Die vier Schockformen – Teil 1: hypovolämisch-hämorrhagischer Schock

 

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Zusammenfassung

In der Notfallmedizin begegnen dem Notarzt regelmäßig „Schockpatienten“ unterschiedlicher Genese. Mögen die Schockformen auf den ersten Blick sehr ähnlich aussehen, beeinflussen doch einige relevante Unterschiede in der jeweiligen Pathophysiologie die notärztliche Therapie.

Abstract

The haemorrhagic shock does not represent the most frequent type of shock (16%), but is still a challenge for the emergency service because of severe bleeding or seriously injured patients. It is necessary that the “shock” and a potential bleeding source are recognized very early for avoiding irreversible decompensation. There are few readings which are easy to raise and are very helpful for assessing the patientʼs state (for example digital palpation of radial pulse or the “recap test”). In summary the most important prehospital measures are:

• effective stop of bleeding,

• improving oxygenation,

• stabilization of circulation (balanced electrolyte solution [BES], hydroxyethyl starch [HES], catecholamines),

• avoiding hypothermia,

• use of tranexamic acid (TXA),

• correct choice of target hospital.

Maybe in the future new alternatives will be available for prehospital volume replacement with effective volume effect but without any side effects like when using HES. It further remains to be seen whether the uncritical use of tranexamic acid will be changed to a more selective and ROTEM-dependent usage.

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