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Präklinische Versorgung des Patienten mit Schock

  • Schwerpunkt: Der Patient im Schock
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Zusammenfassung

Die präklinische Diagnose eines Schocks stützt sich noch immer auf Anamese und körperliche Untersuchung, Verletzungsmuster und einige wenige hämodynamische Parameter, die dem Notarzt zur Verfügung stehen. Neuere Studien belegen, dass ein differenziertes therapeutisches Vorgehen angezeigt ist. Bezüglich des traumatischen hypovolämisch-hämorrhagischen Schocks ist entscheidend, ob ein penetrierendes Trauma und/oder eine unstillbare Blutung vorliegt. In diesem Fall muss der Patient schnellstmöglich einer definitiven chirurgischen Versorgung zugeführt („scoop and run“) und eine moderate Hypotension („treat and run“) toleriert werden. Flüssigkeitssubstitution und Katecholamingabe müssen in diesem Falle zurückhaltend eingesetzt werden. Bei anderen Schockformen kann sehr viel aggressiver therapiert werden, um eine möglichst schnelle Verbesserung der mikrovaskulären Perfusion zu erreichen. Neben adäquater Flüssigkeitssubstitution in einer Kombination aus kolloiden und kristalloiden Lösungen sollten Katecholamine und ggf. Vasopressin eingesetzt werden.

Zentrale Bedeutung kommt bei der präklinischen Versorgung der Auswahl einer geeigneten Zielklinik zu, damit eine schnellstmögliche definitive und damit kausale Therapie erfolgen kann.

Abstract

The preclinical diagnosis of shock is still based on the patient’s history, the physical examination, the injury pattern and a few hemodynamic parameters available in the emergency set-up. The clinical picture is characterised by hypotension and tachycardia, tachypnoe and dyspnoea as well as cerebral impairment. Results from recent clinical trials indicate, that a adapted and specific therapeutic approach for the various shock forms is necessary. In case of traumatic hypovolemic-hemorrhagic shock it is of particular relevance if penetrating trauma and/or uncontrolled bleeding exists. Under these conditions an immediate definite surgical treatment is required (“scoop and run”) and a moderate hypotension should be tolerated. (“treat and run”). Fluid substitution and therapy with catecholamines should be used conservatively. In all other forms of shock the treatment approach can and should be more aggressive in order to improve microvascular perfusion as early as possible. Besides adequate fluid resuscitation in a combination of crystalloid and colloid solutions catecholamines and—under specific circumstances—also vasopressin should be used.

Of utmost importance in the pre-clinical management of patients in shock is the optimal selection of the centre that the patient is referred to in order to establish the fastest and best possible definite treatment for the patient.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, LMU München

    F. Christ

  2. Institut für Notfallmedizin und Medizinmanagement, Klinikum der Universität München

    F. Christ & Chr. K. Lackner

  3. Klinik für Anästhesiologie, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, München

    F. Christ

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  1. F. Christ
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  2. Chr. K. Lackner
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Correspondence to F. Christ.

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Christ, F., Lackner, C.K. Präklinische Versorgung des Patienten mit Schock. Internist 45, 267–276 (2004). https://doi.org/10.1007/s00108-004-1149-z

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  • DOI: https://doi.org/10.1007/s00108-004-1149-z

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