Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Trauma management in the emergency room is an important part of the treatment chain of the severely injured. Important decisions with respect to diagnostics and treatment must be made under time pressure. Successful trauma management in the emergency room requires a hospital tailored treatment protocol. ⋯ In order to continuously evaluate and improve performance in the emergency room local quality circles are needed that truly follow that aim. Important factors are reliability of agreement between the different disciplines and continuous communication of results to the team members. In order to be successful such quality circles need people that care.
-
Pelvic injuries are often associated with multiple injuries of other body regions, neurovascular and visceral lesions, as well as hemodynamic instability. The use of a standardized classification characterizing the severity and stability of pelvic fractures and the early stabilization of pelvic ring injuries in appreciation of damage control principles has helped to improve the number of survivors. ⋯ Standardized clinical investigations and modern concepts even in the preclinical therapy of complex pelvic fractures make a contribution to enhancement of treatment options. Because of the still problematic long-term results after surgery of instable pelvic fractures, the need for modern treatment concepts has to be adapted to the requirements.
-
Multiple trauma is still the most common cause of death in the age group below 40 years but rarely occurs in prehospital emergencies in Germany. Therefore, personal experience of emergency physicians in prehospital treatment of multiple trauma is often limited. ⋯ The current German multiple trauma S3 guidelines provide algorithms for preclinical treatment. The underlying scientific evidence in this respect is, however, low.
-
After severe multiple injuries (first hit) a two-phase immunological response with early hyperinflammation followed by immunosuppression can be observed. This process involves a variety of humoral and cellular factors. ⋯ The clinical course can be positively influenced by adequate intensive care therapy, avoiding iatrogenic second hits by non-emergency surgical interventions during a phase of immunological dysregulation. Important decision parameters besides time to initial trauma include adequate oxygenation, no coagulopathy, declining inflammatory mediators and normalized serum lactate.
-
Consequences of accidents are found not only in physical but also in psychological and social areas. The quality of life of severely injured patients is significantly reduced compared with the normal population even years after the trauma. Subjective experiences of severely injured patients during and after hospitalization have a major impact on the subsequent quality of life. ⋯ Besides pain management the focus lies especially in work-related rehabilitation and psychological support which is also decisive for the success of rehabilitation of accident victims. For severely injured patients it is important to provide sufficient support, e.g. through a case manager which does not end with discharge from the rehabilitation facility. The aim of all efforts is reintegration into the working and social environment and the best possible quality of life.