Die S3-Leitlinie Polytrauma

Kernaussagen

Thoraxtrauma

Eine klinische Untersuchung des Thorax und der Atemfunktion soll durchgeführt werden.

GoR A

Die Untersuchung sollte mindestens die Bestimmung der Atemfrequenz und die Auskultation der Lunge umfassen. Eine wiederholte Untersuchung sollte erfolgen.

GoR B

Die Inspektion (Seitendifferenz der Atemexkursion, Vorwölbung einer Seite, paradoxe Atmung), die Palpation (Schmerzen, Krepitationen, Hautemphysem, Instabilität) und die Perkussion (hypersonorer Klopfschall) des Thorax sowie die Pulsoxymetrie und, bei beatmeten Patienten, die Überwachung des Beatmungsdrucks können hilfreich sein.

GoR 0

Die Verdachtsdiagnose Pneumo- und/oder Hämatothorax soll bei einseitig abgeschwächtem oder fehlendem Atemgeräusch (nach Kontrolle der korrekten Tubuslage) gestellt werden. Das Fehlen eines solchen Auskultationsbefundes, insbesondere bei Normopnoe und thorakaler Schmerzfreiheit, schließt einen größeren Pneumothorax weitgehend aus.

GoR A

Die mögliche Progredienz eines kleinen, zunächst präklinisch nicht diagnostizierbaren Pneumothorax sollte in Betracht gezogen werden.

GoR B

Die Verdachtsdiagnose Spannungspneumothorax sollte gestellt werden bei einseitig fehlendem Atemgeräusch bei der Auskultation der Lunge (nach Kontrolle der korrekten Tubuslage) und dem zusätzlichen Vorliegen von typischen Symptomen, insbesondere einer schweren respiratorischen Störung oder einer oberen Einflussstauung in Kombination mit einer arteriellen Hypotension.

GoR B

Ein klinisch vermuteter Spannungspneumothorax soll umgehend dekomprimiert werden.

GoR A

Ein durch Auskultationsbefund diagnostizierter Pneumothorax sollte bei Patienten, die mit Überdruck beatmet werden, dekomprimiert werden.

GoR B

Ein durch Auskultationsbefund diagnostizierter Pneumothorax sollte bei nicht beatmeten Patienten in der Regel unter engmaschiger klinischer Kontrolle beobachtend behandelt werden.

GoR B

Die Entlastung eines Spannungspneumothorax sollte durch eine Nadeldekompression, gefolgt von einer chirurgischen Eröffnung des Pleuraspalts mit oder ohne Thoraxdrainage, erfolgen.

GoR B

Ein Pneumothorax sollte – sofern die Indikation besteht – durch eine Thoraxdrainage behandelt werden.

GoR B

Die Eröffnung des Pleuraraums sollte mittels Minithorakotomie erfolgen. Die Einlage der Thoraxdrainage sollte ohne Verwendung eines Trokars erfolgen.

GoR B

Schädel-Hirn-Trauma

Beim Erwachsenen sollte eine arterielle Normotension mit einem systolischen Blutdruck nicht unter 90 mmHg angestrebt werden.

GoR B

Ein Absinken der arteriellen Sauerstoffsättigung unter 90 % sollte vermieden werden.

GoR B

Die wiederholte Erfassung und Dokumentation von Bewusstseinsklarheit, Bewusstseinstrübung oder Bewusstlosigkeit mit Pupillenfunktion und Glasgow Coma Scale soll erfolgen.

GoR A

Auf die Gabe von Glukokortikoiden soll verzichtet werden.

GoR A

Bei Verdacht auf stark erhöhten intrakraniellen Druck, insbesondere bei Zeichen der transtentoriellen Herniation (Pupillenerweiterung, Strecksynergismen, Streckreaktion auf Schmerzreiz, progrediente Bewusstseinstrübung), können die folgenden Maßnahmen angewandt werden:

• Hyperventilation

• Mannitol

• hypertone Kochsalzlösung

GoR 0

Bei perforierenden Verletzungen sollte der perforierende Gegenstand belassen werden, eventuell muss er abgetrennt werden.

GoR B

Wirbelsäulenverletzungen

Eine gezielte körperliche Untersuchung inklusive der Wirbelsäule und der mit ihr verbundenen Funktionen soll durchgeführt werden.

GoR A

Bei bewusstlosen Patienten soll bis zum Beweis des Gegenteils von dem Vorliegen einer Wirbelsäulenverletzung ausgegangen werden.

GoR A

Beim Fehlen folgender 5 Kriterien ist davon auszugehen, dass keine instabile Wirbelsäulenverletzung vorliegt:

• Bewusstseinsstörung

• neurologisches Defizit

• Wirbelsäulenschmerzen oder Muskelhartspann

• Intoxikation

• Extremitätentrauma

GoR A

Akutschmerzen im Wirbelsäulenbereich nach Trauma sollten als ein Hinweis auf eine Wirbelsäulenverletzung gewertet werden.

GoR B

Bei akuter Lebensbedrohung (zum Beispiel Feuer/Explosionsgefahr), die nur durch sofortige Rettung aus dem Gefahrenbereich beseitigt werden kann, soll auch bei Verdacht auf eine Wirbelsäulenverletzung die sofortige und unmittelbare Rettung aus dem Gefahrenbereich erfolgen, ggf. auch unter Vernachlässigung von Vorsichtsmaßnahmen für den Verletzten.

GoR A

Die Halswirbelsäule soll vor der eigentlichen technischen Rettung immobilisiert werden.

GoR A

Der Transport sollte möglichst schonend und unter Schmerzfreiheit erfolgen.

GoR B

Patienten mit neurologischen Ausfällen und vermuteter Wirbelsäulenverletzung sollten primär und mindestens in ein regionales Traumazentrum mit Wirbelsäulenchirurgie transportiert werden.

GoR B

Extremitätenverletzungen

Stark blutende Verletzungen der Extremitäten, welche die Vitalfunktion beeinträchtigen können, sollen mit Priorität versorgt werden.

GoR A

Die Versorgung von Verletzungen der Extremitäten soll weitere Schäden vermeiden und die Gesamtrettungszeit beim Vorliegen weiterer bedrohlicher Verletzungen nicht verzögern.

GoR A

Alle Extremitäten eines Verunfallten sollten präklinisch orientierend untersucht werden.

GoR B

Eine auch nur vermutlich verletzte Extremität sollte vor grober Bewegung/dem Transport des Patienten ruhiggestellt werden.

GoR B

Grob dislozierte Frakturen und Luxationen sollten, wenn möglich, und insbesondere bei begleitender Ischämie der betroffenen Extremität/langer Rettungszeit annähernd präklinisch reponiert werden.

GoR B

Jede offene Fraktur sollte von groben Verschmutzungen gereinigt und steril verbunden werden.

