Skip to main content
SpringerLink
Log in

Erstversorgung Schwerstverletzter am Unfallort

Ein Update

Prehospital treatment of severely injured patients in the field

An update

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

In der komplexen, präklinischen Versorgung Schwerstverletzter müssen Notärzte für eine gute Prognose lebens- oder Gliedmaßen bedrohende Verletzungen schnell erkennen und behandeln. Die Zusammenarbeit mit Rettungsdienst, Feuerwehr und Polizei muss koordiniert, der Transport früh organisiert werden.

Die Intubation durch Geübte bei korrekter Indikation wird, insbesondere beim Schädel-Hirn- und schweren Thoraxtrauma, unterstützt, ebenso die Thoraxdrainage beim schweren oder penetrierenden Thoraxtrauma. Kristalloide und kolloidale Lösungen bleiben erste Wahl als Volumenersatz. Die Menge wird individuell an den tastbaren Radialis-/Karotispuls beim stumpfen/penetrierenden Trauma angepasst. Als erweiterte präklinische Diagnostik konnten sich Sonographie und Nahinfrarotspektroskopie bisher nicht durchsetzen.

Der Transport erfolgt frühest möglich in die nächste geeignete Klinik. Trotz längerer Einsatzzeiten durch Nachalarmierung oder umfassendere Maßnahmen beeinflussen Hubschrauber mit einem Traumazentrum als Zielklinik das Outcome positiv.

Abstract

Life or extremity threatening injuries have to be diagnosed and treated rapidly by emergency physicians during prehospital care for severely injured patients. The cooperation with other rescue services, the fire brigade and the police must be coordinated and early transportation has to be organized.

Rapid sequence intubation by trained personnel for correct indications, such as head injury or severe chest trauma is recommended as well as prehospital chest tube placement in cases of severe or penetrating thoracic injury. Crystalloids and colloidal solutions remain the first choice for intravenous volume replacement. The amount of fluid depends on the individual response, such as palpable peripheral and central pulse for blunt or penetrating trauma. Ultrasound or near infrared spectroscopy could not be routinely implemented for extended prehospital diagnostic procedures.

Transportation to the closest appropriate hospital has to be accomplished as early as possible. Helicopters show positive outcomes if the destination is a level I trauma center, even if secondary alarm calls or more extensive measures prolong the prehospital interval.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. U.S. National Center for Health Statistics, Center for Disease Control, U.S. Dept. of Health and Human Services (2005) Fast stats – all injuries. U.S. Dept. of Health and Human Services, Hyattsville/MD

  2. Bundesministerium für Gesundheit und Soziales (2005) Bundesgesundheitsbericht 2005, Kap. 5 – Knochen und Gelenke. Bundesministerium für Gesundheit und Soziales; Berlin

  3. Angus DE, Cloutier E, Albert T (1998) The economic burden of unintentional injury in Canada. SmartRisk Foundation, Toronto

  4. Deutsche Gesellschaft für Unfallchirurgie (2007) Leitlinie Polytrauma der DGU. http://www.dgu-online.de, 17.09.2007

  5. Arbeitsgemeinschaft in Norddeutschland tätiger Notärzte (AGNN) (2007) Therapieempfehlungen. http://www.agnn.de, 17.09.2007

  6. American College of Surgeons Committee on Trauma (2004) Resources for optimal care of the injured patient. In: ATLS Students Manual, 7th edn. American College of Surgeons, Chicago/IL, pp 17–18

  7. Holocomb JB, Salinas J, McManus JM et al. (2007) Manual vital signs reliably predict need for life-saving interventions in trauma patients. J Trauma 59: 821–829

    Article  Google Scholar 

  8. Kanz KG, Sturm J, Mutschler W (2002) Algorithmus für die präklinische Versorgung bei Polytrauma. Unfallchirurg 105: 1007–1014

    Article  PubMed  CAS  Google Scholar 

  9. American College of Surgeons Committee on Trauma (2004) Secondary survey, history. In: ATLS Students Course Manual, 7th edn. American College of Surgeons, Chicago/IL, pp 21–22

  10. Bond RJ, Kortbeek JB, Preshaw RM (1997) Field trauma triage: combining mechanism of injury with the prehospital index for an improved trauma triage tool. J Orthop Trauma 43: 283–287

    CAS  Google Scholar 

  11. Harwood PJM (2006) Which AIS based scoring system is the best predictor of outcome in orthopaedic blunt trauma patients? J Trauma-Injury Infect Crit Care 60: 334–340

    Google Scholar 

  12. Walcher F, Kortüm S, Kirschning T, Weihgold N, Marzi I (2002) Optimierung des Traumamanagements durch präklinische Sonographie. Unfallchirurg 105: 986–994

    Article  PubMed  CAS  Google Scholar 

  13. Walcher F, Weinlich M, Conrad G et al. (2007) Prehospital ultrasound in abdominal trauma. Br J Surg 93: 238–242

    Article  Google Scholar 

  14. Breitkreutz RM, Walcher FMP, Seeger F (2007) Focused echocardiographic evaluation in resuscitation management: concept of an advanced life support-conformed algorithm. Crit Care Med, Focused Applications of Ultrasound in Crit Care Med (Suppl) 35: 161

    Google Scholar 

  15. Knobloch K, Hubrich V, Rohmann P et al. (2005) Nicht-invasive Bestimmung des Herzzeitvolumens durch einen transkutanen CW Doppler in der Luftrettung. Anasthesiol Intensivmed Notfallmed Schmerzther 40: 750–755

