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DOI: 10.1055/s-2004-44882
© Georg Thieme Verlag Stuttgart · New York
Die hämodynamisch wirksame Beckeninstabilität
The Unstable Patient with Pelvic FracturePublication History
Publication Date:
10 March 2004 (online)
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Zusammenfassung
Der hämodynamisch instabile Patient mit Beckenfraktur muss zielgerichtet und zügig diagnostiziert und behandelt werden. Nach blutstillenden Maßnahmen am Unfallort wird er direkt in eine Klinik mit entsprechender Ausrüstung und Erfahrung transportiert. Hier werden häufig schon während der ersten Schockraumphase externe Stabilisierungssysteme wie die Beckenzwinge oder der Fixateur externe angelegt. Ist so noch keine Kreislaufstabilisierung zu erreichen, müssen die lebensbedrohlichen Blutungen tamponiert werden. Auf dem Rückzug können einfache interne Stabilisierungsverfahren zur Anwendung kommen. Im Folgenden werden die verschiedenen Therapieoptionen aufgezeigt und anhand von Beispielen erläutert. Die wesentliche Botschaft ist, dass eine Blutstillung nur bei stabilisiertem Beckenring möglich ist.
Abstract
For the hemodynamically unstable patient with pelvic fracture a target focussed and rapid diagnostic and therapy is mandatory. After hemorrhage control at crash site the direct transport in a trauma center follows. Primary therapy in the emergency room sometimes includes stabilization by a pelvic clamp or an external fixator. If the patient is still hemodynamically unstable the lifethreating bleeding is packed. After that sinple internal osteosynthesis is allowed. The presented article shows the possible options of the therapy. The main message is: Hemorrhage control is not possible without stabilization of the pelvic ring.
Schlüsselwörter
Beckenfraktur - hämodynamische Instabilität - Notfallbehandlung
Key words
Pelvic fracture - hemodynamically unstable - emergent care
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