Skip to main content
Log in

S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung

Schockraumversorgung

S3 guideline on treatment of polytrauma/severe injuries

Trauma room care

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

Zusammenfassung

Die Versorgung schwerstverletzter Patienten im Schockraum bedeutet für das multidisziplinäre Behandlungsteam einen strukturierten Evaluationsprozess in einen zielgerichteten Behandlungsprozess zu überführen. Neben dem Faktor Zeit und dem Erkennen vital bedrohlicher Verletzungen, die häufig unter dem Begriff „deadly six“ zusammengefasst werden, sollten aber auch sog. „Bagatellverletzungen“ nicht übersehen werden, da sie die Lebensqualität nach Trauma mitunter entscheidend beeinflussen können. Die S3-Leitlinie Polytrauma erhebt nicht den Anspruch auf Vollständigkeit. Wichtige Inhalte, wie z. B. die Versorgung von Kindern sind bisher noch nicht in die Leitlinie eingeflossen, werden aber für die Überarbeitung fest eingeplant.

Abstract

For the multidisciplinary treatment team, the medical care of the most severely injured patients in the trauma room means they have to convert a structured evaluation process into a target-oriented treatment process. Apart from the time factor and the detection of life-threatening injuries that are often summarised under the term“deadly six“, also so-called trivial injuries should not be overlooked, because they occasionally can crucially affect the quality of life after trauma. The S3 guideline on polytrauma does not claim to be complete. Important subjects such as the medical care of children have not yet been integrated into the guideline, but it is planned to include them in the next revision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. AWMF (2011) S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung, Registrierungsnummer 012–019, AWMF, Düsseldorf, http://www.awmf.org/leitlinien

  2. Sturm JA, Lackner CK, Bouillon B et al (2002) Advanced Trauma Life Support (ATLS) und Systematic Prehospital Life Support (SPLS). Unfallchirurg 105:1027–1032

    Article  PubMed  CAS  Google Scholar 

  3. Ruchholtz S, Nast-Kolb D, Waydhas C et al (1994) Frühletalität beim Polytrauma – eine kritische Analyse vermeidbarer Fehler. Unfallchirurg 97:285–291

    PubMed  CAS  Google Scholar 

  4. Champion HR, Sacco WJ, Copes WS (1992) Improvement in outcome from trauma center care. Arch Surg 127:333–338

    Article  PubMed  CAS  Google Scholar 

  5. Bouillon B (2009) Brauchen wir wirklich keinen „trauma leader“ im Schockraum? 112:400–401

  6. Ertel W, Trentz O (1997) Neue diagnostische Strategien beim Polytrauma. Chirurg 68:1071–1075

    Article  PubMed  CAS  Google Scholar 

  7. Sakellariou A, Mcdonald PJ, Lane RH (1995) The trauma team concept and its implementation in a district general hospital. Ann R Coll Surg Engl 77:45–52

    PubMed  CAS  Google Scholar 

  8. American College of Surgeons Committee on Trauma (2006) Resources for optimal care of the injured patient. American College of Surgeons, Chicago

  9. Okamoto K, Norio H, Kaneko N et al (2002) Use of early-phase dynamic spiral computed tomography for the primary screening of multiple trauma. Am J Emerg Med 20:528–534

    Article  PubMed  Google Scholar 

  10. Ma J, Mateer J (1997) Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med 29:312–316

    Article  PubMed  CAS  Google Scholar 

  11. Bruckner BA, Di Bardino DJ, Cumbie TC et al (2006) Critical evaluation of chest computed tomography scans for blunt descending thoracic aortic injury. Ann Thorac Surg 81:1339–1347

    Article  PubMed  Google Scholar 

  12. McNamara J, Messersmith J, Dunn R et al (1970) Thoracic injuries in combat casualties in Vietnam. Ann Thorac Surg 10:389–401

    Article  PubMed  CAS  Google Scholar 

  13. Boyd M, Vanek V, Bourguet C (1992) Emergency room resuscitative thoracotomy: when is it indicated? J Trauma 33:714–721

    Article  PubMed  CAS  Google Scholar 

  14. Nast-Kolb D, Waydhas C, Kastl S et al (1993) The role of an abdominal injury in follow-up of polytrauma patients. Chirurg 64(7):552–559

    PubMed  CAS  Google Scholar 

  15. Matthes G, Stengel D, Seifert J et al (2003) Blunt liver injuries in polytrauma: results from a cohort study with the regular use of whole body helical computed tomography. World J Surg 27:1124–1130