GoR B

Aktive Blutungen sollten gemäß einem Stufenschema behandelt werden:

• manuelle Kompression/Druckverband

• (Hochlagerung)

• Tourniquet

GoR B

Indikationen für einen sofortigen Gebrauch des Tourniquets/der Blutsperre können sein:

• lebensgefährliche Blutungen/Multiple Blutungsquellen an einer Extremität

• keine Erreichbarkeit der eigentlichen Verletzung

• mehrere Verletzte mit Blutungen

GoR 0

Das Amputat sollte grob gereinigt und in sterile, feuchte Kompressen gewickelt werden. Es sollte indirekt gekühlt transportiert werden.

GoR B

• Literatur

• Einführende Kästen

• 1 Council of Europe. Developing a methodology for drawing up guidelines on best medical practices: Recommendation Rec (2001) 13 adopted by the Committee of Ministers of the Council of Europe on 10 October 2001 and explanatory memorandum. Strasbourg Cedex: Council of Europe; 2001
• 2 Schmiegel W et al. S3-Leitlinie “Kolorektales Karzinom”. Available from: http://www.krebsgesellschaft.de/download/s3_ll_kolorektales_karzinom_2008.pdf

• Thoraxtrauma

• 1a Ahmed-Nusrath A, Nusrath MA, Annamaneni R. Faecal mediastinitis following decompression of suspected tension pneumothorax. Emerg Med J 2007; 24: 830 [LoE 5]
• 2a Ahmed MY, Silver P, Nimkoff L et al. The needle-wire-dilator technique for the insertion of chest tubes in pediatric patients. Pediatr Emerg Care 1995; 11: 252-254 [LoE 4]
• 3a Altman E, Ben-Nun A, Curtis WJ et al. Modified Seldinger technique for the insertion of standard chest tubes. Am J Surg 2001; 181: 354-355 [LoE 5]
• 4a Andrabi SA, Andrabi SI, Mansha M et al. An iatrogenic complication of closed tube thoracostomy for penetrating chest trauma. N Z Med J 2007; 120: U2784 [LoE 5]
• 5a Andrivet P, Djedaini K, Teboul J et al. Spontaneous pneumotho-rax: comparison of thoracic drainage vs. immediate or delayed needle aspiration. Chest 1995; 108: 335-338 [LoE 4]
• 6a Argall J, Desmond J. Seldinger technique chest drains and complication rate. Emerg Med J 2003; 20: 169-170 [LoE 1]
• 7a Aufmkolk M, Ruchholtz S, Hering M et al. Wertigkeit der subjektiven Einschätzung der Thoraxverletzungsschwere durch den Notarzt. Unfallchirurg 2003; 106: 746-753 [LoE 4]
• 8a Aylwin CL, Brohi K, Davies GD et al. Pre-hospital and in-hospital thoracostomy: indications and complications. Ann R Coll Surg Engl 2008; 90: 54-57 [LoE 3]
• 9a Bailey RC. Complications of tube thoracostomy in trauma. J Accid Emerg Med 2000; 17: 111-114 [LoE 4]
• 10a Baldt M, Bankier A, Germann P et al. Complications after emergency tube thoracostomy: assessment with CT. Radiology 1995; 195: 539-543 [LoE 4]
• 11a Ball CG, Lord J, Laupland KB et al. Chest tube complications: how well are we training our residents?. Can J Surg 2007; 50: 450-458 [LoE 2]
• 12a Barak M, Iaroshevski D, Ziser A. Rapid atrial fibrillation following tube thoracostomy insertion. Eur J Cardiothorac Surg 2003; 24: 461-462 [LoE 5]
• 13a Barton E. Tension pneumothorax. Curr Opin Pulm Med 1999; 5: 269-274 [LoE 5]
• 14a Barton E, Epperson M, Hoyt D et al. Prehospital needle aspiration and tube thoracostomy in trauma victims: a six-year experience with aeromedical crews. J Emerg Med 1995; 13: 155-163 [LoE 4]
• 15a Bayne CG. Pulmonary complications of the McSwain Dart. Ann Emerg Med 1982; 11: 136-137 [LoE 5]
• 16a Beall jr. AC, Bricker DL, Crawford HW et al. Considerations in the management of penetrating thoracic trauma. J Trauma 1968; 8: 408-417 [LoE 4]
• 17a Behnia MM, Garrett K. Association of tension pneumothorax with use of small-bore chest tubes in patients receiving mechanical ventilation. Crit Care Nurse 2004; 24: 64-65 [LoE 5]
• 18a Ben Zeʼev I. Percutaneous thoracostomy with plastic-shielded locking trocar. J Thorac Cardiovasc Surg 1995; 110: 273 [LoE 5]
• 19a Bergaminelli C, De Angelis P, Gauthier P et al. Thoracic drainage in trauma emergencies. Minerva Chir 1999; 54: 697-702 [LoE 4]
• 20a Bernstein A, Waqaruddin M, Shah M. Management of spontaneous pneumothorax using a Heimlich flutter valve. Thorax 1973; 28: 386-389 [LoE 4]
• 21a Bertino RE, Wesbey GE, Johnson RJ. Horner syndrome occurring as a complication of chest tube placement. Radiology 1987; 164: 745 [LoE 5]
• 22a Biffl WL. Needle thoracostomy: a cautionary note. Acad Emerg Med 2004; 11: 795-796 author reply 796 [LoE 5]
• 23a Blostein P, Hodgman C. Computed tomography of the chest in blunt thoracic trauma: results of a prospective study. J Trauma 1997; 43: 13-18 [LoE 2]
• 24a Bokhari F, Brakenridge S, Nagy K et al. Prospective evaluation of the sensitivity of physical examination in chest trauma. J Trauma 2002; 53: 1135-1138 [LoE 2]
• 25a Brasel K, Stafford R, Weigelt J et al. Treatment of occult pneumothoraces from blunt trauma. J Trauma 1999; 46: 987-990 [LoE 1]
• 26a Bristol JB, Harvey JE. Safer insertion of pleural drains. Br Med J (Clin Res Ed) 1983; 286: 348-349 [LoE 5]
• 27a Britten S, Palmer SH. Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis. J Accid Emerg Med 1996; 13: 426-427 [LoE 2]
• 28a Britten S, Palmer SH, Snow TM. Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure. Injury 1996; 27: 321-322 [LoE 4]
• 29a Bushby N, Fitzgerald M, Cameron P et al. Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma. Emerg Med Australas 2005; 17: 443-449 [LoE 3]
• 30a Butler KL, Best IM, Weaver WL et al. Pulmonary artery injury and cardiac tamponade after needle decompression of a suspected tension pneumothorax. J Trauma 2003; 54: 610-611 [LoE 5]
• 31a Campbell P, Neil T, Wake PN. Hornerʼs syndrome caused by an intercostal chest drain. Thorax 1989; 44: 305-306 [LoE 4]
• 32a Carney M, Ravin CE. Intercostal artery laceration during thoracocentesis: increased risk in elderly patients. Chest 1979; 75: 520-522 [LoE 4]
