Explosions- und Schussverletzungen sind seltene, aber komplexe Verletzungen. In Anbetracht der weltpolitischen Lage, von Terroranschlägen, Unfällen und Gewalttaten gehören sie potenziell zur Versorgungsrealität jedes Anästhesisten, Chirurgen und Notfallmediziners. Dieser Beitrag soll die notfallchirurgischen Behandlungsprinzipien und Standards des Schockraummanagements von thorakoabdominellen Explosions- und Schussverletzungen näherbringen.
Abstract
In Germany, blast and gunshot injuries are uncommon but complex injury entities. Due to the global political situation, terrorist attacks, accidents, or acts of violence, these injuries are potentially part of the reality of care for every anaesthetist, surgeon, and emergency physician. In principle, this type of injury should be treated in a trauma centre with appropriate expertise, but the knowledge of basic treatment principles is necessary for all practitioners. First, emergency training and surgical simulation courses should be carried out regularly to remain confident in emergency surgery techniques and treatment strategies. In addition, minimally invasive methods are predominantly used in elective surgery, meaning that the routine of primarily open surgery is missing. Therefore, it is important that surgeons learn surgical steps to be better prepared for emergency open surgery.
The critical principle of damage control surgery is stopping the bleeding and the contamination and preventing a delay in intensive care therapy. For penetrating thoracic trauma, a chest tube must be inserted. If the patient is hemodynamically unstable, an anterolateral thoracotomy should be performed to achieve bleeding control, e.g., by cross-clamping the aorta or pulmonary hilum. For stable patients, a video-assisted thoracoscopy might be an option.
The standard abdominal approach is the median laparotomy. Bleeding control can be achieved by hiatal aortic cross-clamping and packing of the abdomen, followed by a systematic exploration. If necessary, a laparostomy must be established. Moreover, if chest injuries are ruled out, the resuscitative endovascular balloon occlusion of the aorta (REBOA) can be considered as a bridge to surgery.
Whether projectiles, fragments, or shrapnels require removal depends on the location and the potential complications of tissue dissection. Penetrating injuries due to blasts and gunshots are always contaminated.
Schlüsselwörter
Explosionsverletzungen - Schussverletzungen - penetrierendes Trauma - Damage Control Surgery
Keywords
blast injury - gun injury - penetrating trauma - damage control surgery
