意拔出的。
3、对于这样一个大的开胸手术，预防性使用抗生素应该是需要的。此外备血输液也都是必须的吧。
4、至于说到开胸心脏按压，还是应该视术中情况而定吧。
说的不对的，请老师多指教，谢谢！
（2）BO:
about the case. Tongdour and fish0220 had very good view.
patient had stab wound to Left lower chest or upper abd. i'd like to discuss it after we talk about how to treat trauma patient first time when you see the patient. you too be patient. i hope at the end , you can tell me what you can do to help this patient fast and right.
（3）BO:
a bonus question: please do answer.
how chest have you cracked (which means median sternotomy and thoracotomy)?
fish0220:
对于手术入路的选择，应以简易的手术方式尽快接近心脏为目的，一般来说，左前外切口容易接近左室、右室前壁，胸骨正中或右前外切口用于处理右房和腔静脉伤。该患者个人认为应选择左侧胸廓切开术，这样也有利于必要时增加腹部切口的准备。由于个人对胸外没有临床手术经验，请老师指点。谢谢！
（4）BO:
i want to explain more about the bolus question:
the bolus question about cracking chest is not regarding this patient in the picture. it is a general question for every general surgery. please don't think chest is belong to the thoracic surgeon. as i mentioned before, trauma surgeon should be able to operate on any body cavity, chest is a common one. so i'd like to know how many chests have you cracked, are you comfortable to open a chest if you have to .
fish0220:
我并没有实际做过开胸的手术，当然腹部的某些手术可能涉及到胸腔的问题，如果必须由我来做，也许可以开，但绝对无法达到胸外专科医生的水平。我想大多数医生只可能在某个领域有所专长，可以达到comfortable的水平。个人认为，对于创伤患者的诊治，关键在于及时判断病情、做出初期的处理意见，而在实际的治疗过程中，只要条件允许，可以按照病情需要请相关科室医生会诊，这样也是对患者的负责吧。难道国外的创伤医生真的都是“全能战士”了？
（5）BO:
for trauma surgeon, we always face life threatening injury. you are the first doctor to see the trauma patient. the patient may be dying in front of you, there is no time for you to call consult. for example: stab wound to the left chest, forth intercostal space, patient just arrived, gasping breath, BP 40/0, pulse 30. right after you see him, he lost his pulse. what wound you do? are you going to call cardiothoracic surgeon, or you just cut the patient? i cut one, and brought him back. he walked out the hospital.
you are not going to do complicated vavle repair or CABG, You open the chest to try to save the patient's life, most stop the bleeding, cardiac massage, clamp the aorta.
trauma surgeon (or general surgeon ) treat a patient as a whole, not just a belly surgeon.
fish0220:
回复BoYang1998兄关于创伤医生开胸急救的问题：
对于您举的例子，也就是说在那种只有你一个人在现场的情况下，当然您的处理手段是必需的。但对于一个相对成熟的急救体系而言，我个人认为，对于您举的那样生命危急的患者，应该在急救信息发出时即应预先召集好相关的急救人员做好急救准备，即您在讲座中所提到的“创伤团队”。
据我了解，在美国，院前急救人员会将创伤患者按损伤严重程度分为三类：Ⅰ类(伴或不伴生命体征不稳定，有生命威胁的创伤)由创伤服务主任带领全体创伤小组成员等候在急诊室，以便在患者到达后及时开展诊断和抢救；Ⅱ类(生命体征稳定，有潜在生命威胁的创伤)为选择性要求创伤小组成员在患者到达急诊室时及时展开诊断与救治；Ⅲ类(生命体征稳定，无生命威胁的创伤)为损伤较轻，仅由创伤小组中的急诊医师和急诊护士提供服务，必要时邀请创伤外科医师会诊。
而在主要创伤中心，患者急诊入院处理期间，各专科医师，尤其是骨科、神经外科、胸心外科和整形外科医师都需要密切介入。大多数创伤中心，各专科医师更多地起着会诊作用，但这些专科都是创伤项目必不可少的组成部分，他们的责任是在急诊室检查患者，鉴别专科损伤，设计和实施适合于每个患者的治疗计划。所以我个人认为，除非是情非得以，对于创伤人员的救护还应请相关的专科医师给予最恰当的诊疗。当然，对于您所说的整体诊疗的观点，是完全同意的。
（6）BO:
what you are saying is partially right. those subspecialty will be available but they won't stand at trauma bay as you do, waiting for the patient coming. traumatic injury is so unpredictable, nobody knows what's going on with the coming patient until he comes. so it is not practical to have all the subspecialty be at trauma bay. at the same time, trauma patient's condition changes so fast, you have no time to call for help when the patient arrives.
the fact in the USA now is: as a trauma surgeon, you are supposed to take care of any trauma patient. if you are a certified trauma surgeon, you don't need to be the director of trauma surgery to take critical patient. as far as other specialties, if you don't call for consult, they won't show up. like the case i mentioned above, it happened at midnight, you won't have a cardiothoracic surgeon standing side by side with you, waiting for the patient coming. since critcal trauma injury happens every night, there is no way to have other specialty be in house as a trauma surgeon does. after you stablize the patient, if the patient has complicated heart or aorta injury or other injuries, then you call them and they will come to help you. when you choose to be a trauma surgeon, you choose to be in the disasters, you choose to fight death all the time. i will talk about more about trauma team soon.
johnsonyyy：
既然Bo兄有如此好的资源，建议您详细的讲一讲！
关于trauma bay的设置、人员配备、运作流程、工作常规，我觉得都是很好的内容，都值得学习。比如说一个病人送过来，谁站在那个位置，谁负责插管，谁负责开静脉通道，谁负责监控生命体征，都得要有明确的分工协作才能忙而不乱，洁身时间，效率达到最大化，希望Bo兄介绍你们的经验：一个病人送过来，多少个医生护士该立即行动起来？如何行动？
创伤外科医生的培养和条件我觉得也是值得详细讨论的。Bo雄可以结合自己实际的经验，比如说讲一讲您自己当初是怎么走上这条道路的，给我们一点启发！
关于抢救的原则问题，Bo兄应该详细列出来讲。一个病人来了，首先要干什么，怎么作；然后要干什么，怎么做；怎么判断这个病人该进行这个，进行那个？都是有趣的话题！
到具体病例，比如那个自杀的病人，Bo熊可以把你的问题提出来，大家讨论。然后Bo雄给出当时你们的做法，我们在一起回顾那些做对了，哪些做得不够好，对大家对Bo熊都是提高！
这些是我的一点小小的建议，我希望这个讲座会办得很成功，成为的又一经典！我会继续关注这个讲座并积极参与其中，向各位学习！
（7）BO:
Johnsonyyyyyyyyyyyyy, i like your questions, right to the point, ahead of time. your question needs a whole chapter to answer. here comes our second part of this talk. trauma system, trauma center and trauma team.
（8）BO:
questions for today: please do answer. i want to know if i need talk about those procedures.
1. how many chest tubes have you put in? how do you do it?
2. how many central lines have you done, including internal jugular vein, subclavian vein, femoral vein? how many arterial lines have you done? how many pulmonary artery catheter(SWAN catheter) have you done?