• 33a Casillas JA, De La Fuente A. Right atrium perforation by a pleural drain. Report of a case with survival. Thorac Cardiovasc Surg 1983; 31: 247-248 [LoE 4]
• 34a Chan L, Reilly KM, Henderson C et al. Complication rates of tube thoracostomy. Am J Emerg Med 1997; 15: 368-370 [LoE 4]
• 35a Chen S, Chang K, Hsu C. Accuracy of auscultation in the detection of haemopneumothorax. Eur J Surg 1998; 164: 643-645 [LoE 1]
• 36a Chen S, Markmann J, Kauder D et al. Hemopneumothorax missed by auscultation in penetrating chest injury. J Trauma 1997; 42: 86-89 [LoE 3]
• 37a Coats T, Wilson A, Xeropotamous N. Pre-hospital management of patients with severe thoracic injury. Injury 1995; 26: 581-585 [LoE 4]
• 38a Collins J, Levine G, Waxman K. Occult traumatic pneumothorax: immediate tube thoracostomy versus expectant management. Am Surg 1992; 58: 743-746 [LoE 4]
• 39a Committee on Trauma. Advanved Trauma Life Support (ATLS®) – Reference Manual. Chicago: American College of Surgeons; 2001. [LoE 5]
• 40a Committee on Trauma. Advanved Trauma Life Support (ATLS®) – Reference Manual. Chicago: American College of Surgeons; 1997. [LoE 5]
• 41a Conces jr. DJ, Tarver RD, Gray WC et al. Treatment of pneumothoraces utilizing small caliber chest tubes. Chest 1988; 94: 55-57 [LoE 4]
• 42a Cooper C, Hardcastle T. Xpand chest drain: assessing equivalence to current standard therapy – a randomised controlled trial. S Afr J Surg 2006; 44: 131-135 [LoE 1]
• 43a Cox PA, Keshishian JM, Blades BB. Traumatic arteriovenous fistula of the chest wall and lung. Secondary to insertion of an intercostal catheter. J Thorac Cardiovasc Surg 1967; 54: 109-112 [LoE 4]
• 44a Cullinane D, Morris J, Bass J et al. Needle thoracostomy may not be indicated in the trauma patient. Injury 2001; 32: 749-752 [LoE 4]
• 45a Curtin J, Goodman L, Quebbeman E et al. Thoracostomy tubes after acute chest injury: relationship between location in a pleural fissure and function. AJR 1994; 163: 1339-1342 [LoE 4]
• 46a Daly RC, Mucha P, Pairolero PC et al. The risk of percutaneous chest tube thoracostomy for blunt thoracic trauma. Ann Emerg Med 1985; 14: 865-870 [LoE 4]
• 47a David A. Thoraxsaugdrainagen bei der Erstversorgung von Brustkorbverletzungen. Notfallmed 1985; 11: 1481 [LoE 4]
• 48a Davis DP, Pettit K, Rom CD et al. The safety and efficacy of prehospital needle and tube thoracostomy by aeromedical personnel. Prehosp Emerg Care 2005; 9: 191-197 [LoE 2]
• 49a De La Fuente A, Sanchez R, Suarez J et al. Left ventricular perforation by a pleural drainage tube. Report of a case with survival. Tex Heart Inst J 1994; 21: 175-176 [LoE 4]
• 50a Deakin C, Davies G, Wilson A. Simple thoracostomy avoids chest drain insertion in prehospital trauma. J Trauma 1995; 39: 373-374 [LoE 4]
• 51a Delius R, Obed F, Horst M et al. Catheter aspiration for simple pneumothorax. Arch Surg 1989; 124: 833-836 [LoE 3]
• 52a Demartines N, Kiener A, Scheidegger D et al. [Thoracic drainage at the accident site]. Helv Chir Acta 1990; 57: 273-277 [LoE 4]
• 53a Demartines N, Kiener A, Scheidegger D et al. [Thoracic drainage at the accident site]. Helv Chir Acta 1990; 57: 273-277 [LoE 4]
• 54a Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients. Eur J Cardiothorac Surg 2002; 22: 673-678 [LoE 2]
• 55a Di Bartolomeo S, Sanson G, Nardi G et al. A population-based study on pneumothorax in severely traumatized patients. J Trauma 2001; 51: 677-682 [LoE 4]
• 56a Dominguez Fernandez E, Neudeck F, Piotrowski J. [Perforation of the heart wall – a rare complication after thoracic drainage treatment]. Chirurg 1995; 66: 920-922 [LoE 4]
• 57a Duponselle EF. The level of the intercostal drain and other determinant factors in the conservative approach to penetrating chest injuries. Cent Afr J Med 1980; 26: 52-55 [LoE 4]
• 58a Eckstein M, Suyehara D. Needle thoracostomy in the prehospital setting. Prehosp Emerg Care 1998; 2: 132-135 [LoE 2]
• 59a Eddy A, Luna G, Copass M. Empyema thoracis in patients undergoing emergent closed tube thoracostomy for thoracic trauma. Am J Surg 1989; 157: 494-497 [LoE 4]
• 60a Enderson B, Abdalla R, Frame S et al. Tube thoracostomy for occult pneumothorax: a prospective randomized study of its use. J Trauma 1993; 35: 726-729 [LoE 1]
• 61a Eriksson A. Fatal iatrogenic exsanguination from pleural drain insertion into the inferior cava. Thorac Cardiovasc Surg 1982; 30: 191-193 [LoE 4]
• 62a Etoch S, Bar-Natan M, Miller F et al. Tube thoracostomy. Factors related to complications. Arch Surg 1995; 130: 521-525 [LoE 4]
• 63a Fitzgerald M, Mackenzie CF, Marasco S et al. Pleural decompression and drainage during trauma reception and resuscitation. Injury 2008; 39: 9-20 [LoE 5]
• 64a Foresti V, Villa A, Casati O et al. Abdominal placement of tube thoracostomy due to lack of recognition of paralysis of hemidiaphragm. Chest 1992; 102: 292-293 [LoE 5]
• 65a Fraser RS. Lung perforation complicating tube thoracostomy: pathologic description of three cases. Hum Pathol 1988; 19: 518-523 [LoE 4]
• 66a Gaillard M, Herve C, Mandin L et al. Mortality prognostic factors in chest injury. J Trauma 1990; 30: 93-96 [LoE 3]
• 67a Galloway P, King P, Freeland P et al. Use of autosuture surgiport for pleural drain insertion. Injury 1993; 24: 538-540 [LoE 4]
• 68a Gammie JS, Banks MC, Fuhrman CR et al. The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy. JSLS 1999; 3: 57-61 [LoE 4]
• 69a Gammie JS, Banks MC, Fuhrman CR et al. The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy. JSLS 1999; 3: 57-61 [LoE 4]
• 70a Garramone RJ, Jacobs L, Sahdev P. An objective method to measure and manage occult pneumothorax. Surg Gynecol Obstet 1991; 173: 257-261 [LoE 4]
• 71a Gill S, Nkere U, Walesby R. An expansible cannula: a new technique for chest drain insertion. Thorax 1992; 47: 657-659 [LoE 4]
