《外科学》创伤与战伤(英文)

DEFINITION
Trauma is the injury caused by mechanical or chemical factors, which leads to tissue integrity damaged and loss of function.
Chapter 1 Classification of the Trauma
3. Wound causing factors
Cold weapon wounds （冷兵器伤）: Knife Firearm wounds （火器伤）: gun Burns（烧伤）: High temperature Cold injury（冷伤）: Low temperature Blast injury （冲击伤）: 爆震伤 Chemical injury （化学伤）: chemical weapon Radiation injury （放射性损伤）: Electromagnetic radiation，Particulate radiation
Trauma And War Injury
Risk factors
Traffic accident, industrial injury, Natural disaster, war injury and so on.

CONTENT
1. The concept of trauma. 2. The classification of trauma. 3. The pathphysiology of trauma. 4. The diagnosis of trauma. 5. The treatment of trauma.
Immunomodulating
Both glucocorticoids and catecholamines directly inhibit the production of type 1 cytokines, such as IL-12, IL-2, TNF-α and INF-γ, that enhance cellular immunity and T-helper 1 (Th1) formation and conversely favor the production of type 2 cytokines, such as IL-10, IL-4, IL-13, that induce humoral immunity and T-helper 2 (Th2) formation. Thus, during an immune challenge, stress causes an adaptive Th1 to Th2 shift in order to protect the tissues from the potentially destructive actions of the pro-inflammatory type 1 cytokines and other products of activated macrophages. The homeostatic role of stress-induced Th2 shift against overshooting of cellular immunity often complicates pathologic conditions where, either cellular immunity is beneficial (e.g. carcinogenesis, infections) or humoral immunity is deleterious (e.g. allergy, autoimmune diseases).
1. For the integrity of skin
1). The opened injury :
Abrasion（摖伤） Laceration（撕裂伤） Incised wounds or cut wounds （切伤/
砍伤） Puncture wounds （刺伤）
2). The blunt injury : Contusion （挫伤） Crush injury（挤压伤） Sprain（扭伤） Concussion （震荡伤） Luxation and semiluxation （关节脱位/半脱位） Closed bone fracture （闭合性骨折） Closed internal injury （闭合性内脏伤）
Opened injury
Opened fracture
Chapter 2 Pathophysiology of trauma
Trauma can trigger a cascade of pathological response which includes inflammatory/immune reaction, neuroendocrine response and functional change of vital organ.
2. For injured place and organ
Craniocerebral injury （颅脑伤） : Chest injury （胸部伤）: hematopneumothrax Abdomen injury （腹部伤）: burst spleen,
perforated bowel Limbs （四肢伤）: fracture, dislocation Spinal injury （脊柱伤）: fracture, paraplegia
1.The inflammatory/immune reaction
1. Inflammatory: local tissue inflammatory
2. Immunosuppressing: glucocorticoids inhibit inmmunocytes function.
3. Immunomodulating : Systemic inflammatory response syndrome(SIRS) Compensatory anti-inflammatory response syndrome(CARS)