Patients older than 75 years showed a unique trimodal distribution of mortality with a later onset of events by one week following the initial trauma. Cosgriff N., Moore E.E., Sauaia A., Kenny-Moynihan M., Burch J.M., Galloway B. During the last 15 years considerable international collaborative effort was invested to define polytrauma in a reproducible standardised fashion [1,2]. Autoren: Wie lange dauert die Heilung nach einem Beckenbruch. [2], Further research in the trauma deaths has resulted in the description of trauma deaths with a trimodal distribution. Four of the Polytrauma Rehabilitation Centers (PRC) and four Polytrauma Transitional Rehabilitation Programs (PTRP) are collocated on the same VA medical campus: Successful performance of the primary survey can quickly identify life-threatening injuries that need immediate management, and other injuries that may become life-threatening if not managed appropriately. Coagulation abnormalities in polytrauma patients present in 2 forms- Acute coagulopathy of trauma (ACT) and Resuscitation associated coagulopathy (RAC). Millions of patients seek medical help as a result of trauma, with a substantial proportion of patients suffering from life-changing or life-limiting injuries. Andernfalls stirbt der Patient möglicherweise an einer Überzuckerung. Definitive fixation of fracture is still a controversial topic. Hypovolämie mit zugehöriger Schocksymptomatik ist ebenfalls ein wesentlicher Bestandteil des Polytraumas und muss sofort behandelt werden. aDepartment of Orthopaedics, All India Institute of Medical Sciences, Raebareli, UP, 229405, India, bSouthport and Ormskirk NHS Trust Southport, UK, cDepartment of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India, dDepartment of Onco-Anaesthesiology and Palliative Medicine, Dr BRAIRCH, All India Institute of Medical Sciences, New Delhi, 110029, India. Physiological parameters such as pulse rate, blood pressure, pulse pressure, ventilatory rate, arterial blood gas (ABG) analysis, body temperature, and urinary output should be checked as they reflect the adequacy of resuscitation. Polytrauma can be caused by motor vehicle accidents, falls from heights, bullet injuries, blast injuries caused by explosive devices, etc. da Costa L.G.V., Carmona M.J.C., Malbouisson L.M. Zu beachten ist, dass das Verletzungsmuster die Vorgehensweise der Volumensubstitution bestimmt. 10.1016/s0003-3944(03)00208-6 Abstract Aims: To compare specific features and prognosis of polytrauma victims requiring urgent laparotomy, after a free fall from a height (FFH) or a motor vehicle accident (MVA). What should be in your first-aid kit? Deswegen ist es so wichtig, nicht nur am Erste-Hilfe-Kurs zum Erwerb des Führerscheins teilzunehmen, sondern auch die erworbenen Kenntnisse regelmäßig aufzufrischen. Background Folgendes Phänomen kann sich jedoch trotz gesicherter Oxygenierung negativ auswirken: Bei der Spontanatmung nimmt der intrathorakale Druck während der Inspiration ab, wodurch Luft in die Lunge gelangt. Most patients with polytrauma land in the emergency department. This is a review of changes in the practice of treating polytrauma managemtent within the years prior to 2020. In diesem Fall muss auch sofort operiert werden. Epidemiology of trauma deaths. Ein Fixateur externe funktioniert wie eine Schraubzwinge. In patients who are apnoeic or who have a Glasgow coma scale (GCS) less than 8, the airway should be secured, most commonly with orotracheal intubation is indicated. [5][6], Airway Management (including cervical spine protection). The assessment of neurological function includes central and peripheral deficits or injuries. Trauma teams are necessary for the successful management of trauma patients, Trauma patients benefit from an interprofessional team approach, The trauma team leader should organize the trauma team to perform the primary survey quickly and systematically. The primary survey follows the ABCDE system that includes assessment and management of Airway, Breathing, Circulation, Disability, and Exposure. Learn about signs, causes, and treatment. The trends towards normal physiology indicate effective resuscitation. Polytrauma has a significant impact on the wellbeing and provided healthcare for the