Präklinische Polytraumaversorgung: S3-Leitlinie

Abstract

The guidelines follow the priorities established by the A-B-C-D-E scheme. They focus on the treatment of actual disturbances of vital functions and not so much on their anticipated development. Important recommendations with regard to the indication for intubation and ventilation, fluid therapy, diagnosis and treatment of severe chest injuries (tension pneumothorax in particular), management of severe traumatic brain injury, pelvic and vertebral injuries, priorities in the management of extremity fractures as well as indications for the choice of the receiving hospital are given. The recommendations are discussed in view of future concerns and developments.

Management of bleeding and coagulopathy following major trauma: an updated European guideline

“…This approach may, however, increase the hydrostatic pressure on the wound, cause dislodgement of blood clots, a dilution of coagulation factors and undesirable cooling of the patient. The concept of low volume fluid resuscitation, so-called "permissive hypotension", avoids the adverse effects of early aggressive resuscitation while maintaining a level of tissue perfusion that, although lower than normal, is adequate for short periods [162]. Its general effectiveness remains to be confirmed in randomised clinical trials; however, two studies published in the 1990s demonstrated increased survival when a low and delayed volume fluid resuscitation concept was used in penetrating [163] or penetrating and blunt [164] trauma.…”

Does Radar Technology Support the Diagnosis of Pneumothorax? PneumoScan—A Diagnostic Point-of-Care Tool

“…On scene, emergency physicians and emergency medical technicians (EMT) can only adequately detect a traumatic PTX by combining single findings of clinical examination [7, 8]. Even if present studies report that a wait-and-see attitude in occult PTX (even in ventilated patients) can be as safe as chest tube placement [14, 15], it is not clear which kind of cases are applicable to this statement [5].…”

“…Therefore, only mechanism of injury, and clinical examination with assessment of ventilation can be consulted for diagnosing or excluding PTX. Due to low sensitivity (43–90%) and specificity (79–98%) of each single criterion, only their combination allows secure assessment [2, 7, 8]. …”

“…The initial, secure, and fast detection or exclusion of PTX has however a high impact on the management, especially if continuous monitoring and immediate treatment of PTX through chest tube placement cannot be guaranteed [2, 7, 8]. …”

“…An anytime bedside available, examiner-independent, easy to use, and fast method with high diagnostic accuracy in terms of a point-of-care device to rule out PTX would be desirable [7]. Therefore, an innovative and nonionizing micropower impulse radar- (MIR-) based tool—the PneumoScan engineered by PneumoSonic Inc. (Cleveland, OH, USA)—is investigated to exclude PTX in the context of shock trauma room treatment of severely injured patients.…”