• 72a Givens M, Ayotte K, Manifold C. Needle thoracostomy: implications of computed tomography chest wall thickness. Acad Emerg Med 2004; 11: 211-313 [LoE 3]
• 73a Graham AN, Cosgrove AP, Gibbons JR et al. Randomised clinical trial of chest drainage systems. Thorax 1992; 47: 461-462 [LoE 2]
• 74a Harcke HT, Pearse LA, Levy AD et al. Chest wall thickness in military personnel: implications for needle thoracentesis in tension pneumothorax. Mil Med 2007; 172: 1260-1263 [LoE 2]
• 75a Heim P, Maas R, Tesch C et al. [Pleural drainage in acute thoracic trauma. Comparison of the radiologic image and computer tomography]. Aktuelle Radiol 1998; 8: 163-168 [LoE 4]
• 76a Helling T, Gyles N, Eisenstein C et al. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma 1989; 29: 1367-1370 [LoE 4]
• 77a Heng K, Bystrzycki A, Fitzgerald M et al. Complications of intercostal catheter insertion using EMST techniques for chest trauma. ANZ J Surg 2004; 74: 420-423 [LoE 4]
• 78a Hiebl A. Problematik von Heimlich-Ventilen in der Notfallversorgung. Medizinische Fakultät der Ludwig-Maximilians-Universität, München: Medizinische Fakultät der LMU; 2001 [LoE 4]
• 79a Hing A, Caldwell E, Nguyen T et al. Pre-hospital care of gun shot and stabbing injuries: an evaluation of practice and clinical outcome. Pre-hospital Immediate Care 2001; 5: 6-11 [LoE 4]
• 80a Hirshberg A, Thomson S, Huizinga W. Reliability of physical examination in penetrating chest injuries. Injury 1988; 19: 407-409 [LoE 1]
• 81a Hostetler MA, Davis CO. Bilateral localized tension pneumothoraces refractory to needle decompression. Pediatr Emerg Care 1999; 15: 322-324 [LoE 4]
• 82a Huber-Wagner S, Korner M, Ehrt A et al. Emergency chest tube placement in trauma care – which approach is preferable?. Resuscitation 2007; 72: 226-233 [LoE 2]
• 83a Hyde J, Sykes T, Graham T. Reducing morbidity from chest drains. BMJ 1997; 314: 914-915 [LoE 5]
• 84a Jenkins C, Sudheer P. Needle thoracocentesis fails to diagnose a large pneumothorax. Anaesthesia 2000; 55: 925-926 [LoE 4]
• 85a Johnson G. Traumatic pneumothorax: is a chest drain always necessary?. J Accid Emerg Med 1996; 13: 173-174 [LoE 4]
• 86a Kang SS. Use of the disposable laparoscopic trocar-cannula for chest tube insertion. J Am Coll Surg 1994; 179: 230 [LoE 5]
• 87a Kirkpatrick AW. Clinician-performed focused sonography for the resuscitation of trauma. Crit Care Med 2007; 35: S162-172 [LoE 5]
• 88a Lechleuthner A, Bouillon B, Neugebauer E et al. Prehospital chest tubes – incidence and analysis of iatrogenic injuries in the emergency medical service in Cologne. Theor Surg 1994; 9: 220-226 [LoE 4]
• 89a Lee C, Revell M, Porter K et al. The prehospital management of chest injuries: a consensus statement. Faculty of Pre-hospital Care, Royal College of Surgeons of Edinburgh. Emerg Med J 2007; 24: 220-224 [LoE 5]
• 90a Leigh-Smith S, Davies G. Tension pneumothorax: eyes may be more diagnostic than ears. Emerg Med J 2003; 20: 495-496 [LoE 5]
• 91a Leigh-Smith S, Harris T. Tension pneumothorax – time for a re-think. Emerg Med J 2005; 22: 8-16 [LoE 1]
• 92a Lyass S, Simha M, Muggia-Sullam M. Use of a laparoscopic trocar for tube thoracostomy-a rapid and safe method for chest tube placement. Eur J Emerg Med 1995; 2: 96 [LoE 5]
• 93a Mainini SE, Johnson FE. Tension pneumothorax complicating small – caliber chest tube insertion. Chest 1990; 97: 759-760 [LoE 4]
• 94a Mandal A, Thadepalli H, Mandal A et al. Posttraumatic empyema thoracis: a 24-year experience at a major trauma center. J Trauma 1997; 43: 764-771 [LoE 5]
• 95a Marinaro JL, Kenny CV, Smith SR et al. Needle thoracostomy in trauma patients: what catheter length is adequate?. Acad Emerg Med 2003; 10: 495 [LoE 3]
• 96a Martin T, Fontana G, Olak J et al. Use of pleural catheter for the management of simple pneumothorax. Chest 1996; 110: 1169-1172 [LoE 5]
• 97a Massarutti D, Trillo G, Berlot G et al. Simple thoracostomy in prehospital trauma management is safe and effective: a 2-year experience by helicopter emergency medical crews. Eur J Emerg Med 2006; 13: 276-280 [LoE 2]
• 98a McConaghy PM, Kennedy N. Tension pneumothorax due to intrapulmonary placement of intercostal chest drain. Anaesth Intensive Care 1995; 23: 496-498 [LoE 4]
• 99a Mcintosh N, Becher JC, Cunningham S et al. Clinical diagnosis of pneumothorax is late: use of trend data and decision support might allow preclinical detection. Pediatr Res 2000; 48: 408-415 [LoE 4]
• 100a Mcpherson JJ, Feigin DS, Bellamy RF. Prevalence of tension pneumothorax in fatally wounded combat casualties. J Trauma 2006; 60: 573-578 [LoE 2]
• 101a Mcroberts R, Mckechnie M, Leigh-Smith S. Tension pneumothorax and the “forbidden CXR”. Emerg Med J 2005; 22: 597-598 [LoE 5]
• 102a McSwain jr. NE. The McSwain Dart: device for relief of tension pneumothorax. Med Instrum 1982; 16: 249-250 [LoE 5]
• 103a McSwain jr. NE. A thoracostomy tube for field and emergency department use. JACEP 1997; 6: 324-325 [LoE 4]
• 104a Meisel S, Ram Z, Priel I et al. Another complication of thoracostomy – perforation of the right atrium. Chest 1990; 98: 772-773 [LoE 4]
• 105a Melamed E, Blumenfeld A, Lin G. Locking plastic tie – a simple technique for securing a chest tube. Prehosp Disaster Med 2007; 22: 344-345 [LoE 5]
• 106a Mellor DJ. A new method of chest drain insertion. Anaesthesia 1996; 51: 713-714 [LoE 5]
• 107a Millikan JS, Moore EE, Steiner E et al. Complications of tube thoracostomy for acute trauma. Am J Surg 1980; 140: 738-741 [LoE 4]
• 108a Mines D, Abbuhl S. Needle thoracostomy fails to detect a fatal tension pneumothorax. Ann Emerg Med 1993; 22: 863-866 [LoE 4]
