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Thoraxverletzungen

Thorax injuries

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Zusammenfassung

Bei Thoraxtraumen unterscheidet man ätiologisch je nach Gewalteinwirkung die stumpfe von der penetrierenden Verletzungsform. Im europäischen Alltag überwiegt bei weitem die stumpfe Gewalteinwirkung, die nur in ca. 5% eine offene Thorakotomie, aber fast immer eine effektive Thoraxdrainage erfordert. Die Morbidität der stumpfen Verletzung wird geprägt durch die begleitende Lungenkontusion mit u. U. tödlichem ARDS. Spezielle Ventilationsformen, optimale Schmerzausschaltung und Organsubstitutionstherapie sind hier entscheidende Maßnahmen.

Die penetrierende Thoraxverletzung erfordert dagegen in ca. 80% rasches operatives Eingreifen transpleural oder transsternal, je nach Verletzungsmuster. Für die notfallmäßige Erstversorgung am Unfallort gilt das Prinzip „scoop and run“: Minuten bis zur Notfallthorakotomie können entscheidend sein, zeitraubende stabilisierende Maßnahmen am Unfallort selbst haben hier hinter dem schnellstmöglichen Transport zurückzustehen.

Abstract

Thorax injuries may be divided etiologically into blunt and penetrating types, depending on the nature of the insult. In European practice, the former predominates by far, and in only about 5% of cases thoracotomy provides the necessary thorax drainage. Morbidity in this type of injury typically involves concomitant lung contusion, sometimes with fatal acute respiratory distress syndrome. In these cases, special ventilation forms, optimal reduction of pain, and organ replacement are the decisive therapeutic methods. In contrast, about 80% of penetrating trauma to the thorax require prompt transpleural or trans-sternal surgery, depending on the type of injury. Emergency first aid must follow the principle of “scoop and run”. Each minute elapsed until emergent thoracotomy can be decisive to survival in these cases, and the fastest possible transport from the place of injury takes priority over time-consuming stabilization.

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  1. Universitätsklinik für Thorax- und Gefäßchirurgie, Universität Ulm

    H. Schelzig, J. Kick, K. H. Orend & L. Sunder-Plassmann

  2. Universitätsklinik für Thorax- und Gefäßchirurgie, Universität Ulm, Steinhövelstraße 9, 89075 , Ulm

    H. Schelzig

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Schelzig, H., Kick, J., Orend, K.H. et al. Thoraxverletzungen. Chirurg 77, 281–298 (2006). https://doi.org/10.1007/s00104-005-1146-3

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