3. how many emergent cricothyoidectomy or tracheostomy have you done?
as a trauma chief resident or trauma surgeon, cental lines or chest tubes should be done in 1-2 minutes, tracheostomy should be within 5 minutes.
i really appreciate your answers to the questions i asked. they will help me plan the discussion. thanks
tongdour：
偶是在读的研究生，对临床工作真是没大动过手，只是见过气管插管，胸腔引流、环甲膜切开，以上的这些如果对于急救，没有其他学医的在的话，偶相信自己可以大胆进行，而且不会犯什么致命的错误，反正是救命要紧嘛……
对于中心导管置管、SWAN导管只在课本上知道，可从来没见过，其实真的很需要这方面的知识，实习两年都没见过也没听过哪个科用，自己感觉是不是操作真的不简单？不知道BoYang兄能不能传点现场的照片上来看看？有个感性认识也好啊……
还有，BoYang兄讲的创伤级别RED WHITE GREEN，你自己都能记下来吗？能分的那么确切吗？唉，尤其是这样评估划分级别的东西实在太难记了，偶学医最烦的就是这些，不知道BoYang兄有什么妙招没有？其实在临床中，见到的许多东西和课本的理论都是不一样的，很多教授都没有按一些理论来进行操作，比如胃CA的根治，有谁真的按照分组来清扫淋巴结？还D1、D2、D3的分呢？不过真见过一例，是老主任的老同学，教授做了7个小时，平时的一般胃癌2、3个小时就下来了，不知道国外的医疗环境怎么样？
还有那个trauma personnel protocal，BoYang兄那是严格按照理论来站位吗？偶感觉理论归理论，可能说出来大家都明白，但要在国内，估计没人会那么站位……
所以也希望BoYang兄能捎带着介绍下国外的医疗环境，大夫日常工作都是那么的井然有序吗?
(9)BO:
thank you Tongdour for responding all questions. i still hope to see more responses. based on his response, i'd like to discuss a little bit about those basic procedures before we go on.
还有，BoYang兄讲的创伤级别RED WHITE GREEN，你自己都能记下来吗？能分的那么确切吗？唉，尤其是这样评估划分级别的东西实在太难记了，
i can't remember all of them either, ~_^. it took me a while to find those documents. what's important to me is: it is red or white. then i will go down and ask the nurse what is coming in.
比如胃CA的根治，有谁真的按照分组来清扫淋巴结？还D1、D2、D3的分呢？不过真见过一例，是老主任的老同学，教授做了7个小时，平时的一般胃癌2、3个小时就下来
right now, we emphysize evidence based practice. many traditional rules have been proved not right. we have shaped our practice based on large clinical trials. there are standard practice, if you are not following the standards, once you have complication, you will lose your case easily and pay a lot money to compensate the patient.
还有那个trauma personnel protocal，BoYang兄那是严格按照理论来站位吗？偶感觉理论归理论，可能说出来大家都明白，但要在国内，估计没人会那么站位……
Sometimes it is very hard to keep things in order, so trauma surgeon and trauma chief have to be strong and aggressive. you can ask people to shut up or move out of your way. in trauma bay, we work like sodiers.
i was going to discuss how to set up trauma bay, but i found it may be necessary to discuss those skill procedures i mentioned above. please let me know if you like to discuss those procedures. i really like to see more responses.
Another favor i want to ask. my dear friends, could you please translate all my responses to the questions from you guys. thanks a lot.
道可道非常道：
"首先想明确一下bo兄那边的创伤救治体系。创伤外科医师是接受有普外基础并接受专门培训后的医师，要求能独立操作人体各部位的手术。"
（1）BO:
there is a little bit confusion. as i said trauma surgery is part of general surgery. general surgeons should be able to take care of trauma patients without further training. means treat patients at trauma bay and in the OR.
the further training part is for critical care. it is one year fellowship. DURING the fellowship, you will certainly treat more trauma patients at trauma bay and in the OR and in the ICU. after one year fellowship of critical care, the surgeon can run ICU, take care of all the ICU patient. trauma and critical care are combined together.
道可道非常道：
创伤外科中心也是独立体系的。就是说，这个中心24小时有人守候但只对创伤接诊，其他比如急腹症并不负责。因为小弟目前值急诊外科班，我们这只要是外科不分是否是外伤，都由一个医师负责。
（2）BO:
still i want emphasize that trauma is part of general surgery. when we are on call, we take care all the trauma patients and emergent surgical patients. that why general surgeons should be good at trauma and comfortable to take care of trauma patients.
when the trauma attending is operating in the OR and can't go to the trauma bay as the trauma patient is coming, the trauma chief resident is promoted to be the team leader, and so is every body pormoted to upper level in the trauma team. sometimes when we are busy, maybe just a 3rd year resident and an intern take care of trauma patients at trauma bay if the patient is not that sick.
道可道非常道：
"3、小弟值班总是忐忑不安熬过每一白天和黑夜，尤其是担心急救车送来的病人，因为事前完全没有任何心理准备。就这点想请教波兄：在兄弟那，比如说一个路人看见了一场车祸，那么他就拨打911或其他号码，然后会有飞机或急救车来，请问这个急救车是创伤中心出的车吗？等急救人员到达现场后，初步评估伤情代码，他把这个代码直接发到创伤中心吗，还是有专门的网络平台协调此事。因为，一个区域很可能被不同的创伤中心重复覆盖，是什么机构来协调急救车去的方向以及把这个代码传给哪个中心。"
（3）BO:
Ambulance doesn't belong to the trauma center, here they belong to an organization, lifenet which may be part of the fire department or an independent company. when find the patient, they will contact the closest trauma center first.
道可道非常道：
"4、如果是患者家属送创伤病人来医院，第一个接诊的是急诊科的医师吗？还是有专门的创伤医师在急诊科等候？这种情况下，是由谁发出代码，通过什么工具？"
（4）BO:
this happens sometimes. two weeks ago, i had a patient with multiple gun shot wound to abdomen and chest, walked into the ER, asking for help. for those patient, the triage nurse at ER will send out page with code like "1-1-2-0" for last patient which means: trauma read, one patient, at trauma bay 2, 0 minutes--meaning patient's already here. the trauma team are always in house, we just run down from anywhere in the hospital to the ER, trying to get there as soon as possible.
all the pages with codes are sent out to our pager by the ER triage nurse based on the criterior of RED, WHITE. the EMT (emergency medicine technician) just tell the ER nurse what injury the patient has. they don't decide it is trauma red or trauma white.
道可道非常道：
"5、面对胸口刀扎伤的病人，如果生命体征平稳，是否就先观察，完善检查及围手术期准备。但要是生命体征不平稳，创伤外科医师就可以立即开胸救命吗？要是救治失败，患者死亡，如何举证证明是病情过重死而不是抢救不当致死？因为在国内，面对同样的情况，要是患者死在医院，家属有可能就要告医院了。"
（5）BO:
for stable patient, you may want to do more studies before you cut him. trauma does have a lot socail economic issue. we have many gangsters, drug dealers who get shot, coming to us. any operations to trauma patients don't need operative consent. that is a law, because if the patient is dying, he can't sign the consent. the law suits for trauma surgeon on trauma cases are not common, because everybody knows the patient was injuried before he arrives, the surgeon is trying to save his lift. a good legal system can help this kind problem.
