Skip to main content
SpringerLink
Log in

Präklinische Polytraumaversorgung: S3-Leitlinie

Preclinical management of multiples injuries: S3 guideline

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

Zusammenfassung

Die Empfehlungen der Leitlinie sind in den prioritätengesteuerten Ablauf der präklinischen Behandlung nach den Prinzipien des ABCDE-Schemas eingebettet. Sie orientieren sich in den Behandlungsindikationen so weit wie möglich an objektivierbaren Kriterien der tatsächlich gestörten Funktionen und weniger an deren vermuteter oder befürchteter Entwicklung. Wichtige Empfehlungen zur Indikation und Durchführung der Notfallnarkose, Intubation und Beatmung, der Flüssigkeitstherapie, der Diagnose und Therapie von Thoraxverletzungen, insbesondere des Spannungspneumothorax und des einfachen Pneumothorax, dem Vorgehen bei Schädel-Hirn-Trauma und bei Verdacht auf Wirbelsäulen- und Beckenverletzungen, dem prioritätengerechten Management von Extremitätenverletzungen sowie Hinweise auf die Wahl des Zielkrankenhauses und Ausblicke auf die Möglichkeiten einer Gerinnungstherapie in der Präklinik werden besprochen, ebenso wie Ausblicke auf mögliche Entwicklungen in der notärztlichen Therapie.

Abstract

The guidelines follow the priorities established by the A-B-C-D-E scheme. They focus on the treatment of actual disturbances of vital functions and not so much on their anticipated development. Important recommendations with regard to the indication for intubation and ventilation, fluid therapy, diagnosis and treatment of severe chest injuries (tension pneumothorax in particular), management of severe traumatic brain injury, pelvic and vertebral injuries, priorities in the management of extremity fractures as well as indications for the choice of the receiving hospital are given. The recommendations are discussed in view of future concerns and developments.

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

Literatur

  1. Albert SG, Ariyan S, Rather A (2011) The effect of etomidate on adrenal function in critical illness: a systematic review. Intensive care Med 37:901–910

    Article  PubMed  CAS  Google Scholar 

  2. Arbeitsgemeinschaft Südwestdeutscher Notärzte (agswn) IfNuMI, Bundesärztekammer (BÄK), Bundesvereinigung der Arbeitsgemeinschaften der Notärzte Deutschlands (BAND) et al (2008) Eckpunktepapier zur notfallmedizinischen Versorgung der Bevölkerung in Klinik und Präklinik. Notfall Rettungsmed 11:421–422

    Article  Google Scholar 

  3. Beck A, Bayeff-Filloff M, Kanz KG et al (2005) Algorithmus für den Massenanfall von Verletzten an der Unfallstelle: Ein systematisches Review. Notfall Rettungsmed 8:466–473

    Article  Google Scholar 

  4. Beck A, Gebhard F, Kinzl L et al (2001) Principles and techniques of primary trauma surgery management at the site. Unfallchirurg 104:1082–1099

    Article  PubMed  CAS  Google Scholar 

  5. Cotton BA, Guillamondegui OD, Fleming SB et al (2008) Increased risk of adrenal insufficiency following etomidate exposure in critically injured patients. Arch Surg 143:62–67

    Article  PubMed  Google Scholar 

  6. DeAngelis NA, Wixted JJ, Drew J et al (2008) Use of the trauma pelvic orthotic device (T-POD) for provisional stabilisation of anterior-posterior compression type pelvic fractures: a cadaveric study. Injury 39:903–906

    Article  PubMed  Google Scholar 

  7. Deutsche Gesellschaft für Unfallchirurgie e. V (2006) Weißbuch Schwerverletzten-Versorgung. Empfehlungen zur Struktur, Organisation und Ausstattung stationärer Einrichtungen zur Schwerverletzten-Versorgung in der Bundesrepublik Deutschland. DGU, Berlin

  8. Dulchavsky SA, Schwarz KL, Kirkpatrick AW et al (2001) Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma 50:201–205

    Article  PubMed  CAS  Google Scholar 

  9. Ficke JR, Pollak AN (2007) Extremity war injuries: development of clinical treatment principles. J Am Acad Orthop Surg 15:590–595