populations. Thoracic conditions that are immediately life-threatening include: Bleeding is a common and potentially severe consequence of polytrauma. EAC emphasized managing the most time-critical orthopaedic injuries only and others after optimal resuscitation to minimize secondary inflammatory response. Essential information that is required by the trauma team is: Each member of the trauma team is vital in providing a high standard of care to the patient. Anatomy-based injury severity scores are commonly used with physiological scores for reporting severity of injury in a standardized manner. Airway assessment and management is the first priority in the ATLS protocol. Jeder dieser Ärzte hat eine genau festgelegte Funktion. Shock with tissue hypoperfusion is another leading contributor to the development of ACoTS. Eine vollständige neurologische Untersuchung ist in diesem Zusammenhang nicht zielführend, da sie präklinisch zu wenig Information liefert und mit einem hohen Zeitverlust einhergehen kann. It was observed that patients of trauma had an acute inflammatory period of 2–5 days after inflicting trauma and remained at increased risk of ARDS, multi-organ failure. Ist der Patient in einer Klinik angekommen, wird er in den so genannten Schockraum gebracht. Die Diagnose eines Polytraumas wird meist schon vom Notarzt am Unfallort gestellt. Fehlt auf einer Seite das Atemgeräusch, vermutet der Anästhesist eine zusammengefallene Lunge, z. A vital role of the nursing staff in the polytraumatized patient is to act as an advocate for the patient, where they can voice particular concerns to the team, with important regard given to the patient's pain level. Wird bei dieser ersten Untersuchung keine lebensbedrohende Verletzung festgestellt und ist der Patient weiterhin kreislaufstabil, dann ist die nächste Untersuchung eine Computertomografie des gesamten Körpers. Bei einer Schädigung des Rückenmarks treten Lähmungserscheinungen und Sensibilitätsausfälle unterhalb des betroffenen Abschnittes auf. ... Außerdem soll bei diesem Schritt eine Halswirbelsäulenstabilisierung stattfinden. Der Anästhesist ist für das Herz-Kreislauf System und die Beatmung des Patienten zuständig. The evaluation, management, and prognosis of polytraumas are significantly different from isolated injuries. Clinical signs of hypovolemic shock include: Treatment of hypovolemic shock requires intravenous administration of fluids such as electrolyte solutions, salt solutions, or blood/blood components. 2019 Oct 11; [PubMed PMID: 31604472], Hefny AF,Kunhivalappil FT,Paul M,Almansoori TM,Zoubeidi T,Abu-Zidan FM, Anatomical locations of air for rapid diagnosis of pneumothorax in blunt trauma patients. 2019 Jun 17; [PubMed PMID: 31203832], Regel G,Stalp M,Lehmann U,Seekamp A, Prehospital care, importance of early intervention on outcome. The compromised airway being the biggest and fastest killer, it needs to be assessed and managed at the earliest followed by breathing, circulation, and neurological insults. One hundred and eighty-seven patients were included . Golden hour is a very well-known term used by trauma surgeons. conducted a randomized controlled trial to evaluate the concept of Early Total Care (ETC) in which definitive fracture fixation of long bone was carried out within 24 h of injury. Authors proposed to use physiological parameters (such as hemoglobin, pulse rate, blood pressure, pH, lactate levels, lung function, etc. The following section highlights patient related factors, interventions, and outcomes in polytrauma from some recent studies. The priority remains the identification and stabilization of potentially life-threatening injuries. Includes prompt infusion of tranexamic acid, fibrinogen concentrate, and packed red blood cells helps in reducing blood product consumption compared to the massive transfusion protocol for initial resuscitation of major trauma patients.52, Due to the improvement in philosophy of trauma care from early total care to prompt individualized safe management, use of early advanced trauma life support, improved quality in healthcare services, advancement in management options and more stringent traffic rules and safety, the overall survival rates after polytrauma are increasing. Early