Versorgung des Polytraumas[1]

Zusammenfassung

Die Systematik des Advanced Trauma Life Support® (ATLS®) ermöglicht eine strukturierte und effiziente initiale Diagnostik und Behandlung von polytraumatisierten Patienten im Schockraum. Die Basis für ein erfolgreiches Schockraummanagement nach ATLS® bildet ein funktionierendes interdisziplinäres Team unter der Leitung eines erfahrenen Trauma Leaders. Die primären Aufgaben des Teams sind die Sicherstellung der Vitalfunktionen durch eine adäquate Oxygenierung und die Infusions- und Transfusionstherapie zur Kreislaufstabilisierung. Parallel dazu werden je nach Dringlichkeit diagnostische und therapeutische Interventionen durchgeführt. Der nachfolgende Beitrag beschreibt das Schockraummanagement nach den Grundsätzen des ATLS®.

Abstract

Structured and efficient care for patients with multiple injuries in the emergency department requires treatment algorithms to synchronize and to enhance the efforts of the trauma team. ATLS® provides these algorithms by defining treatment priorities and responsibilities. Primary goals are a patent, protected airway and adequate breathing or artificial ventilation followed by fluid resuscitation and hemorrhage control. These immediate live saving measures are accomplished along with further diagnostic and therapeutic interventions. The following article describes the management of patients with multiple injuries in the emergency department based on the ATLS® algorithm.

schwere Verletzung - Polytrauma - Schockraum - Advanced Trauma Life Support® - ATLS®

multiple injuries - polytrauma - emergency room - Advanced Trauma Life Support® - ATLS®

Literatur

• 1 Shakiba H, Dinesh S, Anne M K. Advanced trauma life support training for hospital staff. Cochrane Database Syst Rev 2004 CD004173
• 2 Guideline Committee of the German Registered Society for Trauma Surgery . Recommended Guidelines for Diagnostics and Therapy in Trauma Surgery.  Eur J Trauma. 2001;  27 137-150
• 3 Yucel N, Lefering R, Maegele M. et al . Trauma Associated Severe Hemorrhage (TASH)-Score: probability of mass transfusion as surrogate for life threatening hemorrhage after multiple trauma.  J Trauma. 2006;  60 1228-1236; discussion 1236
• 4 Manoach S, Paladino L. Manual In-Line Stabilization for Acute Airway Management of Suspected Cervical Spine Injury: Historical Review and Current Questions.  Ann Emerg Med. 2007;  50 236-245
• 5 Li J, Murphy-Lavoie H, Bugas C, Martinez J, Preston C. Complications of emergency intubation with and without paralysis.  Am J Emerg Med. 1999;  17 141-143
• 6 Leigh-Smith S, Harris T. Tension pneumothorax - time for a re-think?.  Emerg Med J. 2005;  22 8-16
• 7 Brasel K J, Guse C, Gentilello L M, Nirula R. Heart rate: is it truly a vital sign?.  J Trauma. 2007;  62 812-817
• 8 Parks J K, Elliott A C, Gentilello L M, Shafi S. Systemic hypotension is a late marker of shock after trauma: a validation study of Advanced Trauma Life Support principles in a large national sample.  Am J Surg. 2006;  192 727-731
• 9 Rixen D, Raum M, Bouillon B, Lefering R, Neugebauer E. Base deficit development and its prognostic significance in posttrauma critical illness: an analysis by the trauma registry of the Deutsche Gesellschaft für Unfallchirurgie.  Shock. 2001;  15 83-89
• 10 Dutton R P, Mackenzie C F, Scalea T M. Hypotensive resuscitation during active hemorrhage: impact on inhospital mortality.  J Trauma. 2002;  52 1141-1146
• 11 Kwan I, Bunn F, Roberts I. Timing and volume of fluid administration for patients with bleeding.  Cochrane Database Syst Rev. 2003;  , CD002245
• 12 Roberts I, Alderson P, Bunn F. et al . Colloids versus crystalloids for fluid resuscitation in critically ill patients.  Cochrane Database Syst Rev. 2004;  , CD000567
• 13 Huber-Wagner S, Qvick M, Mussack T. et al . Massive blood transfusion and outcome in 1062 polytrauma patients: a prospective study based on the Trauma Registry of the German Trauma Society.  Vox Sang. 2007;  92 69-78
• 14 McIntyre L, Hebert P C, Wells G. et al . Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients?.  J Trauma. 2004;  57 563-568
• 15 Spahn D R, Cerny V, Coats T J. et al . Management of bleeding following major trauma: a European guideline.  Crit Care. 2007;  11 R17
• 16 Lienhart H G, Wenzel V, Braun J. et al . Vasopressin for therapy of persistent traumatic hemorrhagic shock: The VITRIS.at study.  Anaesthesist. 2007;  56 145-150
• 17 Butcher I, Maas A I, Lu J. et al . Prognostic Value of Admission Blood Pressure in Traumatic Brain Injury: Results from The IMPACT Study.  J Neurotrauma. 2007;  24 294-302
• 18 Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale.  Lancet. 1974;  2 81-84
• 19 Rossaint R, Cerny V, Coats T J. et al . Key issues in advanced bleeding care in trauma.  Shock. 2006;  26 322-331
• 20 Farahmand N, Sirlin C B, Brown M A. et al . Hypotensive patients with blunt abdominal trauma: performance of screening US.  Radiology. 2005;  235 436-443
• 21 Wherrett L J, Boulanger B R, McLellan B A. et al . Hypotension after blunt abdominal trauma: the role of emergent abdominal sonography in surgical triage.  J Trauma. 1996;  41 815-820
• 22 Rotondo M F, Schwab C W, McGonigal M D. et al . „Damage control”: an approach for improved survival in exsanguinating penetrating abdominal injury.  J Trauma. 1993;  35 375-382
• 23 Cothren C C, Osborn P M, Moore E E. et al . Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift.  J Trauma. 2007;  62 834-839
• 24 Voggenreiter G, Eisold C, Sauerland S, Obertacke U. Diagnosis and immediate therapeutic management of chest trauma. A systematic review of the literature.  Unfallchirurg. 2004;  107 881-891
• 25 Bullock M R, Chesnut R, Ghajar J. et al . Surgical management of acute subdural hematomas.  Neurosurgery. 2006;  58 16-24
• 26 Bullock M R, Chesnut R, Ghajar J. et al . Surgical management of acute epidural hematomas.  Neurosurgery. 2006;  58 7-15
• 27 Hofman P A, Goris R J. Timing of osteosynthesis of major fractures in patients with severe brain injury.  J Trauma. 1991;  31 261-263
• 28 Brundage S I, McGhan R, Jurkovich G J, Mack C D, Maier R V. Timing of femur fracture fixation: effect on outcome in patients with thoracic and head injuries.  J Trauma. 2002;  52 299-307
• 29 Keel M, Trentz O. Pathophysiology of polytrauma.  Injury. 2005;  36 691-709

1 Erstveröffentlichung des Beitrages in der Anästhesiol Intensivmed Notfallmed Schmerzther 2007; 42: 716 - 722
Die vorliegende Fassung wurde geringfügig überarbeitet.