    PubMed  Google Scholar 

  10. Hildreth AN, Mejia VA, Maxwell RA et al (2008) Adrenal suppression following a single dose of etomidate for rapid sequence induction: a prospective randomized study. J Trauma 65:573–579

    Article  PubMed  CAS  Google Scholar 

  11. Hussmann B, Lefering R, Waydhas C et al (2011) Prehospital intubation of the moderately injured patient: a cause of morbidity? A matched-pairs analysis of 1200 patients from the DGU Trauma Registry. Crit Care 15:207

    Article  Google Scholar 

  12. Jabre P, Combes X, Lapostolle F et al (2009) Etomidate versus ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomised controlled trial. Lancet 374:293–300

    Article  PubMed  CAS  Google Scholar 

  13. Kirkpatrick AW (2007) Clinician-performed focused sonography for the resuscitation of trauma. Crit Care medicine 35:162–172

    Article  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  15. Lee C, Porter KM, Hodgetts TJ (2007) Tourniquet use in the civilian prehospital setting. Emerg Med J 24:584–587

    Article  PubMed  CAS  Google Scholar 

  16. Lienhart HG, Wenzel V, Braun J et al (2007) Vasopressin for therapy of persistent traumatic hemorrhagic shock: The VITRIS.at study. Anaesthesist 56:145–148, 150

    Article  PubMed  CAS  Google Scholar 

  17. Lyon M, Walton P, Bhalla V et al (2011) Ultrasound detection of the sliding lung sign by prehospital critical care providers. Am J Emerg Med (Epub ahead of print)

  18. Muakkassa FF, Marley RA, Workman MC et al (2010) Hospital outcomes and disposition of trauma patients who are intubated because of combativeness. J Trauma 68:1305–1309

    Article  PubMed  Google Scholar 

  19. Plurad DS, Talving P, Lam L et al (2011) Early vasopressor use in critical injury is associated with mortality independent from volume status. J Trauma 71:565–572

    Article  PubMed  Google Scholar 

  20. Probst C, Hildebrand F, Frink M et al (2007) Prehospital treatment of severely injured patients in the field: an update. Chirurg 78:875–884

    Article  PubMed  CAS  Google Scholar 

  21. Rowan KR, Kirkpatrick AW, Liu D et al (2002) Traumatic pneumothorax detection with thoracic US: correlation with chest radiography and CT-initial experience. Radiology 225:210–214

    Article  PubMed  Google Scholar 

  22. Ruchholtz S, Waydhas C, Ose C et al (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 52:879–886

    Article  PubMed  Google Scholar 

  23. Schochl H, Frietsch T, Pavelka M et al (2009) Hyperfibrinolysis after major trauma: differential diagnosis of lysis patterns and prognostic value of thrombelastometry. J Trauma 67:125–131

    Article  PubMed  Google Scholar 

  24. Shakur H, Roberts I, Bautista R et al (2010) Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 376:23–32

    Article  PubMed  CAS  Google Scholar 

  25. Sperry JL, Minei JP, Frankel HL et al (2008) Early use of vasopressors after injury: caution before constriction. J Trauma 64:9–14

    Article  PubMed  CAS  Google Scholar 

  26. Volpicelli G (2011) Sonographic diagnosis of pneumothorax. Intensive Care Med 37:224–232

    Article  PubMed  Google Scholar 

  27. Warner KJ, Cuschieri J, Jurkovich GJ et al (2009) Single-dose etomidate for rapid sequence intubation may impact outcome after severe injury. J Trauma 67:45–50

    Article  PubMed  CAS  Google Scholar 

  28. Waydhas C, Sauerland S (2007) Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation 72:11–25

    Article  PubMed  Google Scholar 

  29. Worsing RA Jr (1984) Principles of prehospital care of musculoskeletal injuries. Emerg Med Clin North Am 2:205–217

    PubMed  Google Scholar 

  30. Xirouchaki N, Magkanas E, Vaporidi K et al (2011) Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med 37:1488–1493

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    C. Waydhas

Authors
  1. C. Waydhas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. Waydhas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Waydhas, C. Präklinische Polytraumaversorgung: S3-Leitlinie. Unfallchirurg 115, 8–13 (2012). https://doi.org/10.1007/s00113-011-2102-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-011-2102-y

Schlüsselwörter

Keywords

Search

Navigation