Concept formulation for the early-stage pathogenetic treatment of the severe injuries and traumas

Abstract. 451 lethal outcomes of 5581 casualties with gunshot wounds occurring at the medical treatment facilities have been analyzed. Total lethality rate was 8,1%. Lethal outcome time varied from 1 to 19 days (10,6±1,9). 50,3% of casualties died during the advanced trauma management (Role 2), 17,3% – at the Role 3 hospitals, 32,4% – at the Role 4 hospitals. The predominant injury localization causing death was abdominal wounds – 34,8%, and head injuries – 23,1%. The main cause of death of wounds casualties arriving at the medical treatment facilities was life-threatening injury consequences (34,8%) and developing complications (45,5%). Fatal injuries to the major organs and permanent blood loss were considered to be the cause of death in 19,7% of casualties. 37% of the total number of lethal outcomes died because of acute blood loss, in 77,2% of cases it was internal hemorrhage, in 22,8% – external hemorrhage. In 1% of cases early death was caused by acute respiratory failure. In general, the development of more than one third of lethal outcomes could be prevented. Special medical products and equipment were developed by the Department of War Surgery Kirov Military Medical Academy, RF Ministry of Defense in cooperation with the leading research and educational establishments and production enterprises. They are: equipment for the prehospital hemorrhage control, asphyxia management, open and tension pneumothorax management, traumatic shock treatment and complication prevention, as well as activities for creating devices controlling internal hemorrhage. All these form the basis for elimination of life-threatening consequences of injuries at the prehospital stage. This allows us to discuss the development of the idea of a traumatic disease, being put forward by professor Ilia Deriabin, in terms of the concept of «the early-stage pathogenetic treatment of the severe injuries and traumas».