• 109a Moskal T, Liscum K, Mattox K. Subclavian artery obstruction by tube thoracostomy. J Trauma 1997; 43: 368-369 [LoE 4]
• 110a Netto FA, Shulman H, Rizoli SB et al. Are needle decompressions for tension pneumothoraces being performed appropriately for appropriate indications?. Am J Emerg Med 2008; 26: 597-602 [LoE 2]
• 111a Niemi T, Hannukainen J, Aarnio P. Use of the Heimlich valve for treating pneumothorax. Ann Chir Gynaecol 1999; 88: 36-37 [LoE 2]
• 112a Noppen M, Alexander P, Driesen P et al. Manual aspiration versus chest tube drainage in first episodes of primary spontaneous pneumothorax. Am J Respir Crit Care Med 2002; 165: 1240-1244 [LoE 4]
• 113a Nosher JI, Siegel R. Over-the-wire placement of large bore thoracostomy tubes. Cardiovasc Intervent Radiol 1993; 16: 195-197 [LoE 4]
• 114a Pattison GT. Needle thoracocentesis in tension pneumothorax: insufficient cannula length and potential failure. Injury 1996; 27: 758 [LoE 4]
• 115a Peek G, Firmin R. Reducing morbidity from insertion of chest drains. Br Med J 1997; 315: 313 [LoE 5]
• 116a Peek GJ, Firmin RK, Arsiwala S. Chest tube insertion in the ventilated patient. Injury 1995; 26: 425-426 [LoE 4]
• 117a Peters S, Wolter D, Schultz J. [Dangers and risks of thoracic drainage at the accident site]. Unfallchirurg 1996; 99: 953-957 [LoE 4]
• 118a Rashid M, Acker A. Cardiac herniation with catheterization of the heart, inferior vena cava, and hepatic vein by a chest tube. J Trauma 1998; 45: 407-409 [LoE 4]
• 119a Rawlins R, Brown KM, Carr CS et al. Life threatening haemorrhage after anterior needle aspiration of pneumothoraces. A role for lateral needle aspiration in emergency decompression of spontaneous pneumothorax. Emerg Med J 2003; 20: 383-384 [LoE 5]
• 120a Remerand F, Luce V, Badachi Y et al. Incidence of chest tube malposition in the critically ill: a prospective computed tomography study. Anesthesiology 2007; 106: 1112-1119 [LoE 2]
• 121a Roberts J, Bratton S, Brogan T. Efficacy and complications of percutaneous pigtail catheters for thoracostomy in pediatric patients. Chest 1998; 114: 1116-1121 [LoE 4]
• 122a Röggla M, Wagner A, Brunner C et al. The management of pneumothorax with the thoracic vent versus conventional intercostal tube drainage. Wien Klin Wochenschr 1996; 108: 330-333 [LoE 2]
• 123a Rüter A, Trentz O, Wagner M. Thorax-Akuttherapie: Minithorakotomie als empfohlenes Vorgehen. In: Rüter A, Trentz O, Wagner M, Hrsg. Unfallchirurgie. München, Wien, Baltimore: Urban & Schwarzenberg; 1995: 315-316 [LoE 5]
• 124a Rutherford RB, Hurt jr. HH, Brickman RD et al. The pathophysiology of progressive, tension pneumothorax. J Trauma 1968; 8: 212-227 [LoE 5]
• 125a Schmidt U, Stalp M, Gerich T et al. Chest tube decompression of blunt chest injuries by physicians in the field: effectiveness and complications. J Trauma 1998; 44: 98-100 [LoE 4]
• 126a Schöchl H. Präklinische Versorgung des schweren Thoraxtraumas. Notfallmedizin 1994; 6: 310 [LoE 4]
• 127a Shih C, Chang Y, Lai S. Successful management of perforating injury of right atrium by chest tube. Chung Hua I Hsueh Tsa Chih 1992; 50: 338-340 [LoE 4]
• 128a Spanjersberg W, Ringburg A, Bergs B et al. Prehospital chest tube thoracostomy: effective treatment or additional trauma?. J Trauma 2005; 59: 96-101 [LoE 2]
• 129a Sriussadaporn S, Poomsuwan P. Post-traumatic empyema thoracis in blunt chest trauma. J Med Assoc Thai 1995; 78: 393-398 [LoE 4]
• 130a Steier M, Ching N, Roberts EB et al. Pneumothorax complicating continuous ventilatory support. J Thorac Cardiovasc Surg 1974; 67: 17-23
• 131a Subotich D, Mandarich D. Accidentally created tension pneumothorax in patient with primary spontaneous pneumothorax-confirmation of the experimental studies, putting into question the classical explanation. Med Hypotheses 2005; 64: 170-173 [LoE 5]
• 132a Symbas P. Chest drainage tubes. Surg Clin N Am 1989; 69: 41-46 [LoE 5]
• 133a Tang A, Hooper T, Hasan R. A regional survey of chest drains: evidence-based practice?. Postgrad Med J 1999; 75: 471-474 [LoE 5]
• 134a Thal AP, Quick KL. A guided chest tube for safe thoracostomy. Surg Gynecol Obstet 1988; 167: 517 [LoE 5]
• 135a Thomson S, Huizinga W, Hirshberg A. Prospective study of the yield of physical examination compared with chest radiography in penetrating thoracic trauma. Thorax 1990; 45: 616-619 [LoE 1]
• 136a Tomlinson MA, Treasure T. Insertion of a chest drain: how to do it. Br J Hosp Med 1997; 58: 248-252 [LoE 5]
• 137a Trupka A, Waydhas C, Hallfeldt KKF et al. The value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma. J Trauma 1997; 43: 405-411 [LoE 2]
• 138a Velanovich V, Adams C. The use of colostomy bags for chest tube drainage. Ann Thorac Surg 1988; 46: 697-698 [LoE 5]
• 139a Velez SE, Sarquis G. [Utility of digital thoracotomy in chest trauma]. Rev Fac Cien Med Univ Nac Cordoba 2006; 63: 7-10 [LoE 3]
• 140a Waksman I, Bickel A, Szabo A et al. Use of endoscopic trocar-cannula for chest drain insertion in trauma patients and others. J Trauma 1999; 46: 941-943 [LoE 4]
• 141a Wayne MA, McSwain jr. NE. Clinical evaluation of a new device for the treatment of tension pneumothorax. Ann Surg 1980; 191: 760-762 [LoE 4]
• 142a Williams JG, Riley TR, Moody RA. Resuscitation experience in the Falkland Islands campaign. Br Med J (Clin Res Ed) 1983; 286: 775-777 [LoE 4]
• 143a Wormald P, Knottenbelt J, Linegar A. A triage system for stab wounds to the chest. S Afr Med J 1989; 76: 211-212 [LoE 3]
• 144a York D, Dudek L, Larson R et al. A comparison study of chest tube thoracostomy: air medical crew and in-hospital trauma service. Air Med J 1993; 12: 227-229
• 145a Zengerink I, Brink PR, Laupland KB et al. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?. J Trauma 2008; 64: 111-114 [LoE 2]