道可道非常道：
7、bo兄提到的操作，我大部分都操作较少，气管插管也只是在模拟人上上熟练操作。因为一般都是麻醉科的大夫来做。但其中的锁骨下静脉穿刺中心静脉置管术我做的相对其他还是多些，我用的是arrow的导管，上面写是美国进口，呵呵，不知道bo兄是否也用这个，在此求证一下。事实上，发这个贴的时候，我刚才肿瘤内科置管回来，因为内科拿不准的也经常找外科帮忙。我这边基本上是一个人操作，在患者床边完成。就我个人而言，大概做过200例左右吧，误穿到动脉有5例左右，出现气胸1例，穿刺失败大概10例。气胸那例病人是一个恶液质的病人，明确气胸后，就立即在患者床边以seldinger‘s法于第二肋间置入单腔arrow中心静脉导管，引流效果还不错。但即便患者签字同意，当出现并发症的时候，解释起来还是很费劲，现在医患之间缺乏信任，不知道bo兄那出现并发症，家属是否纠缠。
（6）BO:
Your result is awesome. one pneumothoax in 200 subclavian, 0.5%. that is excellent. average it is about 1% over the USA. You are an expert for central line. we do have same complication (every surgeon has complications). patients and their family are fine, they understand it. no biggy. but do tell them the risk first and never lie about complication, that is the way how we deal with complications.
We use Arrow central line kit too.
明确气胸后，就立即在患者床边以seldinger‘s法于第二肋间置入单腔arrow中心静脉导管-------- this is very smart way for central line induced PTx. we just put a big chest tube for the patient. he he.
道可道非常道：
8、说了很多了，最后请教bo兄，创伤外科是个风险很大的专业，国外的医师在行医过程中是如何自我保护的？
（7）BO:
all of us have malpractice insurance. as i said, the law suits have not been that bad from trauma patient. most time it is involved a missed injury. trauma team has to be thorough on trauma patients. anothing is: don't hurt yourself when you are doing procedures or operations, because some patients may have blood-borne diseases, such as hepatitis. you don't want those problems.
Thanks a lot for DAO XIONG's questions. it is very helpful. from your questions, i can find out what you are interested in, how much sense my talkings make. hope to see more questions.
i will start to discuss about procedures next time.
thanks
Bo
wrr13017217873 wrote:
创伤外科确是当今外科的新领 域,国内外有很多不同的模式组建,但有一点是一致的,需要多学科多专业的配合协同工作.
问题是领导这个有麻醉,普通外科,骨科,心胸外科,泌尿外科,颅脑外科多专业的综合体有谁主导,这就是不同组建模式的分岐点.如LZ提供照片the caos at trauma bay. bad organization,显的是膨冗，杂乱。可能是观看占大多数。
国内的急救中心往往以外科ICU为中心,有什么专科情况再请会诊，这种模式常常会有各种专业处置不协调顾此失彼的可能。
另有种少见的模式是组建一个创伤科由一个比较通晓普外泌外骨创伤，颅脑创伤胸伤的外科高年资主任医师担领导指挥，他最好主导专业是普外，又在上述各专业轮转并担任主持工作。在他领导下有6个--8个各专业较低年资主治或住院医师，有这样的班子能对多种复合伤马上作出伤情评估并作出相应紧急处理，在进行手术处理时腹部泌外洧化器官损伤，或胸部创伤同时进行修复，当有四肢伤时可在第一时间进行一期处置。当然形成这样一个团队是需要大约 较长的培育时间，产生一个掌握这个团队的主任指挥需要更长的时间和自身的钻研训练。
实践证实上述模式在国内是行之有效的能极大提高创伤抢救效果。
that's a very sophisticated view of trauma surgery. i don't know that there is any trauma bay at ED in china. Trauma bay is the place for us to do initial assessment and resuscitate patients, especially those dying ones. for the initial resuscitation, we have a trauma surgeon, trauma chief resident and a junior resident. we call neurosurgery for head trauma, ortho for fracture, vascular surgery for large vessel injury, plastic surgery for facial trauma, CT surgery surgery for ruptured aorta. we rarely call urology for consult. we also take care of all the simple chest problems, such as vessel bleeding (not ruptured great vessels), lobectomy for lung injury. trauma surgeon and trauma team is the core taking care of all the trauma patients, other specialties are just consulting teams. i know there is no such subspecialty, trauma surgery, in China. porbably it is time to set up such subspecialty as part of general surgery.
道可道非常道：
1、希望bo兄能提供中心静脉导管的套装的图片。我好奇国内的arrow是否是原装进口。因为在套装中导丝是通过穿刺注射器的尾端进入静脉的，不需要拔下注射器。还有，套装中有平头针，用来判断是否是静脉血。根据现有的这个操作如何判断动脉、静脉血。
i take the syringe off and put the guide wire through the needle. at the same time make sure it is the vein by looking at the color of the blood and the way it bleeds, pulstile or just dripping.
2、针对锁骨下入路中心静脉穿刺，锁骨形状不尽相同，这点是否在操作细节上有区别？
pretty much poke below the turning of the clavicle, walk down to the subclavian space and just the hand then shoot to the sternal notch.
those procedures need some practice. shouldn't be too difficult, but you should always be careful.
"我放的胸腔引流管不计其数，有在第二肋间锁骨中线放的，有在腋中线处放的，有在腋下腋中线放的。每次目的都不同。
锁骨下深静脉置管是我最多的选择。
气管插管、气管切开，也是作了不少。
上述操作，这么多年来，还真没有遇到书上说的那么多并发征。
锁骨下深静脉置管我从来不选择体位，我的体会，任何位置都可以穿。
气管插管是在每次手术麻醉时，跟麻醉医生学的，自己在急诊时就用上了。
曾经10分钟左右，我将上述3条管放入病人体中，病人得救了。"
that's pretty much every third year general surgery resident should be able to do. if you don't think you can do that, then you may want to more pracitice.
"BO,will u please put more cases on DXY for discussion?In that way we can see the difference between US doctors and us directly."
i will have a lot more cases after we start discussions about specific injuries. thanks for your suggestion.
li_88_xin wrote:
请问环甲膜切开cricothyroidotomy和经口或鼻腔气管插管Intubation，有何区别，我的意思是他们的适应症和如何选择？请bo兄和其他战友指点。
when patient has upper airway problem, you can't secure the airway with intubation on time to save the patient. you cut him, either emergent cricothyroidotomy or tracheostomy.
(1)i have been putting a lot of time into this discussion. i think it is worthwhile. hope all of us can learn something. it is your supports, interests, responses and questions that keeps me going. i thank you all.
i am very glad to see 小李废刀's question. you all are welcome to discuss your own cases. if i am not sure about the solution, i will discuss with other trauma surgeons in our trauma center.
"数日前，应邀到ICU会诊，一男大四学生，车祸伤（脑外伤，骨盆骨折，髋部、下腹部、腰部脱套伤）40天。
主要问题：脓毒症不能控制，呼衰不能脱机。
高热，嗜睡，心动多速，肺清（CT轻微炎症），脱套伤部位多处小切口引流（有脓液，不多），阴囊下肢水肿明显。曾CRRT，水肿可消，停用再肿。肠功能好，EN。
他们考虑脱套伤部位部位感染未能控制，我给予多切口扩大引流，皮下间隙有渗液，脓不多，无明显坏死组织，背部皮下相通。左右放置黎氏管冲洗引流。术毕，阴囊水肿立刻减轻，心率下降。
按时换药，仍发热，阴囊再肿。
目前加强局部换药，有好转。"
(2)before i give my suggestion, i'd like to know more about the patient as a whole:
from head to toe:
1. CNS: How's his mental status, how bad is the head injury
2. cardiovascular: is he hemodynamically stable, or he's in shock, on pressors?