identification of acute traumatic coagulopathy using clinical prediction tools: a systematic review. This remains a major public health concern across the globe. Ein hämodynamisches Monitoring und eine zielgerichtete Therapie auf einer entsprechenden Intensivstation sind dabei entscheidend. Die definitive Versorgung solch eines Beckenbruch ist sehr aufwändig und eine anstrengende und schwere Operation für den Patienten. [15] They should only be used by practitioners trained in their use. In einem Schockraum sind (in einer Klinik der Maximalversorgung) mindestens vier Ärzte anwesend, in der Regel ein Anästhesist, ein Neurochirurg, ein Unfallchirurg und ein Allgemeinchirurg. Unter dem Notfallbild des Polytraumas versteht man eine gleichzeitig entstandene Verletzung mehrerer Körperregionen oder Organsysteme, wobei mindestens eine der Verletzungen oder eine Kombination aus zwei Verletzungen lebensbedrohlich ist. Ultrasound of the chest may suggest the location of air pockets in the chest indicative of pneumothoraces.[11]. Im Schockraum der Klinik erfolgt dann die weitere Diagnostik und Versorgung durch ein Trauma-Team, das im Idealfall aus Ärzten verschiedener Fachrichtungen (Anästhesie, Chirurgie, Radiologie, Orthopädie, Innere Medizin, Neurologie, Neurochirurgie) und entsprechendem Fachpersonal zusammengesetzt ist. A shift from MODS to brain-related death was observed. External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopaedics. A nurse should be ready to remove the patient's clothing upon arrival in the emergency department so that all possible injuries may be fully exposed. Santry H.P., Psoinos C.M., Wilbert C.J. Use of Prothrombin Complex Concentrate (PCC); clotting factor concentrates (factor VIIa) where appropriate. Flüssigkeit findet sich in der Bauchhöhle nur dann, wenn der Patient innere Blutungen hat. epidural hematoma,
Communication with the patient, and possibly family, during this time, will help reduce anxiety. Polytrauma gilt in diesem Zusammenhang der Grundsatz, akut lebensgefährliche Störungen der Vitalfunktionen bzw. Polytrauma/TBI System of Care. Pharmacists may also have involvement depending on the medical needs of the individual patient and must be prepared to rapidly deploy medications in conjunction with the trauma or emergency room clinicians. subarachnoid bleed,
Journal of neurosurgical sciences. The patient is said to be resuscitated if stable hemodynamic, no hypoxemia, normal coagulation, normothermia, normal urine output, serum pH toward normal. Polytrauma defined by the new berlin definition: a validation test based on propensity-score matching approach. Dazu gehören Stürze beim Fensterputzen von der Leiter oder von einem Drehstuhl. Diese definiert ein Polytrauma durch relevante Verletzungen von mindestens zwei Körperregionen mit einem AIS-Wert (Abbreviated Injury Scale) von ≥3, wobei zusätzlich einer der folgenden Parameter vorliegen muss: Alter ≥70, Azidose, Hypotension, Koagulopathie und Bewusstlosigkeit. They emphasized that each patient reacts differently to trauma and healthcare resources are differently distributed in different countries. Falls ein Buchstabe eine Pathologie aufweist, spricht man z.B. Giannoudis P.V., Giannoudis V.P., Horwitz D.S. They proposed that surgeons may apply different strategies and remain flexible in management to suit best to patients. This condition is in contrast to isolated trauma injury where there is a single injury encountered. In 1989, Bone LB et al. Mit einem Computertomografen können sehr dünne Schichtaufnahmen des Patienten gemacht werden, auf denen sowohl die Knochen als auch die Weichteile beurteilt werden können. Das Ziel ist eine Stabilisierung des Zustandes und der zügige Transport in eine Klinik, nicht die endgültige Therapie. The leading cause of traumatic death worldwide is road traffic collision, followed by suicide and homicide. The trauma nurse is expected to have many skills and needs to be adaptable to the often rapidly changing clinical situation. The trauma team checks for breathing and air entry by listening to breathing sounds and observing chest movement. [10] If a tension pneumothorax is suspected, do not delay treatment waiting for radiological confirmation. Lozman J., Deno D.C., Feustel