Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie : AINS
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2007
Review[Initial management of polytraumatized patients in the emergency department].
Advanced Trauma Life Support (ATLS) provides a structured and efficient approach to the treatment of patients with multiple trauma in the emergency department. The performance of a well functioning interdisciplinary trauma team coordinated by an experienced trauma leader plays a pivotal role during the initial phase of patient care. The team's primary task is to establish and maintain stable vital signs by ensuring adequate oxygenation and fluid resuscitation while diagnostic or immediate life saving interventions and procedures are initiated. The following article describes the management of patients with multiple injuries in the emergency department based on the ATLS algorithm.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2007
Review[The polytrauma patient in the intensive care unit].
Patients admitted to an intensive care unit with the diagnosis "polytrauma" differ from other patients by their typical trauma-associated morbidity (diffusive bleeding, traumatic brain injury, lung contusion), and by the staged surgical treatment of multiple injuries. The complexity of the clinical picture, and the complexity of the chronological order of the operative phases require a close cooperation of the medical specialist disciplines involved. The perioperative morbidity and mortality of polytrauma victims has been reduced significantly within the last 30 years due to an adapted transfusion- and substitution regime (rational utilization of anemia tolerance, calculated substitution of coagulation factors), due to modern therapeutic regimes for the patient with traumatic brain injury (stabilization of cerebral perfusion pressure, stabilization of adequate cerebral oxygenation), and due to the modern therapeutic strategies of mechanical ventilation (lung-protective ventilation, kinetic therapy, non-invasive ventilation). The aim of this review is to describe these modern therapeutic principles of the intensive care unit treatment of the polytrauma patient.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2007
Review[Prehospital treatment of severe trauma].
The prehospital management of patients with severe trauma should focus on stabilization of vital signs. Major goal is the early transport in a specialized trauma center. After immobilization of cervical spine maintenance of oxygen delivery is the primary and most important intervention. ⋯ Amounts of Infusion should be decided on blood loss, patients with traumatic brain injury need at least a normotensive blood pressure. Patients with uncontrolled severe bleeding should not receive excessive infusion before urgent surgical treatment can be performed. Prehospital induction of anesthesia must be carefully considered because of the enhanced risk.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Oct 2007
Case Reports[Case report: prehospital therapy of the severely burned patient].
On the basis of a case report the prehospital management of severely burned patients is discussed. The prevention of hypovolemia, hypothermia or hypoxemia are the primary targets. It is necessary to estimate the burn size and depth. The burn shock fluid resuscitation, prevention of hypothermia, pain- and airway management are described as well as the transport from the scene of accident to a proximal emergency unit or to a specialized burn intensive care unit.