Prähospitale Strategien zur Minimierung des Blutverlustes

Zusammenfassung

Die „kritische“ Blutung ist definiert durch ihr lebensbedrohliches Ausmaß und stellt die häufigste prähospital vermeidbare Todesursache dar. Für äußere Blutungen existieren adäquate prähospitale Therapiestrategien – sie müssen aber stets in ein Gesamtkonzept entsprechend dem <C>ABCDE-Algorithmus (<C> für „critical bleeding“) eingebettet sein. In diesem Beitrag wird auf lokale manuelle Maßnahmen zur prähospitalen Blutungskontrolle fokussiert.

Abstract

Seriously injured patients represent only a small group of patients in the emergency medical service with 0.5% (ground based) to 5% (HEMS), but they are associated with a high mortality rate. Among people younger than 45, trauma is the most common cause of death, mostly as a result of severe traumatic brain injury (TBI) and/or extreme hemorrhage. As the outcome of severe TBI prehospitally can only be influenced to a very limited extent, a majority of preventable deaths in prehospital setting are caused by “critical” bleeding. The “critical” bleeding is defined by its life-threatening dimension. Anticoagulation medication can have a reinforcing effect. Adequate prehospital therapy strategies exist for external bleeding. In contrast, internal bleeding regularly evades a causal prehospital care, so that in such cases, transport prioritization and rapid definitive surgical intervention remain the only option. In the civilian environment the tested and evaluated “ABCDE” scheme must be preceded by the <C> (for “critical bleeding”) in order to react time-critically to compressible external bleeding, possibly even prior to airway management. These findings have found their way into the current version of the S3 guideline on treatment of multi system trauma by the German Society for Trauma Surgery (DGU). According to this “severely bleeding injuries that can impair vital functions should be treated with priority”. Thus, this publication focuses on prehospital bleeding control.

Schlüsselwörter

kritische Blutung - äußere Blutung - prähospitale Blutungskontrolle - Blutungsstillung

Key words

critical bleeding - external bleeding - prehospital bleeding control - stop the bleeding

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