Der Unfallchirurg
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Accidental hypothermia (AH) can be defined as an unintentional decrease in core temperature below 35 degrees C during cold exposure by individuals without intrinsic thermoregulatory dysfunction. Pathophysiological changes can be attributed both to the severity of hypothermia and to co-morbid factors such as trauma, submersion, intoxication and underlying diseases. In trauma victims stratified according to the Injury Severity Score, the factor hypothermia is considered to be a poor prognostic sign for survival. ⋯ Mortality in the CAVR group was 28% and total mortality reached 32%. Complications of CAVR are related to placement and removal of vascular catheters and may be severe in these patients with impaired coagulation. CAVR permits a good access to the (trauma-) patient and rewarming can be continued synchronously with diagnosis and treatment of various injuries.
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The scapulothoracic dissociation (SD) is a complex injury of the shoulder girdle, mostly associated with polytraumatized critically ill patients. This case report of 3 patients shows the variety of possible injuries combined with SD. ⋯ The 3 patients are presented from trauma to management, with remarks to various possibilities in treatment. Reports of other groups include multicenter studies with small numbers of patients, making it different to look for homogenity or defining standards, whereas current guidelines are being mentioned, including remarks on the management of these mostly polytraumatized and vitally endangered patients.