3. respiratory: what's the reason for his resp. failure? what's the ventilator setting
4. GI: any intra-abdominal injury, abscess, when was the last time he had a CT of abd and pelvis
5. GU: Renal failure, what's the creatinin and urine output.
6. EXT.: how bad is The deglove injury, any necrotic tissue needs to be further debrided
7. hem/ID (hemotology and infections disease): what infection does he have? is he septic, what's blood Cx? is he anemic?
8. FEN (fluids, electrolytes and nutrition): is he fully resuscitated, is he wet or dry? any electrolytes disturbance. it is good he is on enteral nutrition. how do you feed him.
9. prophylaxis: is he on any prophylactic medication for DVT (sq heparin, SCDs) and ulcer stress ulcer
10. dispo: did physical therapist see him? when can the patient be transfer out ICU (not specificly for this patient).
if you see an ICU patient, it is a good idea to have all these item go through your mind, then you probably won't miss something. 小李废刀, i think your debridement helped. if you can take some pictures of that patient, that be helpful.
小李废刀 wrote:
Thnx, Bo.
我现在在外地公干，无法详细描述，且我看他时已伤后40天，很多情况不清楚，大体说一下。
病人此前，曾脱机，水肿减轻，后又反复。
1. CNS: 可能脑挫裂伤，现形成轻度脑积水，意识状态：多数嗜睡，有时似乎清醒，我不太专业，换药时睁眼，有定向反应，需用止痛药。
2. cardiovascular: hemodynamically stable
3. respiratory: what's the reason for his resp. failure? 不清楚，这也是我想知道的，考虑与感染、炎症、组织水肿有关。what's the ventilator setting?最初SIMV，现在可能是PSV。
4. GI: No intra-abdominal injury, abscess, CT showing 皮下隧道，骨盆骨折，
5. GU: BUN Cr 轻度升高，尿量正常。
6. EXT.: 探查看，似乎未见明显坏死组织，脂肪水肿，偏韧，有些地方，如腰部（近脊柱）看不清，以黎氏管冲洗，换管未发现明显坏死组织。
7. hem/ID (hemotology and infections disease): 症状体征CT看肺部感染不重，通过清创，似乎创面感染也不太严重，曾经有脓毒症证据，深静脉导管早已拔除。
8. FEN (fluids, electrolytes and nutrition): 大体正常，以EN为主，最近我让bolus 匀浆饮食。
9. prophylaxis: 最近我让应用低分子肝素，穿弹力袜；胃肠道功能好，抑酸药停了。
10. dispo: 理疗师看了，不过康复效果较差，关节僵硬，我看将由家属康复更好；我希望他能脱机后转入普通病房，离开ICU这个细菌库
(3)BO:
looks like he is not septic. major problems are
1. head injury which neurosureon should have some input. he probably can't protect his airway.
2. resp. failure. does he have ARDS? How long has he been on Vent. he failed extubation once already, and can't be wean off vent. you probably want to think about tracheostomy. interesting enough, it is easier to wean off after tracheostomy.
3. wound: looks like needs aggressive dressing change and debridement PRN.
4. Rehab is a big issue for him too.
小李废刀 wrote:
Tracheostomy done long days before.
(4)BO:
i have too limited information to figure out why he is vent dependent. do you have CXR, CT of the chest, blood gas, ventilator setting in details, like what mode, rate, how much peep and pressure support? how's his phosphorous level?
chenguoliang wrote:
BoYang1998兄
我想请问在你们那里病人急需用血需要办理什么手续？大约要多久？
(1)BO：
even before patient's arrival, we have emergent blood release, type O packed RBC, at least 4 units ready at trauma bay. if the patient needs blood, he will get it in 0 seconds since it is already there. we treat patients first, no money issue is involved at that time. all the blood was donated by volunteers and collected by Red Cross. our blood bank gets blood from Red Cross.
yuwen_luo wrote:
BoYang1998兄,你好!已加紧学习了上面的精彩讲座,谢谢.
我想了解一些国外关于"严重腹部外伤的控制性手术治疗"方面的信息.由于社会的日益发展,严重的腹部创伤\复合伤屡屡碰到,一次性的彻底手术往往难以抢救成功,分期控制性手术有意想不到的效果.国外这方面的研究进展如何?
(2)BO：
damage control surgery was orignally advocated by trauma surgeons since trauma patients sometimes are very unstable and more time in the OR will just make the patient worse, like the lethal triads i discussed before in a post about damage control surgery. this idea has been adopted by my general surgeons for other situation. for severe trauma injury, as you mentioned, damage control works quite well. we do it almost every day. we always have some trauma patients with an open abdomen in the ICU, waiting for wash-out, second look, completion of the surgery....
i have some disussion about damage control in "trauma case #1" too which was a gun shot wound to the abd, IVC injury.
Damage control surgery is an idea. because pt is not stable enough for you to complete the surgery in one stage, we need minimize OR time as short as possible to avoid lethal triads (hypothermia, acidosis, coagulopathy) and we can come back to finish the operation.
i recommended some books before in the past discussions.
chenguoliang wrote:
can you tell me someting about the intern?
(1)BO:
the concept of "Intern" is different between china and USA. HERE, intern means the first year resident, just graduated from medical shcool. it is a transitional year from amedical student to a resident. intern year is the hardest year. you work 80-120 hours a week. starts at 4-5am, goes home at 6-7 pm. always in house call.
interns (first year residents) and junior residents are supposed to come to the hospital between 4-5 am, finish rounds and daily notes by 6 - 6:15 pm. then the chief residents start rounding and make plans for patients, finish by 7 am. we start operations (cut the skin) at 7:30 am. in the academic setting, the attendings see the patients whenever they like. each attending sees his own patients only unless he is covering for his/her partners. all the general surgery services are run by the chief residents.
the rules for interns are: eat whenever you can, sleep whenever you can. the working hours are getting better due the new rule from ACGME who set up a upper limit of working hours of 80 hours/week.
chenguoliang wrote:
我认识一位教授，在美国学术交流的时候，遭遇了车祸，不省人事，由于伤势严重被直升飞机紧急救护至加利福尼亚州大学医疗中心救治。严重的脑震荡、双侧胫腓骨多断开放性、粉碎性骨折、右侧腓肠肌部分缺损、创伤性休克、肾功能衰竭，以及手术并发症导致的肺脂肪栓塞，精神上的创伤的打击要他情绪很低落抑郁。伤后两个月开始康复训练。三个月的综合训练要他恢复的很好！不到半年可以要他恢复正常工作！现在根本看不出来他腿上曾经受过伤害！这在我国是很难想想的！在我们医院病人很多，住院的病人有时候术后还没来得及拆线就出院或者转院了！
在这里我想请boyang兄谈谈国外创伤后康复训练？是如何展开的？康复训练师是怎么培养的？为什么有这么大的“魔力”？
(2)BO:
rehabilitation is a very important part of managing trauma patients. in the hospital, we have specific physical therapist (PT) and occupational therapist (OT). when patients are stable, they go to some rehab facility if they need rehab. those PTs and OT s are very professional and love their job, love to help patient get better.
chenguoliang wrote:
为什么要限制大家呢？唉
的一分好难啊？怎么才能弄到？
(3)BO:
i didn't understand Cheng GuoLiang's note before. now i understand because i was blocked from reading two notes which has a minimum requirement of 10 points. i looked at mine which was 6.
most people visiting this website are medical professionals and interested in general surgery. we are having a professional scientific discussion about general surgery. everybody is equal here and should have equal opportunate to learn and to express their ideas. i don't know the reasons for the limitation set up in other posts. however, in this trauma discussion i think it is better not to set up any minimum requirement of score. thanks.
