Der Anaesthesist
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In the early post-traumatic period severe traumatic brain injuries and massive bleeding from disrupted parenchymal organs, large vessels or crush injuries of the pelvis may present as morphological damage that renders survival impossible, although aggressive fluid and blood replacement therapy in conjunction with immediately stopping blood loss surgically may result in survival in selected cases. In contrast, late mortality from multiple organ failure - which in the past limited survival in 10 to 30% of patients in that condition - has in recent years reduced this as the cause of death to less than 5%. ⋯ A threat to optimal care of the severely injured patient may arise from the economical restraints imposed on health-care providers. When one considers the enormous political and socioeconomical importance of rehabilitating the predominantly young trauma patients and reintegrating them into the work world, an appeal has to be made to all those responsible to secure optimal care for severely injured patients in the future.
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We report a complication during the insertion time of a central venous catheter in a patient with intracerebral bleeding. This complication was caused by an inadvertent dislocation of a subclavian catheter. Hydromediastinum and bilateral hydrothorax developed. ⋯ In the course of events mediastinitis was diagnosed. The clinical condition improved under antibiotic therapy. The patient could be transferred to another clinical unit for endovascular treatment of an arterio-venous cerebral malformation.