• Schädel-Hirn-Trauma

• 1b Alderson P, Roberts I. Corticosteroids for acute traumatic brain injury. Cochrane Database Syst Rev 2005; (1) CD000196
• 2b Balestreri M, Czosnyka M, Chatfield DA et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry 2004; 75: 161-162
• 3b Brihaye J, Frowein RA, Lindgren S et al. Report on the meeting of the WFNS Neuro-Traumatology Committee. Brussels. I. Coma scaling. Acta Neurochir (Wien) 1978; 40: 181-186
• 4b CRASH trial collaborators. Effect of intravenous corticosteroids on death within 14 days in 10 008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial. Lancet 2004; 364: 1321-1328
• 5b CRASH trial collaborators. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury – outcomes at 6 months. Lancet 2005; 365: 1957-1959 [LoE 1b]
• 6b Firsching R, Messing-Jünger M, Rickels E et al. Leitlinie Schädelhirntrauma im Erwachsenenalter der Deutschen Gesellschaft für Neurochirurgie. AWMF online 2007; http://www.uni-duesseldorf.de/AWMF/ll/008-001.htm
• 7b Frowein RA. Classification of coma. Acta Neurochir 1976; 34: 5-10
• 8b Gabriel EJ, Ghajar J, Jagoda A et al. Brain Trauma Foundation. Guidelines for prehospital management of traumatic brain injury. J Neurotrauma 2002; 19: 111-174 [Evidenzbasierte Leitlinie]
• 9b Gurdjian ES, Brihaye J, Christensen JC et al. Glossary of Neurotraumatology. Acta Neurochir (Wien) Suppl. 25 Wien, New York: Springer; 1979
• 10b Karimi A, Burchardi H. Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI) Stellungnahmen, Empfehlungen zu Problemen der Intensiv- und Notfallmedizin. 5.. Auflage. Köln: asmuth druck + crossmedia; 2004
• 11b Langham J, Goldfrad C, Teasdale G et al. Calcium channel blockers for acute traumatic brain injury (Cochrane Review). The Cochrane Library, Issue 1. Chichester: John Wiley & Sons, Ltd.; 2004
• 12b Lorenz R. Neurotraumatologie. Standardisierte Nomenklatur. Berlin: Springer; 1990
• 13b Kraus JF, Black MA, Hessol N et al. The incidence of acute brain injury and serious impairment in a defined population. Am J Epidemiol 1984; 119: 186-201
• 14b Kraus JF, Fife D, Conroy C. Incidence, severity, and outcomes of brain injuries involving bicycles. Am J Public Health 1987; 77: 76-78
• 15b Maas A et al. EBIC-Guidelines for mangement of severe head injury in adults. Acta Neurchir (Wien) 1997; 139: 286-294 [Evidenzbasierte Leitlinie]
• 16b Marion DW, Carlier PM. Problems with initial Glasgow Coma Scale assessment caused by prehospital treatment of patients with head injuries: results of a national survey. J Trauma 1994; 36: 89-95
• 17b Marmarou A, Lu J, Butcher I et al. Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma 2007; 24: 270-280 [LoE 3a]
• 18b Roberts I. Aminosteroids for acute traumatic brain injury. (Cochrane Review) In: The Cochrane Library, Issue 1. Chichester: John Wiley & Sons, Ltd.; 2004
• 19b Roberts I. Barbiturates for acute traumatic brain injury. (Cochrane Review) In: The Cochrane Library, Issue 1. Chichester: John Wiley & Sons, Ltd.; 2004
• 20b Schierhout G, Roberts I. Anti-epileptic drugs for preventing seizures following acute traumatic brain injury. (Cochrane Review) In: The Cochrane Library, Issue 1. Chichester: John Wiley & Sons, Ltd.; 2004
• 21b Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale.. Lancet 1974; 2: 81-84
• 22b Teasdale G, Jennett B. Assessment and prognosis of coma after head injury. Acta Neurochir (Wien) 1976; 34: 45-55
• 23b The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Management and Prognosis of Severe Traumatic Brain Injury. 2000 Im Internet: http://www2.braintrauma.org/guidelines/downloads/btf_guidelines_management.pdf [Evidenzbasierte Leitlinie]
• 24b The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Management and Prognosis of Severe Traumatic Brain Injury. Update 2003. Im Internet: http://www2.braintrauma.org/guidelines/downloads/btf_guidelines_cpp_u1.pdf [Evidenzbasierte Leitlinie]
• 25b The Brain Trauma Foundation, The American Association of Neurological Surgeons, The Joint Section on Neurotrauma and Critical Care. Guidelines for the Management of Severe Traumatic Brain Injury. 3rd. ed. Im Internet: http://www.braintrauma.org/guidelines/downloads/JON_24_Supp1.pdf [Evidenzbasierte Leitlinie]
• 26b Tien HC, Cunha JR, Wu SN et al. Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival?. J Trauma 2006; 60: 274-278 [LoE 3b]
• 27b Tönnis W, Loew F. Einteilung der gedeckten Hirnschädigungen. Ärztliche Praxis 1953; 5: 13-14
• 28b Wakai A, Roberts IG, Schierhout G. Mannitol for acute traumatic brain injury. Cochrane Database Syst Rev 2007; (1) CD001049 [LoE 3b]
• 29b Willis C, Lybrand S, Bellamy N. Excitatory amino acid inhibitors for traumatic brain injury. (Cochrane Review) In: The Cochrane Library, Issue 1. Chichester: John Wiley & Sons, Ltd.; 2004

