Shark attacks are rare but are associated with a high morbidity and significant mortality.鲨鱼袭击很少见，但发病率高，死亡率高。 We report the case of a patient's survival from a shark attack and their subsequent emergency medical and surgical management.我们报告了患者因鲨鱼袭击而幸存的情况，以及他们随后的紧急医疗和外科治疗。

Using data from the International Shark Attack File, we review the worldwide distribution and incidence of shark attack.使用国际鲨鱼袭击档案中的数据，我们回顾了鲨鱼袭击的全球分布和发生率。 A review of the world literature examines the features which make shark attacks unique pathological processes.对世界文献的回顾研究了使鲨鱼发作独特病理过程的特征。

我们提供了有关鲨鱼袭击管理策略的建议，以及避免在人类与这些濒临灭绝的生物相遇时产生不良后果的技术。

Few creatures solicit the apprehension that sharks engender.很少有人会招来鲨鱼产生的恐惧。 In an aquatic environment where most humans can at best 'keep their heads above water', the predatory capabilities of the shark render land-based, bipedal primates easy prey.在大多数人充其量只能在水面之上的水生环境中，鲨鱼的掠食能力使陆生双足类灵长类动物容易捕食。

不能说世界上鲨鱼袭击的发生值得对鲨鱼表现出的忧虑或反感程度，但是当鲨鱼袭击确实发生时，效率往往令人印象深刻。

在本文中，我们报告了一次非致命性鲨鱼袭击的详细信息，并回顾了一个幸运的罕见事件，但它可能危及生命。

鲨鱼攻击管理：案例介绍

A 26 year old man was surfing with his friend outside the Castles' break of Cactus Beach, a popular yet remote venue on the Great Australian Bight.一名11岁的男子正与他的朋友一起在城堡的仙人掌海滩休息区冲浪，仙人掌海滩是澳大利亚大湾区一个受欢迎的偏僻场地。 The attack occurred at approximately 00:20 h on a clear day, with air temperatures in the high twenties and in 25–XNUMX m of clear water.袭击发生在晴朗的一天大约XNUMX:XNUMX小时，二十多岁的气温和XNUMX-XNUMX m的清澈水域中。

The victim and his friend, who was 15 m away, were alone in the bay.受害者和他的朋友（相距3 m）独自在海湾中。 The victim was lying astride his surfboard and paddling with his right arm, gently circling to counter the action of the tide, while waiting for a wave.受害者正躺在冲浪板上，用右臂划水，轻轻地盘旋以抵抗潮流，同时等待波浪。 He was talking to his friend over his left shoulder when, without warning, his paddling arm was seized by a shark, approximately 3.5–XNUMX m in length.当他在没有警告的情况下，划桨臂被一条大约XNUMX–XNUMX m的鲨鱼抓住时，他正在与他的朋友在左肩上聊天。

He struck the shark with his left arm, which it also seized in its mouth.他用左臂打了鲨鱼，鲨鱼也咬在嘴里。 On seeing him in danger, the patient's friend paddled over, and punched the shark in its gills several times, attempting to make it release the patient.见到他处于危险中后，患者的朋友划了过去，并在鲨鱼的腮中猛击了几次，试图使其释放出患者。 When this did not work, the friend gouged its eyes, and the shark loosened its grip and re-submerged.当这不起作用时，朋友挖了一下眼睛，鲨鱼松开了手，重新淹没了。

病人报告在这个阶段水中有大量血液，看不到鲨鱼，但知道它并没有消失，因为他感觉到它在拉着他冲浪的腿绳——板，它在水中晃来晃去。 两个冲浪者把他们的板子放在一起，把他们的胳膊和腿从水中移开，同时他们决定如何上岸。

The shark returned a second time, bumping up between the two surfboards and tipping both surfers into the water.鲨鱼第二次返回，在两个冲浪板之间碰撞，并将两个冲浪者倾倒在水中。 The shark then attempted to attack the patient's friend, who placed his surfboard between himself and the shark, which took two bites in rapid succession out of the surf board.然后，鲨鱼试图攻击患者的朋友，后者将冲浪板放在自己和鲨鱼之间，鲨鱼迅速地从冲浪板上咬了两口。

The patient, in the mean time, attempted to reach the nearby reef which, being shallower water (6 ft.), he thought would afford him some protection.同时，患者试图到达附近的礁石，该礁石为浅水（50英尺），他认为这将为他提供一些保护。 The shark pursued him over the 2.5 m distance, and seized his left arm, just above the elbow.鲨鱼追赶了他XNUMX m的距离，抓住了他的左臂，就在肘部上方。 At that moment, the patient noticed a XNUMX m wall of white water approaching over the reef.在那一刻，病人注意到礁石上有一堵XNUMX m的白水墙。 As it hit both shark and patient, the shark relinquished its grip and ceased its attack.当鲨鱼同时受到鲨鱼和病人的攻击时，它放弃了抓地力并停止了攻击。

The patient was helped to his surfboard by his friend, and both parties made their way to the beach.病人被他的朋友帮助到他的冲浪板上，并且双方都去了海滩。 The patient was placed supine in the back of his friend's station wagon and they raced to the nearest hospital at Ceduna.病人被仰卧在他朋友的旅行车的后面，然后他们奔赴最近的塞杜纳医院。 On arrival at Ceduna, the patient was quickly assessed and stabilized.到达塞杜纳（Ceduna）后，对患者进行了快速评估和稳定。

He was administered crossmatched blood, intravenous antibiotics, opiate analgesia, and retrieved by air to the Royal Adelaide Hospital for further management.他接受了交叉配比的血液，静脉内抗生素，阿片类镇痛，并被空运回皇家阿德莱德医院进行进一步治疗。 On arrival, he was cardiovascularly stable, alert and oriented, and his arms were the only sites of visible injury.到达后，他的心血管稳定，机敏且定向，并且手臂是唯一可见的损伤部位。 Both limbs were vascularly intact, both radial pulses were present and there was no evidence of compartment syndrome.四肢血管完整，均出现放射状脉搏，没有隔室综合征的迹象。

介绍了急诊中的重要术前发现。

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