    Article  PubMed  CAS  Google Scholar 

  16. Schulz C, Heinze S, Lülsdorf P, Klawki P (2004) Erfahrungen beim Einsatz eines mobilen laseroptischen Systems zur noninvasiven Detektion intrakranieller Hämatome. Intensivmed Notfallmed 41: 417–421

    Google Scholar 

  17. Crooks BA, Cohn SM, Bloch S (2005) Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma-Injury Infect Crit Care 58: 806–816

    Google Scholar 

  18. Cohn SM, Nathens AB, Moore FA et al. (2006) Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. American Association for the Surgrey of Trauma, Annual Meeting September 2006

  19. American College of Surgeons Committee on Trauma (2004) Advanced trauma life support – students course manual. In: ATLS Students Course Manual, 7th edn. American College of Surgeons, Chicago/IL, pp 56–62

  20. Bochicchio GV, Scalea TM (2003) Is field intubation useful. Curr Opin Crit Care 9: 524–529

    Article  PubMed  Google Scholar 

  21. Bushby NB, Fitzgerald M, Cameron P et al. (2006) Prehospital intubation and chest decompression is associated with unexpected survival in major thoracic blunt trauma. Emerg Med Australas 17: 443–449

    Article  Google Scholar 

  22. Ruchholtz SM, Waydhas CM, Ose C et al. for the Working Group on Multiple Trauma of the German Trauma Society (2002) Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the trauma registry of the German Trauma Society. J Trauma-Injury Infect Crit Care 52: 879–886

    Google Scholar 

  23. Schmidt U, Stalp M, Gerich T et al. (1998) Chest tube decompression of blunt chest injuries by physicians in the field: effectiveness and complications. J Trauma-Injury Infect Crit Care 44: 98–100

    Google Scholar 

  24. Spanjersberg WR, Ringburg AN, Bergs EA et al. (2005) Prehospital chest tube thoracostomy: effective treatment or additional trauma? J Trauma-Injury Infect Crit Care 59: 788–793

    Google Scholar 

  25. Revell M, Porter K, Greaves I (2002) Fluid resuscitation in prehospital trauma care: a consensus view. Emerg Med J 19: 494–498

    Article  PubMed  CAS  Google Scholar 

  26. Shafi SM, Kauder D (2004) Fluid resuscitation and blood replacement in patients with polytrauma. Clin Orthop 422: 37–42

    Article  PubMed  Google Scholar 

  27. Lakstein D, Blumenfeld A, Sokolov T et al. (2003) Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma-Injury Infect Crit Care (Suppl) 54: S221–S225

    Google Scholar 

  28. Fakhry SM, Scanlon JM, Robinson L et al. (2006) Prehospital rapid sequence intubation for head trauma: conditions for a successful program. J Trauma-Injury Infect Crit Care 60: 997–1001

    Google Scholar 

  29. Marik PE, Varon J, Trask T (2002) Management of head trauma. Chest 122: 699–711

    Article  PubMed  Google Scholar 

  30. Adamides AA, Winter CD, Philip ML et al. (2006) Current controversies in the management of patients with severe traumatic brain injury. ANZ J Surg 76: 163–174

    Article  PubMed  Google Scholar 

  31. Schinkel C, Kmetic A, Andress HJ et al. (2005) Spine injuries in multiple injury patients. An analysis of the German trauma registry. J Bone Joint Surg Br (Suppl I) 88: 142

    Google Scholar 

  32. Rossi G, Horodyski M, Heffeman TP et al. (2002) Spine-board transfer techniques and the unstable cervical spine. Spine 29: E134–E138

    Article  Google Scholar 

  33. Lee C, Porter K (2007) The prehospital management of pelvic fractures. Emerg Med J 24: 130–133

    Article  PubMed  Google Scholar 

  34. Lee C, Porter KM (2005) Prehospital management of lower limb fractures. Emerg Med J 22: 660–663

    Article  PubMed  CAS  Google Scholar 

  35. Arakaki A, Tsai TM (1993) Thumb replantation: survival factors and re-exploration in 122 cases. J Hand Surg [Br] 18: 152–156

    Google Scholar 

  36. Clarke JRM (2002) Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma-Injury Infect Crit Care 52: 420–425

    Google Scholar 

  37. Kühne CA, Ruchholtz S, Sauerland S et al. (2004) Personelle und strukturelle Voraussetzungen der Schockraumbehandlung Polytraumatisierter. Unfallchirurg 107: 851–861

    Article  PubMed  Google Scholar 

  38. Ruchholtz S, Kühne CA, Siebert H (2007) Das Traumanetzwerk der Deutschen Gesellschaft für Unfallchirurgie. Unfallchirurg 110: 373–380

    Article  PubMed  CAS  Google Scholar 

  39. Biewener A, Aschenbrenner U, Sauerland S et al. (2005) Einfluss von Rettungsmittel und Zielklinik auf die Letalität nach Polytrauma. Unfallchirurg 108: 370–377

    Article  PubMed  CAS  Google Scholar 

  40. Frink M, Probst C, Hildebrand F et al. (2007) Einfluss des Transportmittels auf die Letalität bei polytraumatisierten Patienten. Unfallchirurg 110: 334–340

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Unfallchirurgische Klinik der Medizinischen Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    C. Probst, F. Hildebrand, M. Frink, P. Mommsen & C. Krettek

Authors
  1. C. Probst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Hildebrand
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Frink
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Mommsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Krettek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Probst.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Probst, C., Hildebrand, F., Frink, M. et al. Erstversorgung Schwerstverletzter am Unfallort. Chirurg 78, 875–884 (2007). https://doi.org/10.1007/s00104-007-1410-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-007-1410-9

Schlüsselwörter

Keywords

Search

Navigation