• Wirbelsäulenverletzungen

• 1c Amar PA, Levy ML. Pathogenesis and pharmacological strategies for mitigatin secondary damage in acute spinal cord injury. Neurosurgery 1999; 44: 1027-1040
• 2c American College of Surgeons. Advanced Trauma Life Support. Chicago: 1997
• 3c Asamoto S, Sugiyama H, Iida M et al. Trauma sites and clinical features associated with acute hyperextension spinal cord injury without bone damage-relationship between trauma site and severity. Neurol Med Chir (Tokyo) 2001; 41: 1-6 discussion 6–7
• 4c Asazuma T, Satomi K, Suzuki N et al. Management of patients with an incomplete cervical spinal cord injury. Spinal Cord 1996; 34: 620-625
• 5c Bandiera G, Stiell IG, Wells GA et al. The Canadian c-spine rule performs better than unstructured physician judgment. Ann Emerg Med 2003; 42: 395-402
• 6c Beck A, Krischak G, Bischoff M. Wirbelsäulenverletzungen und spinales Trauma. Notfall Rettungsmed 2009; 12: 469-479
• 7c Beck A, Gebhard F, Kinzl L et al. Spinal cord injury without radiographic abnormalities in children and adolescents. Knee Surg, Sports Traumatol Arthrosc 2000; 8: 186-189
• 8c Beck A, Gebhard F, Kinzl L et al. Prinzipien und Techniken der unfallchirurgischen Erstversorgung am Einsatzort. Unfallchirurg 2001; 104: 1082-1099
• 9c Blackmore C, Emerson S, Mann F et al. Cervical spine imaging in patients with trauma: Determination of fracture risk to optimize use. Radiology 1999; 211: 759-766
• 10c Bracken MB, Holford TR. Effects of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological function in NASCIS2. J Neurosurg 1993; 79: 500-507
• 11c Bracken MB, Shepard MJ, Collins WF et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322: 1405-1411
• 12c Bracken MB, Shepard MJ, Collins jr. WF et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg 1992; 76: 23-31
• 13c Bracken MB, Shepard MJ, Hellenbrand KG et al. Methylprednisolone and neurological function 1 year after spinal cord injury. Results of the National Acute Spinal Cord Injury Study. J Neurosurg 1985; 63: 704-713
• 14c Bracken MB, Shepard MJ, Holford TR et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997; 277: 1597-1604
• 15c Bracken MB, Shepard MJ, Holford TR et al. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third National Acute Spinal Cord Injury randomized controlled trial. J Neurosurg 1998; 89: 699-706
• 16c Chandler DR, Nemejc C, Adkins RH et al. Emergency cervical-spine immobilization. Ann Emerg Med 1992; 21: 1185-1188
• 17c Chen XY, Carp JS, Chen L et al. Corticospinal tract transection prevents operantly conditioned H-reflex increase in rats. Exp Brain Res 2002; 144: 88-94
• 18c Cline JR, Scheidel E, Bigsby EF. A comparison of methods of cervical immobilization used in patent extrication and transport. J Trauma 1985; 25: 649-653
• 19c Coleman WP, Benzel D, Cahill DW et al. A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. J Spinal Disord 2000; 13: 185-199
• 20c Cooper C, Dunham CM, Rodriguez A. Falls and major injuries are risk factors for thoracolumbar fractures: cognitive impairment and multiple injuries impede the detection of back pain and tenderness. J Trauma 1995; 38: 692-696
• 21c Craig G, Nielsen MS. Rigid cervical collars and intracranial pressure. Intensive Care Med 1991; 17: 504-505
• 22c Davies G, Deakin C, Wilson A. The effects of a rigid collar on intracranial pressure. Injury 1996; 27: 647-649
• 23c Domeier RM, Evans RW, Swor RA et al. Prospective validation of out-of-hospital spinal clearance criteria: a preliminary report. Acad Emerg Med 1997; 4: 643-646 [LoE 1a]
• 24c Domeier RM, Swor RA, Evans RW et al. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma 2002; 53: 744-750
• 25c Ducker TB. Treatment of spinal-cord injury. N Engl J Med 1990; 322: 1459-1461
• 26c Ducker TB, Zeidman SM. Spinal cord injury: Role of steroid therapy. Spine 1994; 19: 2281-2287
• 27c Epstein N, Hood DC, Ransohoff J. Gastrointestinal bleeding in patients with spinal cord trauma. Effects of steroids, cimetidine, and mini-dose heparin. J Neurosurg 1981; 54: 16-20
• 28c Frankel H, Rozycki G, Ochsner MG et al. Indication for obtaining surveillance thoracic and lumbar spine radiographs. J Trauma 1994; 37: 673-676
• 29c Galandiuk S, Raque G, Appel S et al. The two-edged sword of large-dose steroids for spinal cord trauma. Ann Surg 1993; 218: 419-427
• 30c George ER, Scholten DJ, Buechler CM et al. Failure of methylprednisolone to improve the outcome of spinal cord injuries. Am Surg 1995; 61: 659-664
• 31c Gerndt SJ, Rodriguez JL, Pawlik JW et al. Consequences of high-dose steroid therapy for acute spinal cord injury. J Trauma 1997; 42: 279-284
• 32c Gertzbein SD. Neurologic deterioration in patients with thoracic and lumbar fractures after admission to the hospital. Spine 1994; 19: 1723-1725
• 33c Hanson JA, Blackmore CC, Mann FA et al. Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening. AJR Am J Roentgenol 2000; 174: 713-717
• 34c Ho AM-H, Fung KY et al. Rigid cervical collar and intracranial pressure of patients with severe head injury. J Trauma 2002; 53: 1185-1188
• 35c Hoffman JR, Mower WR, Wolfson AB et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. New Engl J Med 2000; 343: 94-99
• 36c Holmes JF, Panacek EA, Miller PQ et al. Prospective evaluation of criteria for obtaining thoracolumbar radiographs in trauma patients. J Emerg Med 2003; 24: 1-7
• 37c Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia 2001; 56: 511-513
• 38c Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med 1999; 17: 135-137
• 39c Kuhnigk H, Bomke S, Sefrin P. [Effect of external cervical spine immobilization on intracranial pressure]. Aktuelle Traumatol 1993; 23: 350-353
• 40c Kwan I, Bunn F, Roberts I. Committee obotWP-HTC. Spinal immobilisation for trauma patients. The Cochrane LibraryIssue 4: Update Software 2001
• 41c Lam AM. Spinal cord injury: management. Curr Opin Anesth 1992; 5: 632-639
• 42c Matsumoto T, Tamaki T, Kawakami M et al. Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury. Spine 2001; 26: 426-430
• 43c Meldon SW, Moettus LN. Thoracolumbar spine fractures: clinical presentation and the effect of altered sensorium and major injury. J Trauma 1995; 39: 1110-1114 [LoE 4]
• 44c Mirza SK, Krengel 3rd WF, Chapman JR et al. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop 1999; 359: 104-114 [LoE 4]
• 45c Muhr MD, Seabrook DL, Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care 1999; 3: 1-6 [LoE 1a]
• 46c Nechwatal E. [Critical notes on the transport of patients with cervical spinal cord injuries]. Chirurg 1975; 46: 521-523
• 47c Nockels RP. Nonoperative management of acute spinal cord injury. Spine 2001; 26: S31-S37
• 48c Pointillart V, Petitjean ME, Wiart L et al. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord 2000; 38: 71-76
• 49c Prendergast MR, Saxe JM, Ledgerwood AM et al. Massive steroids do not reduce the zone of injury after penetrating spinal cord injury. J Trauma 1994; 37: 576-579 discussion 579–580
• 50c Raphael J, Chotai R. Effects of the cervical collar on cerebrospinal fluid pressure. Anaesthesia 1994; 49: 437-439
• 51c Rosen PB, McSwain NE, Arata M et al. Comparison of two new immobilization collars. Ann Emerg Med 1992; 21: 1189-1195
• 52c Rosenfeld JF, Vaccaro AR, Albert TJ et al. The benefits of early decompression in cervical spinal cord injury. Am J Orthop 1998; 27: 23-28
• 53c Ross SE, OʼMalley KF, DeLong WG et al. Clinical predictors of unstable cervical spinal injury in multiply injured patients. Injury 1992; 23: 317-319 [LoE 2b]
• 54c Sackett DL, Richardson WS, Rosenberg W et al. Evidence-based medicine: How to practice and teach EBM. London: Churchill Livingstone; 1997
• 55c Sneed RC, Stover SL. Undiagnosed spinal cord injuries in brain-injured children. Am J Dis Child 1988; 142: 965-967
• 56c Stiell IG, Wells GA, Vandemheen KL et al. The Canadian c-spine rule for radiopraphy in alert and stable trauma patients. JAMA 2001; 286: 1841-1848
• 57c Sung RD, Wang JC. Correlation between a positive Hoffmannʼs reflex and cervical pathology in asymptomatic individuals. Spine 2001; 26: 67-70
• 58c Tator CH. Experimental and clinical studies of the pathophysiology and management of acute spinal cord injury. J Spinal Cord Med 1996; 19: 206-214
• 59c Tator CH. Biology of neurological recovery and functional restoration after spinal cord injury. Neurosurgery 1998; 42: 696-708
• 60c Tator CH, Duncan EG, Edmonds VE et al. Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia 1995; 33: 254-262
• 61c Vogel P. [Neurologic disorders after injuries of the spine]. Langenbecks Arch Chir Suppl Kongressbd 1992; 271-273
• 62 Weinstein DE, Ko HY, Graziani V et al. Prognostic significance of the delayed plantar reflex following spinal cord injury. J Spinal Cord Med 1997; 20: 207-211
• 63c Wells JD, Nicosia S. Scoring acute spinal cord injury: a study of the utility and limitations of five different grading systems. J Spinal Cord Med 1995; 18: 33-41
• 64c Wing PC, Nance P, Connell DG et al. Risk of avascular necrosis following short term megadose methylprednisolone treatment. Spinal Cord 1998; 36: 633-636
• 65c Young W. Secondary injury mechanisms in acute spinal cord injury. J Emerg Med 1993; 11 (Suppl. 01) 13-22
• 66c Zeidman SM, Ling GS, Ducker TB et al. Clinical applications of pharmacologic therapies for spinal cord injury. J Spinal Disord 1996; 9: 367-380
• 67c Zhu Q, Ouyang J, Lu W et al. Traumatic instabilities of the cervical spine caused by high-speed axial compression in a human model. An in vitro biomechanical study. Spine 1999; 24: 440-444

