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    " " : = = =;: = = =;====

    #ICE ;=

    %;: 17 F 2016

    =../=/=39

    © NICE 2016. All rights reserved.

    http://nice.org.uk/guidance/ng39http://nice.org.uk/guidance/ng39

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    C==C==

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    1.7 %= == = -; = ; = ......................................................................................... 10

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    1.9 I== = =, ; = .................................................................... 13

    1.10 == = ;; ................................................................................................................................................................ 15

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    3 "= = J-;= == = ............................................................... 20

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    Major trauma (NG39)

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    &==&==

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    Major trauma (NG39)

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    http://www.nice.org.uk/about/nice-communities/public-involvement/your-carehttp://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/using-NICE-guidelines-to-make-decisionshttp://www.nice.org.uk/guidance/ng40http://www.nice.org.uk/guidance/ng40http://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/using-NICE-guidelines-to-make-decisionshttp://www.nice.org.uk/about/nice-communities/public-involvement/your-care

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    = = ; =' K =

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    Major trauma (NG39)

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    1.4 Ma%age$e%* &f che)* *(a+$a % h&)'*a# )e**%g)

    C = == =C = == =

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    (= 16).

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    D= = =@ = -; = ; =D= = =@ = -; = ; =

    1.5.1 ; = =; =; .

    Major trauma (NG39)

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    1.5.2 I= = ; =@ ;

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    = 3 = =

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    Major trauma (NG39)

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    1.5.11 C=; ; ; = ;= (= 16)

    ;= = = ; =

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    Major trauma (NG39)

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    **; = = -; = ; =; = = -; = ; =

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    1.5.24 F ; (16 ) 1 = ; 1 = ; ;;

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    = ; = ;' .

    H ; = ; =H ; = ; =

    1.5.26 H; ; J ; ; (16 ) = ;= (= 16).

    Major trauma (NG39)

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    http://www.nice.org.uk/guidance/CG174/chapter/1-Recommendations#resuscitation-2http://www.nice.org.uk/guidance/ng29/chapter/Recommendations#fluid-resuscitation-2http://www.nice.org.uk/guidance/ng29/chapter/Recommendations#fluid-resuscitation-2http://www.nice.org.uk/guidance/CG174/chapter/1-Recommendations#resuscitation-2

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    1.5.27 F = ;=, J- ; ;

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    = = ) = =

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    == = = =;.

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    = .

    +;- C ;; =+;- C ;; =

    1.5.34 ;- C (== -- = ;; C -) = ; (16 ) ;= =

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    1.5.35 ;=; J== = = C ; = ; (16

    ) ; .

    1.5.36 D = =; ;- C ;= (= 16). ;=; = ; C = =.

    Major trauma (NG39)

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    D =; D =;

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    == ; =.

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    1.6 Red+c%g hea* #&)) % '(e-h&)'*a# a%d h&)'*a# )e**%g)

    1.6.1 "= == ; = = .

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    %%= == =

    1.7.1 #ICE ;= = = = = ; #H

    = = = = ;.

    Major trauma (NG39)

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    1.7.2 A = ;; = = = = =

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    .

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    1.8 D&c+$e%*a*&% % '(e-h&)'*a# a%d h&)'*a# )e**%g)

    #ICE ;= = : ; == == ;=

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    = ===

    (ABCDE).

    Major trauma (NG39)

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    1.8.2 I ;, == = =

    =' == = =.

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    .

    Major trauma (NG39)

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    1.8.8 $= ; = ;;

    J== = === ( '== =').

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    %%= =

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    Major trauma (NG39)

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    = ; = = ; = =

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    1.9.9 I=; ;= = = ; = = ; =

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    ==. %:

    Major trauma (NG39)

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    == = == =

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    ; , ; = =; =.

    Major trauma (NG39)

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    1.10.2 E=; ; =; ; =

    -- == = === @ .

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    ;= =; ;;= ==:

    =

    = = = = C ;= = = =

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    G=; "; C=;' %= =: = =;= = ==.

    2A ;= (F 2016), = = =

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    G=; "; C=;' %= =: = =;= =

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    Major trauma (NG39)

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    C=C=

    I= 2010 " = E=;= #=; A $J

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    == =:

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    Major trauma (NG39)

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    M&(e %f&($a*&%

    = ; ;= = #ICE = .

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    Major trauma (NG39)

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    &== &==

    ;= ;;= == .

    1 P&%*-&f-ca(e c&ag+#a*&% *e)*%g 

    + ;=; = = =-- ;= = = =;

    ; (&$E") ; (EG) =,

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    = ; ;. ;; = = ==

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    2 Lac*a*e #ee# f&( $&%*&(%g )ee(* &f )h&c" 

    I ; == = = ;=;; = ?

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    Major trauma (NG39)

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    3 M&('h%e c&$'a(ed *h "e*a$%e f&( /()*-#%e $a%age$e%* &f 'a%

    I = ;=;; = = J-;= ;; =

    == (= -; = ; =) = = ?

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    4 Wa($%g % 'a*e%*) *h $a!&( *(a+$a

    I = ;=;; = = = ? I ,

    = ;; =J = = =?

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    = ; =J =. I= =, =

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    =.

    IB#: 978-1-4731-1680-1

    Major trauma (NG39)

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     Acc(ed*a*&%

    Major trauma (NG39)

    http://www.nice.org.uk/http://www.nice.org.uk/