Der Unfallchirurg
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Opinions vary with regard to the equipment and structural furnishings required for adequate management of the trauma patient in the dedicated shock suite. In order to assess the current situation in Germany, we conducted a survey of the 76 centers participating in the Polytrauma Registry of the DGU. Fifty-one questionnaires were returned by centers representing all levels of care. ⋯ Fourteen centers desire changes but do not currently have the required money. Information provided by Philips and Siemens suggests that the cost of furnishing a new shock suite ranges between 1.4 and 1.7 million euros. Responses to our survey show that a large gap remains between wishes and reality in the technical infrastructure in many shock suites in Germany.
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This overview reviews the literature on multiply injured patients with traumatic brain injuries. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). A detailed analysis of the literature of traumatic brain injuries has been elaborated by the Brain Trauma Foundation and has been published in the World Wide Web (http://www2.braintrauma.org/). The following procedures should be performed in the emergency room for multiply injured patients with traumatic brain injuries: (1) recording of precise history to identify risk factors for severe traumatic brain injury, (2) measurement of the Glasgow Coma Scale (GCS), pupillary reflex, and mean arterial pressure, (3) diagnostic evaluation with a CT scan, and (4) rapid surgical decompression if indicated.
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The aim of the study was the description of personal and structural preconditions essential for adequate diagnostic requirements and treatment in severely injured patients. Herein we give detailed information regarding both the composition and qualification of the trauma team and the activation criteria as well as instructions for the design of the emergency room and technical requirements. Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches) and classified into evidence levels (1 to 5 according to the Oxford system). ⋯ A CT scanner should be positioned nearby. Adequate management of severely injured patients requires optimal personal and structural conditions. High costs and additional personnel are justified by improved quality of treatment.
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Blunt abdominal trauma is most common in the polytraumatized patient and beside neurocranial trauma one major determinant of early death in these patients. Therefore, immediate recognition of an abdominal injury is of life-saving importance. ⋯ After blunt abdominal trauma, initially ultrasound investigation should be performed in the emergency room. This should not only focus on free intraabdominal fluid but also on organ lesions. Regardless of the findings from ultrasound or clinical examination, the hemodynamically stable patient should undergo a CT-scan of the abdomen in order to proof or exclude an abdominal injury.
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Injuries to the pelvis may occur as a life threatening situation which then requires immediate surgical treatment. A review of the literature represents the range of current recommendations. ⋯ Emergency management of pelvic fractures means treatment of a life threatening injury in first place. Although there are different methods that can be used, they all follow the same principle of resuscitation and mechanical stabilization of the pelvis in parallel.