占位待用
谢谢铜豆的热心工作，已在顶楼做了相关修改。
确实，翻译是为了更好的交流和学习。请英文稍欠的战友们在这里找到答案后，回到原帖积极交流，这样，翻译的工作才更有意义！谢谢大家！
Hi, Melody,
thanks for your outstanding job. there was one line you left out. could you please help out? thanks.
"trauma senior/ junior resident: support trauma chief, expose the patient body....document the finding."
Hi,Bo,
I'm sorry for my carelessness. Thanks for your encouragement. I'll keep going~
Here I don't konw how to translate "expose the patient body",摆体位or暴露术区,which is better? Or there is another meaning~
"expose the patient body"
when patients come in, they all wear cloth or cover by something, "to expose the body" means to cut the clothes with trauma shears (special trauma scissors), remove all the covers to expose every part of patient's body forso that primary surveyor can exam the patient quickly. i will discuss more about this step when we talk about the initial assessment of trauma patient.
thanks again for your hard work.
Bo
本贴已累计加分
经过BoYang1998指正，我把修正后的翻译帖在此，供大家学习参考：
创伤代码：
不同的医院有不同的代码。我们有红色级别、白色级别和绿色级别。和fish0220提到的三种级别类似。只有在红色和白色的时候，救治队伍才会赶到急救室。绿色级别的创伤由急诊科医生处理。
红色创伤
创伤性心跳骤停
气道受限
血压<90，或小儿休克
颅脑损伤，GCS 评分<8
近腕或近踝部肢体离断
烧伤面积>15%(2度或3度)或合并呼吸衰竭,合并有外伤
大血管伤
气管带管
肢体瘫痪
躯干、头颅、颈部穿透伤，或伤肢无脉
从外院转来，靠输血维持存活
急诊内科医师判断（过的）
白色创伤
一或多条大的长骨骨折
骨盆骨折
孕24周以上合并可疑的腹部或骨盆外伤
为求专科治疗从他院转来
连枷胸
受困20分钟以上才获救者
甩离交通工具
客舱中有乘伴死亡
绿色级别但年龄>65
意识丧失2分钟以上
由急诊内科医师判别的其它白色创伤
绿色级别
意识清楚，仅有创伤机理（受伤过程），生命体征良好，没有明显的重伤
如果有高龄、严重威胁到生存等情况，仅有受伤过程患者也可升级到“白色”
在院前创伤分类时没有发现受伤过程，但是和上述绿色级别类似者，也可以入绿色组，包括钝器伤
当接到（传呼）通知，我们同时也就看到了色码。如果是“红色”，每个人都兴奋起来，我们知道可能出大事了。于是赶快到创伤急救中心，把东西安装好：比如胸腔引流管，中心管道（装备）盒......
有一件事我想澄清一下。在美国，医生非常独立，5年住院医生涯结束并通过普外委员会的考试后，全美普外委员会会予以承认，你将成为注册普外医师。将有自由权为患者做任何事。单独为患者负责，而不是你的系、部门或医院的头头。这么棘手的病例，如果你觉得能够胜任，你去做就行了。如果需要帮助，你可以叫有经验的同伴帮忙。如果你是私人行医，没有主任或部领导。
本次问题：请一定回答。我好知道是否需要展开这些话题。
1、你置过几根胸管？咋放？
2、建过几条静脉通路，包括颈内静脉，锁骨下静脉，股静脉？动脉通道建过几条呢？肺动脉插管做过几次？
3、急诊气管切开做过几次？
作为创伤科住院总或创伤外科医生，建立中心静脉通道或胸管应在1－2分钟内完成，气管造口应在5分钟内完成。
Vygwyt, outstanding job. thanks
i reviewed the whole translation edited by Dao xiong.
some suggestions:
整形外科医生: should be orthopaedic surgeon (bone doctor)
他发现在那个领域里，利用现有的有限资源: in the field: means at the scene where the accident happened.
每年大约有150,000人死于trauma. (these twon sentences need to be separated. 三个创伤高峰中不同的时间点
损伤后几 shi 分钟到几小时
一个普通外科医生非常适合在创伤科治疗任何创伤病人: comfortable to do something, means you are not nervous, you are confident.
大部分创伤外科医生都富有进取心: aggressive means: aggressive, not afraid, always forward
如果你想做病危特别护理，你需要在大的创伤中心进行1年的病危特别护理的训练: critical care is not nursing. means treat critical patients in the ICU
你就可以在ICU照顾那些病危患者。SHOULD TREAT critical patients
thanks.
提点建议哈
为了方便阅读，也方便大家积极参加讨论，能否请Bo重新编辑一下原帖，把已经基本定稿的译文直接贴在英文下面（包括讲座内容、提问、对战友答题的评价和针对战友提问的回答等），这样Bo的每个帖子就都成了中英文对照了（当然根据翻译情况可能会稍有滞后），我想这样会使更多的战友（特别是后来者）不必绕路到这里查找译文，相应地可以多花些时间在原帖，方便讨论和更好地互动。不知这样是不是更直观，更一目了然。只是又会给Bo添些麻烦。
另外，不知道大家感觉如何，个人觉得Bo有必要稍放慢些速度，不仅因为翻译需要时间，也希望多给大家一点时间消化、吸收和思考，细水长流嘛。
一点浅见，不好意思。
--------------------------------------
刚刚下载浏览了一下第一期的课件，luohui做得很棒！
又看了Bo上面提的建议，先试着回答一下，也请大家多发言：
orthopaedic surgeon: Google了一下，有整形外科医生、矫形外科医生、骨外科医生等译法。Bo倾向于用骨外？请Bo定夺。
in the field: 在现场、当场，个人觉得译为“当时”更符合汉语习惯，还是请Bo定夺。
每年大约有150,000人死于trauma. (these twon sentences need to be separated. 三个创伤高峰中不同的时间点
损伤后几 shi 分钟到几小时
不好意思，Bo的意思没看懂，要把哪两个句子分开？还是已经改正了？
comfortable：意思好懂，对应的汉语词还真不好找，“自如”行吗？
原句a general surgeon should be very comfortable taking care any trauma patients at trauma bay：一个普通外科医生应该能够非常“自如地”在创伤急救室治疗任何创伤病人
aggressive：也是好意会不好言传，“勇往直前”行吗？：大部分创伤外科医生都“勇往直前”。
critical care：救治危重病人
最后，课件里的Trrage还是没有改啊，正确写法是Triage. 这也是大家有些急躁的证据之一吧。
把已经基本定稿的译文直接贴在英文下面（包括讲座内容、提问、对战友答题的评价和针对战友提问的回答等），这样Bo的每个帖子就都成了中英文对照了（当然根据翻译情况可能会稍有滞后），我想这样会使更多的战友（特别是后来者）不必绕路到这里查找译文，相应地可以多花些时间在原帖，方便讨论和更好地互动。不知这样是不是更直观，更一目了然。
that's a good idea
仅因为翻译需要时间，也希望多给大家一点时间消化、吸收和思考，细水长流嘛。另外，不知道大家感觉如何，个人觉得Bo有必要稍放慢些速度
i like this idea too.
