Skip to main content
SpringerLink
Log in

Chirurgisches Management vital bedrohlicher Verletzungen

Surgical management of life-threatening injuries

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

Zusammenfassung

Die Unterbrechung der Schockraumdiagnostik bei schwerverletzten Patienten aufgrund vital bedrohlicher Zustände mit der Notwendigkeit notfallmäßiger operativer Eingriffe stellt eine außerordentliche interdisziplinäre Herausforderung für das gesamte Schockraumteam dar. Da es sich um Eingriffe im Bereich des Abdomens, des Beckens, des Thorax sowie des Kopfs handeln kann, ist ein klarer Handlungsablauf notwendig, der auch die Grenzen der einzelnen Fachdisziplinen überschreiten kann. Bei der Operationstaktik stehen häufig die Prinzipien der „Damage Control Surgery“ im Mittelpunkt des Vorgehens, die in dieser Übersichtsarbeit genauer ausgeführt werden. Ziele der Operationstaktik sind die möglichst schnelle Blutungskontrolle bzw. Druckentlastung unter Minimierung eines zusätzlichen operationsbedingten Traumas. Für das Abdomen und das Retroperitoneum haben Tamponaden mit Textiltüchern einen großen Stellenwert. Alle Entscheidungen bei einer Notoperation müssen unter ungünstigen Bedingungen und unter extremem Zeitdruck gefällt werden. Die Anzahl solcher Notoperationen ist in unserem Gesundheitssystem sehr gering. Der Ablauf und die Entscheidungsfindung dieser kritischen Situation sollten daher in standardisierte Algorithmen eingepasst und trainiert werden. Der „Definitive-Surgical-Trauma-Care“- (DSTC™)-Kurs kann zu dieser Thematik einen Beitrag leisten.

Abstract

Life-threatening situations after multiple trauma which then require interruption of the diagnostic algorithm and immediate surgical treatment after admission are a challenge for the multidisciplinary trauma team. Emergency surgery after trauma may be necessary for the abdomen, the pelvis, the chest as well as the head. Therefore, several disciplines may be involved. Damage control surgery is the leading surgical strategy in emergency surgery in unstable trauma patients. The main aspects of damage control surgery are outlined in this article. The goal of damage control surgery is to gain control of bleeding as soon as possible without additional surgical trauma. Packing plays a central role in damage control surgery of the abdomen and the pelvis. Surgical decision-making occurs under unfavorable circumstances and extreme time pressure. However, surgical interventions in the shock room rarely occur in the German health system. Therefore, indications and decision-making processes of these challenging situations have to be practiced with standardized algorithms. The “Definitive Surgical Trauma Care” (DSTC)- courses may contribute to a straightforward performance in an emergency operation.

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
Abb. 5

Literatur

  1. Brohi K, Cohen MJ, Ganter MT et al (2008) Acute coagulopathy of trauma: hypoperfusion induces systemic anticoagulation and hyperfibrinolysis. J Trauma 64(5):1211–1217; discussion 1217

    Article  PubMed  Google Scholar 

  2. Moore EE, Thomas G (1996) Orr memorial lecture. Staged laparotomy for the hypothermia, acidosis and coagulopathy syndrome. Am J Surg 172(5):405–410

    Article  PubMed  CAS  Google Scholar 

  3. Feliciano DV, Mattox KL, Jordan GL Jr (1981) Intra-abdominal packing for control of hepatic hemorrhage: a reappraisal. J Trauma 21(4):285–290

    Article  PubMed  CAS  Google Scholar 

  4. Doll D, Lenz S, Lieber A et al (2006) What to do if incompressible bleeding from a stab wound occurs in EMS and ER? Temporary control with a Foley catheter. Unfallchirurg 109(10):898–900

    Article  PubMed  CAS  Google Scholar 

  5. Schein M, Saadia R, Jamieson JR et al (1986) The ‚sandwich technique‘ in the management of the open abdomen. Br J Surg 73(5):369–370

    Article  PubMed  CAS  Google Scholar 

  6. Rotondo MF, Schwab CW, McGonigal MD et al (1993) Damage control: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 35(3):375–382; discussion 382–373

