Transthorakale Pfählungsverletzung: Lessons Learned

 

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Zusammenfassung

Vorgestellt wird das Fallbeispiel eines 54-jährigen LKW-Fahrers, der sich bei einem Auffahrunfall eine transthorakale Pfählungsverletzung mit einer scharfkantigen Planke zuzog. Aufgearbeitet wird der Transport unter Spontanatmung, die durchgeführte Diagnostik im Schockraum und die unmittelbar anschließende Therapie. Während der operativen Versorgung wurde bei kreislaufinstabilem Patienten temporär die thorakale Aorta manuell komprimiert. Aus der Versorgung dieser hochdramatischen Verletzung wurden folgende 3 plakative Aussagen abgeleitet, die anschließend vor dem Hintergrund der aktuellen Literatur diskutiert werden.

1. Die Kompression der thorakalen Aorta ist hocheffektiv.

2. Die explorative Laparotomie schafft Sicherheit bei Patienten in extremis.

3. Der Perforationsgegenstand muss ausreichend gekürzt werden.

Abstract

This paper presents the case report of a 54-years old truck driver who suffered from a transthoracic impalement injury after a rear-end collision accident. We analysed the transportation under spontaneous breathing, the diagnostic procedures in the shock room as well as the immediately performed procedures. During surgical treatment, temporary compression of the thoracic aorta was necessary because of cardiopulmonal instability of the patient. On basis of the treatment of this highly dramatic injury, the following three striking conclusions are deduced and are further discussed on the background of the current literature.

1. Compression of the thoracic aorta is highly effective.

2. explorative laparotomy provides security.

3. A perforating item should be shortened sufficiently.

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