orthopaedic surgeon: should be and should only be 骨外科医生
in the field: 在当时现场
每年大约有150,000人死于trauma. this is the first sentence. stop here
then we talk about the trimode. please don't combine these two sentence into one in the translation
损伤后几 shi 分钟到几小时: needs to be average 40 minutes to hours. not just several minutes
comfortable：意思好懂，对应的汉语词还真不好找，“自如”行吗？
原句a general surgeon should be very comfortable taking care any trauma patients at trauma bay：一个普通外科医生应该能够非常“自如地”在创伤急救室治疗任何创伤病人-------------excellent
aggressive：也是好意会不好言传，“勇往直前”行吗？：大部分创伤外科医生都“勇往直前”。very hard to translate. i don't what is the best.
critical care：救治危重病人----------very good
最后，课件里的Trrage还是没有改啊，正确写法是Triage. 这也是大家有些急躁的证据之一吧。this needs to be changed. can somebody help please?
BoYang1998 wrote:
每年大约有150,000人死于trauma. this is the first sentence. stop here
then we talk about the trimode. please don't combine these two sentence into one in the translation
看了课件.ppt第5页，两句话并没有连在一起，Trimode是下面的一个大标题。莫非Bo看的是文本，而非ppt？还是luohui手快，已经改好了？
损伤后几 shi 分钟到几小时: needs to be average 40 minutes to hours. not just several minutes
第二个高峰：损伤后几十分钟到几小时
aggressive：也是好意会不好言传，“勇往直前”行吗？：大部分创伤外科医生都“勇往直前”。very hard to translate. i don't what is the best.
大家再琢磨琢磨，看看有没有更好一点的表达，“无畏”？“果敢”？
最后，课件里的Trrage还是没有改啊，正确写法是Triage. 这也是大家有些急躁的证据之一吧。this needs to be changed. can somebody help please?
这个由luohui大侠负责，他看到此帖后肯定会改的，包括其他变动。
另外，又注意到一句：
It is the leading cause of death in the first forty years of life (1 to 44 yr).
现在的译文是：它是40岁之前的主要死亡原因。
改一下如何？--- 它是人生前40年（1-44岁）的主要死亡原因。
It is the leading cause of death in the first forty years of life (1 to 44 yr).
现在的译文是：它是40岁之前的主要死亡原因。
改一下如何？--- 它是人生前40年（1-44岁）的主要死亡原因 -----------better
aggressive：果敢 ------ good one.
see, translation is not easy. it is much harder than we think. i am not a good translator. but you guys are very good.
每年大约有150,000人死于trauma. this is the first sentence. stop here
then we talk about the trimode. please don't combine these two sentence into one in the translation
看了课件.ppt第5页，两句话并没有连在一起，Trimode是下面的一个大标题。莫非Bo看的是文本，而非ppt？还是luohui手快，已经改好了？
it is separated in my original writing. thanks
you are really good, desert rose. thank you
本贴已累计加分响应Bo兄的要求，我把对话内容翻译在此处，英语中的很多东西只可意会，不可言传，如果死板地去直译，反而失去了“原汁原味”，因此我采用了很多“意译”。先举个例子，比如说：胸有成竹，如果翻译成胸腔里有个竹子，那还能叫原汁原味吗？当然这是汉译英，但反之亦然。
从http://www.....cn/bbs/post/view?bid=48&id=8002631&sty=1&tpg=1&ppg=3&age=0#8002631中的图下方开始：
我拍了很多急救室和ICU的照片。在聊到建立急救室的时候，我会把它们贴上来。谢谢。
我也很感谢这边一位创伤外科医师Dr.Latifi的支持并提供照片。Dr.Latifi是一位资深创伤外科医师，受训于耶鲁，已经帮助很多国家和地区建立了创伤中心。去年他还受邀到中国举办远程医疗讲座。我很想请他和其他的外科医师到我们中心来参加这次讨论。这也是我选择英语来讨论的又一原因。
下次见
Bo
我说伙计们，
我是不是讲太快了？是的话我可以放慢点。
我真的希望你们能回答我的问题。那将帮助我安排好讨论内容。谢谢了
Bo
Lvygwyt的翻译很不错（汗...lvygwyt注）。谢谢。他把所有的帖子放在一起，这挺好。
一些建议：
"after we finish residency and are certified":
指的是：在结束了普外科住院生涯后（5年）并且通过普外委员会的考试，你将被全美普外委员会认可，
取得普外医师资格。
senior partner:队伍中高年资的医师，不一定非是系主任。
当警笛拉响，我们同时也就看到了色码:我们都带着BP机，我们翻页码时，可以看到：1-1-1-10：第一个“1”代表红色创伤，第二个“1”指病人有一位，“2”指第2急救室，“10”：患者将于10分钟后送到。
如果你们在翻译时多加些注释，那就更好了。
感谢Tongdour回答了所有的问题。我仍想看到更多的响应。根据这些响应内容，我先针对那些基本的程序
多做些介绍，然后再继续。
急救室程序
对于每一位病人来说，尤其是外伤病人，我提及的所有程序都非常重要。如果你仅仅是看过而从未尝试去做，或许你都不愿单独去做。那些程序非常的复杂。
插管法：对保护气道很重要，如果你插到了食道里，可能会要了病人命。
胸腔引流管我看过有的住院医师插到了肝脏或脾脏里
环甲膜切开：会导致大出血。血液流到气管里，堵塞气道，也会要了病人的命，更糟的是：没有其他的办法。如果做，就要做好。没有犯错误的余地。
想做的更好，最好的办法就是多实践。你可以请麻醉医生来（指导）你在手术室有选择地插管。我也是这样学会插管的。在胸心外科轮转的时候，你可以去练习胸管插入。不要放过每一次实践的机会，你将会变得擅长并且应付自如。在遇到创伤病人时，有压力的情况下你就可以一显身手（function翻译成这样还行吧，比发挥功能好－lvygwyt注）了。
中心管道：（lvygwyt注：Bo 在提及此时，也说到了肺动脉，所以我认翻译成中心静脉不好，既然动静脉都有，那就翻成管道或通道才合适）
中心管道用于复苏，TPN,给药（如果有多路管道，一些药物可通过外周静脉给药）......中心管道也有潜在的危险。有时候这一操作也会要了病人的命。
插颈内静脉：伤到了颈动脉，导致脑卒中。
锁骨下静脉：伤及锁骨下动脉，无名动脉，可能要胸骨切开止血。
股静脉相对安全。但是，如果患者有下腔静脉损伤，插股静脉没用（lvygwyt：femoral line work work？是不是won’t work），因为输血或输液都（从下腔伤口）流走了。
中心管道对患者很有帮助。每一位普外住院医师都应擅长此操作。
如果你们对这些技术不熟悉，我可以讨论怎么做。
需要举例说明吗？请让我知道答案。
我即将讨论如何建立急救室，但我想先讨论一下上面提到的技术流程很有必要。请告诉我是否需要讨论这些流程，我需要更多的响应。
再帮我一个忙，我的朋友们，能请你们把我所有的答疑都翻译一下吗？一堆感谢。
