Klinisches Polytrauma-Management im Schockraum - Was muss und kann der Unfallchirurg leisten?

 

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Zusammenfassung

Für den klinischen Verlauf polytraumatisierter Patienten ist eine optimale Behandlungsstrategie nach erfolgter Stabilisierung von entscheidender Bedeutung. Die Notwendigkeit eines verantwortlichen Arztes in der frühen klinischen Diagnostik und Versorgung polytraumatisierter Patienten ist unumstritten. Beim zeiteffizienten und zielführenden Vorgehen können Ausbildungssysteme wie z. B. ATLS^® von Nutzen sein. In Deutschland wird die Aufgabe des Trauma Team Leaders in der Regel vom Unfallchirurgen übernommen. Dieser muss in der Lage sein, die personelle Besetzung des Teams im Schockraum den individuellen Bedürfnissen des Patienten anzupassen. Nach Erkennen der wesentlichen Verletzungen muss er schnell die diagnostischen und therapeutischen Konsequenzen ziehen, seine eigenen Fähigkeiten dabei realistisch einschätzen und ggf. frühzeitig Konsiliarärzte hinzuziehen. Insbesondere der Zeit kommt bei vielen Verletzungen, wie z. B. abdominellen Blutungen und schweren Schädel-Hirn-Traumata eine immense Bedeutung zu. Auch verschiedene Behandlungskonzepte bei Polytraumatisierten wie Early Total Care und Damage Control Orthopaedics sind beim weiteren therapeutischen Vorgehen zu berücksichtigen.

Abstract

After stabilization an optimal therapeutic strategy influences outcome in polytraumatized patients. A trauma team leader in early clinical course is necessary to optimize diagnostics and planning of further treatment. Special training systems like ATLS^® can help to standardize management of trauma patients. In most German trauma centers an orthopaedic trauma surgeon is the team leader in the emergency room during early clinical course of patients with multiple injuries. After identification of most threatening injuries he must decide next diagnostics steps and planning of further treatment within a short period of time. Especially in patients with abdominal bleeding and severe brain injury time is the most critical factor. If he is not able to treat these injuries alone, physicians from other specialties must be involved. The trauma team leader must be aware of different treatment concepts like early total care and damage control orthopaedics.

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Korrespondenzadresse

Prof. Dr. med. H.-C. Pape

Department of Orthopaedic Surgery

Division Chief -Traumatology

Suite 911

Kaufmann Med. Building

3471 Fifth Avenue

Pittsburgh

PA, 15213

Phone: 412/605/32 53

Fax: 412/687/37 24

Email: papehc@upmc.edu