Die Versorgung schwerstverletzter Patienten im Schockraum bedeutet fur das multidisziplinare Behandlungsteam einen strukturierten Evaluationsprozess in einen zielgerichteten Behandlungsprozess zu uberfuhren. Neben dem Faktor Zeit und dem Erkennen vital bedrohlicher Verletzungen, die haufig unter dem Begriff „deadly six“ zusammengefasst werden, sollten aber auch sog. „Bagatellverletzungen“ nicht ubersehen werden, da sie die Lebensqualitat nach Trauma mitunter entscheidend beeinflussen konnen. Die S3-Leitlinie Polytrauma erhebt nicht den Anspruch auf Vollstandigkeit. Wichtige Inhalte, wie z. B. die Versorgung von Kindern sind bisher noch nicht in die Leitlinie eingeflossen, werden aber fur die Uberarbeitung fest eingeplant.

S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung

Background: In this retrospective study, we reviewed our protocol for management of hemodynamically unstable patients with pelvic injury. Methods: We managed the patients with the same predetermined plan including controlled hemodynamic resuscitation with early use of vasopressors and pelvic angiography as a first-line treatment. Results: Of 311 patients with pelvic fracture, 32 hemodynamically unstable patients (10.3%) underwent pelvic angiography, which was followed by embolization in 25 cases. Angiography was successful for 24 patients (96%) and extrapelvic bleeding was diagnosed in 5 patients (15%). Three of six laparotomies performed before angiography were nontherapeutic. One of seven laparotomies performed after angiography was negative. Conclusion: A protocol for management of patients with pelvic injury and hemodynamic instability that is associated with controlled resuscitation including vasopressor and early pelvic angioembolization is effective for treating pelvic hemorrhage and diagnosing extrapelvic hemorrhage. Further studies are needed to confirm the respective place of angiographic and surgical control of bleeding.

Early Embolization and Vasopressor Administration for Management of Life-threatening Hemorrhage from Pelvic Fracture

German Trauma Society (DGU) (lead) Office in Langenbeck-Virchow House Luisenstr. 58/59 10117 Berlin German Society of General and Visceral Surgery German Society of Anesthesiology and Intensive Care Medicine German Society of Endovascular and Vascular Surgery German Society of Hand Surgery German Society of Oto-Rhino-Laryngology, Head and Neck Surgery German Interdisciplinary Association for Emergency and Acute Care Medicine German Society of Oral and Maxillofacial Surgery German Society of Neurosurgery German Society of Thoracic surgery German Society of Urology German Radiology Society German Society of Plastic, Reconstructive and Aesthetic Surgeons German Society of Gynecology and Obstetrics German Society of Pediatric Surgery German Society for Transfusion Medicine and Immunohematology German Society for Burn Medicine German Interdisciplinary Association for Intensive and Emergency Medicine German Professional Association of Emergency Medical Services Society of Pediatric Radiology

Level 3 guideline on the treatment of patients with severe/multiple injuries Abstracts

The mortality benefit of whole-body computed tomography (CT) in early trauma management remains controversial and poorly understood. The objective of this study was to assess the impact of whole-body CT compared with selective CT on mortality and management of patients with severe blunt trauma. The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to intensive care units from university hospital trauma centers within the first 72 hours. Initial data were combined to construct a propensity score to receive whole-body CT and selective CT used in multivariable logistic regression models, and to calculate the probability of survival according to the Trauma and Injury Severity Score (TRISS) for 1,950 patients. The main endpoint was 30-day mortality. In total, 1,696 patients out of 1,950 (87%) were given whole-body CT. The crude 30-day mortality rates were 16% among whole-body CT patients and 22% among selective CT patients (p = 0.02). A significant reduction in the mortality risk was observed among whole-body CT patients whatever the adjustment method (OR = 0.58, 95% CI: 0.34-0.99 after adjustment for baseline characteristics and post-CT treatment). Compared to the TRISS predicted survival, survival significantly improved for whole-body CT patients but not for selective CT patients. The pattern of early surgical and medical procedures significantly differed between the two groups. Diagnostic whole-body CT was associated with a significant reduction in 30-day mortality among patients with severe blunt trauma. Its use may be a global indicator of better management.

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Impact of whole-body computed tomography on mortality and surgical management of severe blunt trauma.

Objectives We tested the hypothesis that colloid-induced hemodilution can induce hypocalcemia in the early phase of severe trauma resuscitation and tried to assess other potential causative factors of that hypocalcemia. Design Prospective cohort. Setting Level I academic trauma center. Patients Consecutive severe trauma patients (n = 212, mean Injury Severity Score 34) resuscitated in the prehospital phase without any blood transfusion. Interventions At admission, ionized calcium (corrected to an arterial pH = 7.40) was measured. Measurements and main results Hypocalcemia was defined as a value 15%) between calculated and observed ionized calcium, and these patients had more severe trauma and more frequently had acidosis and/or prehospital cardiac arrest. Using the TRISS methodology, survival was not significantly different from that expected in this trauma population. Conclusion Hypocalcemia frequently occurs on arrival at the hospital in severe trauma patients, and colloid-induced hemodilution and severe shock and/or ischemia-reperfusion appear to be important causative factors.

Early hypocalcemia in severe trauma.

Objectives: Total body computed tomography (CT) scan is increasingly used in traumatised patients, but the need for an initial rapid imaging assessment beforehand remains unknown. To address this problem, we assessed the value of an initial imaging assessment (chest X-ray, pelvic X-ray, abdominal ultrasonography) in severely traumatised patients in a prospective study.

F. Menegaux

Papers

Initial imaging assessment of severe blunt trauma.