    Article  PubMed  CAS  Google Scholar 

  7. Matthes G, Bauwens K, Ekkernkamp A et al (2006) Surgical management of abdominal injury. Unfallchirurg 109(6):437–446

    Article  PubMed  CAS  Google Scholar 

  8. Cothren CC, Osborn PM, Moore EE et al (2007) Preperitonal pelvic packing for hemodynamically unstable pelvic fractures: a paradigm shift. J Trauma 62(4):834–839; discussion 839–842

    Article  PubMed  Google Scholar 

  9. Osborn PM, Smith WR, Moore EE et al (2009) Direct retroperitoneal pelvic packing versus pelvic angiography: a comparison of two management protocols for haemodynamically unstable pelvic fractures. Injury 40(1):54–60

    Article  PubMed  Google Scholar 

  10. Rhee PM, Acosta J, Bridgeman A et al (2000) Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 190(3):288–298

    Article  PubMed  CAS  Google Scholar 

  11. Hall BL, Buchman TG (2005) A visual, timeline-based display of evidence for emergency thoracotomy. J Trauma 59(3):773–777

    PubMed  Google Scholar 

  12. Soreide K, Soiland H, Lossius HM et al (2007) Resuscitative emergency thoracotomy in a Scandinavian trauma hospital – is it justified? Injury 38(1):34–42

    Article  PubMed  CAS  Google Scholar 

  13. Degiannis E, Loogna P, Doll D et al (2006) Penetrating cardiac injuries: recent experience in South Africa. World J Surg 30(7):1258–1264

    Article  PubMed  Google Scholar 

  14. Tominaga GT, Waxman K, Scannell G et al (1993) Emergency thoracotomy with lung resection following trauma. Am Surg 59(12):834–837

    PubMed  CAS  Google Scholar 

  15. Seamon MJ, Pathak AS, Bradley KM et al (2008) Emergency department thoracotomy: still useful after abdominal exsanguination? J Trauma 64(1):1–7; discussion 7–8

    Article  PubMed  Google Scholar 

  16. Heinzelmann M, Imhof HG, Trentz O (2004) Shock trauma room management of the multiple-traumatized patient with skull-brain injuries. A systematic review of the literature. Unfallchirurg 107(10):871–880

    Article  PubMed  CAS  Google Scholar 

  17. Taylor A, Butt W, Rosenfeld J et al (2001) A randomized trial of very early decompressive craniectomy in children with traumatic brain injury and sustained intracranial hypertension. Childs Nerv Syst 17(3):154–162

    Article  PubMed  CAS  Google Scholar 

  18. Olivecrona M, Rodling-Wahlstrom M, Naredi S et al (2007) Effective ICP reduction by decompressive craniectomy in patients with severe traumatic brain injury treated by an ICP-targeted therapy. J Neurotrauma 24(6):927–935

    Article  PubMed  Google Scholar 

  19. Rinker CF, McMurry FG, Groeneweg VR et al (1998) Emergency craniotomy in a rural Level III trauma center. J Trauma 44(6):984–989; discussion 989–990

    Article  PubMed  CAS  Google Scholar 

  20. Bulinski P, Bachulis B, Naylor DF Jr et al (2003) The changing face of trauma management and its impact on surgical resident training. J Trauma 54(1):161–163

    Article  PubMed  Google Scholar 

  21. Jacobs LM, Lorenzo C, Brautigam RT (2001) Definitive surgical trauma care live porcine session: a technique for training in trauma surgery. Conn Med 65(5):265–268

    PubMed  CAS  Google Scholar 

  22. Ali J, Ahmed N, Jacobs LM et al (2008) The advanced trauma operative management course in a Canadian residency program. Can J Surg 51(3):185–189

    PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    S. Flohé

  2. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Essen, Deutschland

    D. Nast-Kolb

Authors
  1. S. Flohé
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Nast-Kolb
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Flohé.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flohé, S., Nast-Kolb, D. Chirurgisches Management vital bedrohlicher Verletzungen. Unfallchirurg 112, 854–859 (2009). https://doi.org/10.1007/s00113-009-1680-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-009-1680-4

Schlüsselwörter

Keywords

Search

Navigation