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DOI: 10.1055/s-0029-1202641
© Georg Thieme Verlag Stuttgart · New York
Notfallversorgung des Verbrennungspatienten – Von der Initialtherapie bis zum Schockraum
Initial care of the severely burned patientPublikationsverlauf
Publikationsdatum:
06. Februar 2009 (online)
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Zusammenfassung
Der Verbrennungsunfall ist ein seltenes Geschehen, dass alle Altersgruppen betrifft, und eine erhebliche Bandbreite der klinischen Schwere aufweist. Wichtigste Determinanten der Letalität ist der Anteil der verbrannten Körperoberfläche (VKÖF), die Tiefe der Verbrennung und ein begleitendes Inhalationstrauma. Die korrekte Einschätzung der Schwere des Traumas ist essentiell um eine adäquate Therapie einzuleiten. Trotz Verbesserungen in der Primärversorgung liegt die Letalität des Schwerverbrannten (> 25 % VKÖF) immer noch bei mehr als 30 %. Im Rahmen einer generalisierten Kreislaufreaktion kommt es beim verbrannten Patienten zu einem Kapillarleck. Flüssigkeit und kolloidale Serumanteile treten aus dem intravasalraum in das Interstititum über, was unbehandelt zu einem letalen hypovolämischen Schock führt. Daher steht neben den allgemeinen Maßnahmen der Notfallversorgung, die adäquate Flüssigkeitstherapie im Zentrum der Erstversorgung.
Abstract
The care of severely burned patient is still an interdisciplinary challenge. Despite improvements in the understanding of the pathophysiology of burn disease, mortality is high if more than 25 % of body surface area is burned. Mortality increases in the presence of inhalaton injury. Initially, the burn trauma leads to a capillary leakage syndrome, resulting in severe hypovolemia. Therefore, adaequate volume substitution is the primary therapy to prevent potential life–threatening hypovolemic shock.
Schlüsselworte
Verbrennung - Notfallversorgung - Kapillarleck - Infusionstherapie - Inhalatationstrauma
Key word
Burn care - hypovolemia - inhalation injury
Kernaussagen
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Verbrennungstraumata sind häufig Kombinationsverletzungen und betreffen alle Altersstufen.
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Bei 15–30 % der Verbrennungspatienten besteht ein Inhalationstrauma, das die Letalität signifikant beeinflusst.
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In der Notfallphase besteht häufig ein hypovolämer Schock. Daher steht die adäquate Volumensubstitution im Vordergrund der Therapie. Mittel der ersten Wahl zur Flüssigkeitssubstitution sind Kristalloide.
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Bei Vorliegen definierter Kriterien sollte der Patient in ein Verbrennungszentrum verlegt werden – die Initialversorgung hingegen kann in jedem Akutkrankenhaus erfolgen.
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Bei Aufnahme des Patienten sollte ein definiertes Protokoll bestehen, um Begleitverletzungen nicht zu übersehen.
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Ergänzendes Material
- Ergänzendes Material
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Prof. Dr. med. Wolfgang Buhre
Prof. Dr. med. Frank Wappler
eMail: w.f.buhre@umcutrecht.nl
eMail: wapplerf@kliniken-koeln.de
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