Der Unfallchirurg
-
Limb injuries are often underestimated in the diagnostic procedures initiated in the resuscitation room. Missed diagnosis is therefore a frequent consequence in this issue. A systematic analysis of evidence-based procedures was therefore investigated in this paper. ⋯ The quality of shock room management is mostly dependent on the experience of the " trauma team" (and especially of the trauma leader). Guidelines and specific trauma algorithms can provide a helpful instrument in this issue.
-
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.
-
Concepts for optimal surgical treatment of the patient with blunt multiple injuries are being evaluated on the basis of the current literature. ⋯ Three different factors determine the clinical course after polytrauma: Trauma represents the first hit, followed by the therapy-induced burden (second hit). In addition, the third hit is represented by the individual response. An evaluation of the clinical status by immunologic monitoring can be performed in order to assess the patient's status.
-
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.
-
Clinical Trial
[Priority-oriented shock trauma room management with the integration of multiple-view spiral computed tomography].
In major trauma it is essential to immediately recognize and treat life-threatening problems and conditions. Most trauma protocols reserve the use of computed tomography for the secondary survey, as patients cannot be attended to during the examination and must be transferred from the emergency room to the CT suite. The relevant reduction in the scanning time of multidetector computed tomography (MDCT) or multislice computed tomography (MSCT) justifies its use as the major diagnostic adjunct for primary trauma survey and initial resuscitation. ⋯ An adequate survey of injuries can be achieved earlier and a targeted therapy can be initiated ahead of time. Integration of MDCT scanners in the primary trauma survey provides a high standard of imaging in a very short time without endangering the patient. When dealing with multiple casualties, MDCT could be used also as an accurate and time-efficient means of hospital triage to diagnose and prioritize patients and to plan further surgical interventions and intensive care.