    Article  PubMed  Google Scholar 

  16. Nast-Kolb D, Trupka A, Ruchholtz S, Schweiberer L (1998) Abdominal trauma. Unfallchirurg 101(2):82–91, Erratum in: Unfallchirurg 101(4):295

    Google Scholar 

  17. Lendemans S, Heuer M, Nast-Kolb D et al (2008) Significance of liver trauma for the incidence of sepsis, multiple organ failure and lethality of severely injured patients. An organ-specific evaluation of 24,771 patients from the trauma register of the DGU. Unfallchirurg 111(4):232–239

    Article  PubMed  CAS  Google Scholar 

  18. Liu M, Lee CH, P’eng FK (1993) Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 35:267–270

    Article  PubMed  CAS  Google Scholar 

  19. Vos PE, Alekseenko Y, Battistin L et al (2006) Ch 16 mild traumatic brain injury. In: Hughes RA, Brainin M, Gilhus NE (eds) European handbook of neurological management, 1st edn. Blackwell Publishing, Edinburgh

  20. Firsching R, Woischneck D, Klein S et al (2001) Classification of severe head injury based on magnetic resonance imaging. Acta Neurochir (Wien) 143:263–271

    Google Scholar 

  21. Panetta T, Sclafani SJ, Goldstein AS et al (1985) Percutaneous transcatheter embolization for massive bleeding from pelvic fractures. J Trauma 25:1021–1029

    PubMed  CAS  Google Scholar 

  22. Bozeman C, Carver B, Zabari G et al (2004) Selective operative management of major blunt renal trauma. J Trauma 57(2):305–309

    Article  PubMed  Google Scholar 

  23. Bracken MB (2002) Steroids for acute spinal cord injury. Cochrane Database Syst Rev CD001046

  24. Cannell H, Silvester KC, O’regan MB (1993) Early management of multiply injured patients with maxillofacial injuries transferred to hospital by helicopter. Br J Oral Maxillofac Surg 31:207–212

    Article  PubMed  CAS  Google Scholar 

  25. Holmgren EP, Dierks EJ, Homer LD et al (2004) Facial computed tomography use in trauma patients who require a head computed tomogram. J Oral Maxillofac Surg 62:913–918

    Article  PubMed  Google Scholar 

  26. Dienemann H, Hoffmann H (2001) Tracheobronchial injuries and fistulas. Chirurg 72(10):1131–1136

    Article  PubMed  CAS  Google Scholar 

  27. Soar J, Deakin CD, Nolan JP et al (2005) European Resuscitation Council Guidelines for Resusitation 2005. Section 7. Cardiac arrest in special circumstaandes. Resusitation 67S1:S135–S170

    Article  Google Scholar 

  28. Hess EP, Campell RL et al (2007) Epidemiology, trends, and outcome of out6-of hospital cardiac arrest of noncardiac origin. Resusitation 72:200–206

    Article  Google Scholar 

  29. Huber-Wagner S, Lefering R, Qvick M et al (2007) Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation 75:276–285

    Article  PubMed  Google Scholar 

  30. David JS, Gueugniaud PY, Riou B et al (2007) Does the prognosis of cardiac arrest differ in trauma patients? Crit Care Med 35:2251–2255

    Article  PubMed  Google Scholar 

  31. Hess JR, Brohi K, Dutton RP et al (2008) The coagulopathy of trauma: a review of mechanisms. J Trauma 65(4):748–754

    Article  PubMed  CAS  Google Scholar 

  32. Lendemans S, Kreuzfelder E, Waydhas C et al (2004) Clinical course and prognostic significance of immunological and functional parameters after severe trauma. Unfallchirurg 107(3):203–210

    Article  PubMed  CAS  Google Scholar 

  33. Holcomb JB, Wade CE, Michalek JE et al (2008) Increased plasma and platelet to red blood cell ratios improves outcome in 466 massively transfused civilian trauma patients. Ann Surg 248(3):447–458

    PubMed  Google Scholar 

  34. Görlinger K, Hanke A, Dirkmann D et al (2009) Impact of a thrombelastometry-based algorithm for point-of-care coagulation management on blood transfusion rate in trauma patients. Hämostaseologie 29:54

    Google Scholar 

  35. CRASH-2 trial collaborators, 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

    Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Lendemans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lendemans, S., Ruchholtz, S. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. Unfallchirurg 115, 14–21 (2012). https://doi.org/10.1007/s00113-011-2103-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-011-2103-x

Schlüsselwörter

Keywords

Navigation