• Extremitätenverletzungen

• 1d Abarbanell NR. Prehospital midthigh trauma and traction splint use: recommendations for treatment protocols. Am J Emerg Med 2001; 19: 137-140
• 2d Anonymous Limb trauma. In: Clinical Practice Guidelines. For use in U.K. Ambulance Services. Guidelines of the Joint Royal Colleges Ambulance Liaison Committee and The Ambulance Service Association. London: Warwick Medical School; 2006. Im Internet: http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/guidelines/limb_trauma_2006.pdf [Evidenzbasierte Leitlinie]
• 3d Beck A. Notärztliche Versorgung des Traumapatienten. Notfall- und Rettungsmed 2002; 1: 57-61
• 4d Beck A. Wunde – Fraktur – Luxation. Notfall- und Rettungsmed 2002; 8: 613-624
• 5d Beck A, Gebhard F, Kinzl L et al. [Principles and techniques of primary trauma surgery management at the site]. Unfallchirurg 2001; 104: 1082-1096 quiz 1097, 1099
• 6d Beekley AC, Sebesta JA, Blackbourne LH et al. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64: S28-37 discussion S37
• 7d Bledsoe B, Barnes D. Traction splint. An EMS relic?. JEMS 2004; 29: 64-69
• 8d Borschneck AG. Traction splint: proper splint design & application are the keys. JEMS 2004; 29: 70 72–75
• 9d Brodie S, Hodgetts TJ, Ollerton J et al. Tourniquet use in combat trauma: UK military experience. J R Army Med Corps 2007; 153: 310-313
• 10d Cuske J. The lost art of splinting. How to properly immobilize extremities & manage pain. JEMS 2008; 33: 50-64 quiz 66
• 11d DGU. Leitlinie Polytrauma. 2007 Im Internet: http://www.dgu-online.de/de/leitlinien/polytrauma.jsp
• 12d Doyle GS, Taillac PP. Tourniquets: a review of current use with proposals for expanded prehospital use. Prehosp Emerg Care 2008; 12: 241-256
• 13d Ficke JR, Pollak AN. Extremity war injuries: Development of clinical treatment principles. J Am Acad Orthop Surg 2007; 15: 590-595
• 14d Hinds JD, Allen G, Morris CG. Trauma and motorcyclists: born to be wild, bound to be injured?. Injury 2007; 38: 1131-1138
• 15d Irving GA, Noakes TD. The protective role of local hypothermia in tourniquet-induced ischaemia of muscle. J Bone Joint Surg Br 1985; 67: 297-301
• 16d Kalish J, Burke P, Feldman J et al. The return of tourniquets. Original research evaluates the effectiveness of prehospital tourniquets for civilian penetrating extremity injuries. JEMS 2008; 33: 44-46 49–50, 52, 54
• 17d Kragh Jr. JF, Walters TJ, Baer DG et al. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma 2008; 64: S38-49 discussion S49–50
• 18d Kragh jr. JF, Walters TJ, Baer DG et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249: 1-7
• 19d Lackner CK, Lewan U, Deiler S et al. Präklinische Akutversorgung von Amputationsverletzungen. Notfall- und Rettungsmedizin 1999; 2: 188-192
• 20d Lakstein D, Blumenfeld A, Sokolov T et al. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma 2003; 54: S221-225
• 21d Lee C, Porter KM. Prehospital management of lower limb fractures. Emerg Med J 2005; 22: 660-663 [LoE 4]
• 22d Lee C, Porter KM, Hodgetts TJ. Tourniquet use in the civilian prehospital setting. Emerg Med J 2007; 24: 584-587
• 23d Melamed E, Blumenfeld A, Kalmovich B et al. Prehospital care of orthopedic injuries. Prehosp Disaster Med 2007; 22: 22-25
• 24d Perkins TJ. Fracture management. Effective prehospital splinting techniques. Emerg Med Serv 2007; 36: 35-37 39
• 25d Probst C, Hildebrand F, Frink M et al. [Prehospital treatment of severely injured patients in the field: an update]. Chirurg 2007; 78: 875-884 [LoE 5]
• 26d Quinn RH, Macias DJ. The management of open fractures. Wilderness Environ Med 2006; 17: 41-48
• 27d Regel G, Bayeff-Filloff M. [Diagnosis and immediate therapeutic management of limb injuries. A systematic review of the literature]. Unfallchirurg 2004; 107: 919-926 [LoE 3a]
• 28d Richey SL. Tourniquets for the control of traumatic hemorrhage: a review of the literature. World J Emerg Surg 2007; 2: 28
• 29d Sackett DL, Richardson WS, Rosenberg W et al. Evidence-based medicine: How to practice and teach EBM. London: Churchill Livingstone; 1997
• 30d Scheinberg S. Traction splint: questioning commended. JEMS 2004; 29: 78
• 31d Slishman S. Traction splint: sins of commission vs. sins of omission. JEMS 2004; 29: 77-78
• 32d Strohm PC, Bannasch H, Goos M et al. [Prehospital care of surgical emergencies]. MMW Fortschr Med 2006; 148: 34 36–38
• 33d Wood SP, Vrahas M, Wedel SK. Femur fracture immobilization with traction splints in multisystem trauma patients. Prehosp Emerg Care 2003; 7: 241-243
• 34d Worsing Jr. RA. Principles of prehospital care of musculoskeletal injuries. Emerg Med Clin North Am 1984; 2: 205-217