问："首先想明确一下bo兄那边的创伤救治体系。创伤外科医师是接受有普外基础并接受专门培训后的医师，要求能独立操作人体各部位的手术。"
BoYang1998答：有点混乱，如我所说，创伤外科是普外的一部分。普外医师应能救护外伤病人，无需进修。指在急救室和手术室展开救护。
进修是针对特别救护而言。为期一年，进修期间，你可以救治很多外伤病人，急救室、手术室、ICU都有。一年的特别护理结束后，外科医生可以指挥ICU，救护所有的ICU患者。外伤和特别护理是联系在一起的。
问：创伤外科中心也是独立体系的。就是说，这个中心24小时有人守候但只对创伤接诊，其他比如急腹症并不负责。因为小弟目前值急诊外科班，我们这只要是外科不分是否是外伤，都由一个医师负责。
BoYang1998答：我再次强调，创伤外科是普外的一部分。接到通知后，我们会去救护所有的创伤患者和急诊外科病人。为什么说普外医生对外伤很在行，救治外伤病人得心应手，这就是原因。
手术室来了外伤患者，创伤科医师无法分身到急救室，创伤科住院总就升级为团队领导，救护队伍里的每一个人都有这样升级的可能。有时候太忙，病人又不是很重，或许急救室仅有一位3年的住院医和一位实习生。
问："3、小弟值班总是忐忑不安熬过每一白天和黑夜，尤其是担心急救车送来的病人，因为事前完全没有任何心理准备。就这点想请教波兄：在兄弟那，比如说一个路人看见了一场车祸，那么他就拨打911或其他号码，然后会有飞机或急救车来，请问这个急救车是创伤中心出的车吗？等急救人员到达现场后，初步评估伤情代码，他把这个代码直接发到创伤中心吗，还是有专门的网络平台协调此事。因为，一个区域很可能被不同的创伤中心重复覆盖，是什么机构来协调急救车去的方向以及把这个代码传给哪个中心。"
BoYang1998答：救护车不归创伤中心管，（美国）这边，它们归一个机构管，生活网可能是消防局或独立的公司的一部分。发现病人后，他们会首先和最近的创伤中心联系。
问："4、如果是患者家属送创伤病人来医院，第一个接诊的是急诊科的医师吗？还是有专门的创伤医师在急诊科等候？这种情况下，是由谁发出代码，通过什么工具？"
BoYang1998答：有时候会有这样的事。两周以前，我接到一个胸腹部多发枪伤的患者，走进急诊室，求救。对于这类患者，急诊室的分拣护士会发出代码页，象“1-1-2-0”意思是红色创伤，一位患者，第2诊室，0时间到达——指患者已经来了。救护队已到位，我们从医院各处赶往急诊室，尽可能地快。
所有的代码页都是由急诊室分拣护士根据红色、白色标准发送至我们的呼机。急诊内科医师仅仅告诉护士患者受的是什么伤。部门不管创伤级别的事。
问："5、面对胸口刀扎伤的病人，如果生命体征平稳，是否就先观察，完善检查及围手术期准备。但要是生命体征不平稳，创伤外科医师就可以立即开胸救命吗？要是救治失败，患者死亡，如何举证证明是病情过重死而不是抢救不当致死？因为在国内，面对同样的情况，要是患者死在医院，家属有可能就要告医院了。"
BoYang1998答：对于病情稳定的患者，在开刀前，你可能要做更多的检查。外伤牵涉到一些社会和经济方面的问题。有很多匪徒、毒贩子，他们遭枪击后，任何的手术操作都不需要手术同意书，这是法律，因为患者就要死了，他没法签字。针对创伤外科医师的法律规定不是通用的，（lvygwyt：如果不是创伤急诊，还是要签字），每个人都知道患者来之前就受伤了，外科医生努力去救他的命。好的法律体系能够帮助（医生）应对这些困境。
lvygwyt：不好意思，来不及翻完了，因为我的急诊也来了。俺去也。
谢谢syyu60兄和lvygwyt 兄的辛苦工作，太高兴你们加入了，小弟明天考试，这两天来就是看看就走了，等明天过后一定全力以赴和你们一起加油！！
祝工作顺利！！！
希望更多站友加入……
这篇文章对你有帮助的呀!"轻轻的告诉你"
成人骨髓成骨细胞体外培养.pdf (204.59k)
这两天老板给活了，有点忙，刚才总结了一下大家对第一部分的修改意见如下，请道兄参考并在总的翻译中修改。如有疏漏的地方，请大家继续指正。
感谢Bo兄的耐心和syyu60、tongdourl、vygwyt等战友的热心，让我们大家的英语和专业知识共同进步！
第一部分：
第一段：
一个整形外科医生…. 一个骨外科医师
第二段：
他发现在那个领域里，利用现有的有限资源… 他发现在当时的现场, …
第三段：
它是人类40岁之前的主要死亡原因 它是人生前40年（1-44岁）的主要死亡原因
在美国，每年大约有150,000人死于三个创伤高峰中不同的时间点。 在美国，每年大约有150,000人死于创伤。创伤造成死亡的三个不同的高峰时段：
损伤后几分钟到几小时 损伤后几十分钟到几小时
第四段：
一个普通外科医生非常适合在创伤科治疗任何创伤病人。一个普通外科医生应该能够非常自如地在创伤室治疗任创伤病人
大部分创伤外科医生都富有进取心 大部分创伤外科医生都很果敢
如果你想做病危特别护理，你需要在大的创伤中心进行1年的病危特别护理的训练
如果你想救治危重病人，你需要在大的创伤中心进行1年的危重病治疗培训
我认领第五部分。（实在不在行，大家多指点。）
（1） trauma bay procedures
创伤外科基本操作
all the procedures i mentioned are very important for any patients, esp. trauma patients. if you just see it and have never tried, you probably don't want to do it alone. there are serious complications of those procedures.
所有我提到过的操作都是非常重要的，尤其是对于创伤患者。如果你只是见过，而从来没有实际操作过，那么你可能不敢单独操作。因为这些操作会有一些严重的并发症。
intubation: very important to protect the airway, if you intubate into the esophagus or can't get the tube in, you may kill the patient.
气管插管：对维持气道通畅非常重要。如果你插管失败或者误入试管，这很可能导致患者窒息死亡。
chest tube: i have seen residents put into the liver and spleen
胸腔引流管：我曾见过住院医师将导管插入病人肝脏或脾脏。
cricothyroidotomy: you can cause a lot of bleeding. the blood gets into the trachea, block the airway, can also kill the patient and worst thing is: there is no other way. if you do it, you gotta do it right. there is no room of mistakes.
环甲膜切开术：操作过程可能导致大出血，出血会导致气道梗阻，这很可能导致患者窒息死亡，而且最糟糕的是，一旦发生这个情况将回天无力。所以要做就必须做成功。
the best way to get better is to practice. you can ask anesthesia to let you intubate your patient in the OR for elective cases. that's how i learned intubation. try to do chest tube when you are on Cardiothoracic rotation. just try all the possible to practice and you will be good and comfortable at it. then you can function under pressure for the trauma patients.
熟能生巧。在手术室要是有合适的病人，你可以请求麻醉师由你来完成气管插管。这也是我本人曾经学习气管插管的途径。可以在胸外转科时多学学置胸导管。利用一切资源想尽一切办法去锻炼，你会逐渐熟练掌握这些操作，从而才能在压力下成功救治创伤患者。
（2）central line:
开通中心静脉通路
central line for Resuscitation, TPN, medication (when they are several drips, some of the medication can be given through peripheral IV) ...... central lines are also potentailly dangerous. sometimes the procedure can kill the patient too.
开通中心静脉通路常用于复苏、全肠外营养支持、某些特殊药物的输注等情况。中心静脉同样具有一定危险性，甚至可能因置管导致患者死亡。
using internal jugular vein: injury to the carotid artery, resulting in stroke.
经颈内静脉中心静脉置管：可能会误伤颈动脉，导致脑卒中。
subclavian vein: injury to subclavian A, innominate artery, may need median sternotomy to fix it.
经锁骨下静脉中心静脉置管：可能会误伤锁骨下动脉、无名动脉，严重时可能需要行正中胸骨切开术来修补。
Femoral vein is relative safer place. however, if the patient has IVC injury, femoral line work work, because transfusion or IV fluids just bleeds out.
经股静脉中心静脉置管术相对比较安全，但是，要是病人下腔静脉损伤，则输注的液体回流过程中将从下腔静脉破损处漏出。
central line is very useful tool to help patient. any general surgery residents should be good at it.
开通中心静脉通路，对患者是非常有用的，任何一个普外科住院医师应当熟练掌握中心静脉置管术。
if you guys are not familiar with those technique, i can discuss how to do it.
如果大家对这些操作不是很熟悉，我会讨论如何操作。
Would you like to illustration of those procedures? please leave me a note for this question too.
大家是否想看这些操作步骤的图示？如果是，请留言告知。
整段翻译。
创伤外科基本操作
所有我提到过的操作都是非常重要的，尤其是对于创伤患者。如果你只是见过，而从来没有实际操作过，那么你可能不敢单独操作。因为这些操作会有一些严重的并发症。
气管插管：对维持气道通畅非常重要。如果你插管失败或者误入试管，这很可能导致患者窒息死亡。
胸导管：我曾见过住院医师将胸导管插入病人肝脏或脾脏。
环甲膜切开术：操作过程可能导致大出血，出血会导致气道梗阻，这很可能导致患者窒息死亡，而且最糟糕的是，一旦发生这个情况将回天无力。所以要做就必须做成功。
熟能生巧。在手术室要是有合适的病人，你可以请求麻醉师由你来完成气管插管。这也是我本人曾经学习气管插管的途径。可以在胸外转科时多学学置胸导管。利用一切资源想尽一切办法去锻炼，你会逐渐熟练掌握这些操作，从而才能在压力下成功救治创伤患者。
开通中心静脉通路
开通中心静脉通路常用于复苏、全肠外营养支持、某些特殊药物的输注等情况。中心静脉同样具有一定危险性，甚至可能因置管导致患者死亡。
经颈内静脉中心静脉置管：可能会误伤颈动脉，从而引起患者脑卒中。
经锁骨下静脉中心静脉置管：可能误伤锁骨下动脉，无名动脉，严重时可能需要行正中胸骨切开术来修补。
经股静脉中心静脉置管术相对比较安全，但是，要是病人下腔静脉损伤，则输注的液体回流过程中将从下腔静脉破损处漏出。
开通中心静脉通路，对患者是非常有用的，任何一个普外科住院医师应当熟练掌握中心静脉置管术。
如果大家对这些操作不是很熟悉，我会讨论如何操作。
大家是否想看这些操作步骤的图示？如果是，请留言告知。
感谢大家的辛苦工作，已根据提示更改，相信大家能坚持！也急切期待更多战友参与。
以下是前文中出现的部分专业词汇，希望能方便大家以后的阅读（尽量保持同步更新,如有错误疏漏之处请大家及时指正）
Trauma surgery 创伤外科
General surgery 普外科
trauma system 创伤急救体系
Trauma center 创伤中心
trauma bay 创伤室
trauma codes 创伤代码
critical care 病危特别救治
access to care 急救反应通道
prehospital care 院前急救
initial care 初步救治
definitive care 最终救治
resuscitate 复苏
rehabilitation 复苏N.
Transfer agreements 转院同意书
Protocols 协议
人员
EMS(emergency medicine services) 急救员
residents 住院医生
trauma chief resident 创伤住院总医师
trauma senior/ junior resident 创伤高/低年资住院医师
cardiothoracic surgeons 胸心外科医师
Technician 技术员
respiratory therapist 呼吸治疗师
OR nurse 手术室护士
Anesthesiologists 麻醉师
Neurosurgeons 神经外科医师
trauma orthopedic surgeons 创伤骨科医师
vascular surgeon血管外科医师
urology surgeon泌尿外科医师
CT surgery CT外科？
orthopedic surgeon 骨科医师
plastic surgeons 整形外科医师
ER doctors 急诊室医师
解剖
internal jugular vein（IJ）颈内静脉
carotid artery颈动脉
cervical spine颈椎
sternomastoid胸锁乳突肌
nipple乳头
clavicle锁骨
sternal end of the clavicle胸锁关节
subclavian vein锁骨下静脉
subclavian A锁骨下动脉
innominate A无名动脉
thyroid notch甲状软骨（上切迹）
thyroid cartilage甲状软骨
sternal notch胸骨颈静脉切迹
suprasternal notch胸骨上凹
cricothyroid interval环甲间隙
cricothyroid membrane环甲膜
cricoid cartilage环状软骨
trachea气管
esophagus食道
peripheral IV周围静脉
IVC 下腔静脉
femoral vein/artery股静脉/动脉
fight atrium房腔交界
trendelenberg position特伦德伦伯(氏)体位
supine position仰卧位
neutral position中立（线）位
sagittal plane矢状面
frontal plane额状面
器械，操作
cricothyroidotomy环甲膜切开
sternotomy胸骨切开术
femoral venipuncture股静脉穿刺
subclavian vein venipuncture锁骨下静脉穿刺
Internal jugular venipuncture/catheterization颈内静脉穿刺/置管
SELDINGER technique “SELDINGER”技术，方法
central line中心静脉通路
tracheal spreader气管扩张器
cuffed endotracheal tube气管内导管（带气囊）
tracheostomy tube气管造口术导管
Catheter导管，导尿管
cordess单腔大孔径导管
intravenous tubing静脉导管
guidewire导丝
chest tube胸腔引流管
Intubation插管
syringe注射器
needle针头
i hemostat血管钳
ncision刀口，切口
scalpel handle刀柄
Sterile gloves无菌手套
electrocardiogram心电图（ECG）
radiographically X光片
ultrasound超声
Suture缝合
transverse skin incision皮肤横切口
palpate触诊
Anesthesia麻醉
Anesthetize the area locally/local anesthetic局麻
antibiotic ointment抗菌药膏
并发症
Aspiration误吸
air embolism空气栓塞
Subglottic stenosis/edema声门水肿或狭窄
Laryngeal stenosis喉狭窄
Laceration of the esophagus食道裂伤
Laceration of the trachea气管裂伤
Mediastinal emphysema纵隔气肿
Vocal cord paralysis声带麻痹，
hoarseness声音嘶哑
thrombosis血栓症
Arteriovenous fistula动静脉瘘
Chylothorax乳糜胸
pneumothorax气胸
hemopneumothorax血气胸
sepsis败血症
Arterial or neurologic injury动脉或神经损伤
由于词汇太多，为方便查询，今起开始分类索引。到第六部分-----5