P.J. Polytrauma often results in severe bleeding, which in turn can lead to hypovolemic shock. Polytrauma and traumatic brain injury (TBI) frequently co-occur and outcomes are routinely measured by the Glasgow Outcome Scale-Extended (GOSE). The chest and axillae should be examined for abrasions, bruising, open wounds, and evidence of penetrating trauma. Border J.R., LaDuca J., Seibel R. Priorities in the management of the patient with polytrauma. People often wonder whether it's best to call 911 or go straight to the hospital. Weitere (Gefährdungen)? Received 2020 Sep 28; Revised 2020 Oct 4; Accepted 2020 Oct 12. After removing clothes for examination, patients should be actively warmed or covered with blankets to minimize heat loss and prevent body temperature from dropping too low. die das hier gelesen haben und danke für die Antworten!! Clothing may need to be cut off. 2014 Jan; [PubMed PMID: 24084027], Forrester JD,August A,Cai LZ,Kushner AL,Wren SM, The Golden Hour After Injury Among Civilians Caught in Conflict Zones. Conventionally it refers to multiple injuries that involve multiple organs or systems. Meistens ist ein Polytrauma ein Notfall und muss sofort versorgt werden. bleeding from the ear,
Most recent guidelines suggest that a balanced transfusion ratio consists of fresh frozen plasma: platelets: RBCs in a ratio of 1:1:1 strategy and early administration of tranexamic acid should be started immediately.48,50 In some European trauma facilities, the use of various agents like fibrinogen concentrate or prothrombin complex concentrate as part of hemostatic management has been advocated.49. The clinical presentation of hypovolemic shock follows the four classes of shock ( Class I, II, III, and IV). They will also check for signs of cervical injury. Zeichen von Knochenbrüchen sind hier eine abnorme Beweglichkeit oder ein Knistern und Reiben während der Bewegung. However long-term and short-term burden such as problems in mobility, self-care, activity of daily living, work-related disability continues to have impact on socioeconomic and quality-of-life in many patients. Ist der Patient noch nicht für eine größere Operation geeignet, kann im Prinzip jeder Knochenbruch erst einmal mit einem Fixateur externe versorgt werden. Ist in dem Krankenhaus kein Comutertomograf in Reichweite, wird der Patient geröntgt. Polytrauma (multitrauma) is a short verbal equivalent used for severely injured patients usually with associated injury (i.e. They postulated that external fixation of bony injuries initially would require less operative time, prevent blood loss and hypothermia, and potentially would prevent patients from ‘second hit’ of definitive surgery; trauma being the first hit.24,25, Certain parameters like Injury Severity Scale (ISS) > 40 (without thoracic trauma), ISS >20 with thoracic trauma, Glasgow Coma Scale (GCS) of 8 or below, multiple injuries with severe pelvic/abdominal trauma and hemorrhagic shock, bilateral femoral fractures, pulmonary contusion noted on radiographs, hypothermia <35 °C, head injury with Abbreviated Injury Scale (AIS) of 3 or greater, IL-6 values above 500 pg/dL were the important parameters for DCO. Ley E.J., Clond M.A., Srour M.K. Da Luz L.T., Nascimento B., Shankarakutty A.K., Rizoli S., Adhikari N.K. Bone L.B., Johnson K.D., Weigelt J., Scheinberg R. Early versus delayed stabilization of femoral fractures. This is expected to decrease delay to surgery complication rates. The objectives of the primary survey are to identify and treat immediately life-threatening conditions. Therapien durchgeführt werden. have proposed a quadri modal distribution of deaths with the fourth peak occurring after the discharge of the patient.9, Apart from predicting patients who would develop complications during management, improvement in the clinical result of polytrauma patients with fractures may be attributed to the staged fracture fixation and individualized treatment strategies.10,11. Initial monitoring should include non-invasive blood pressure cycling 3 to 5 minutes, electrocardiogram (three-lead), and pulse oximetry. Although psychosocial intervention did not change the recovery of physical function; these interventions should not be abandoned because the greatest gains in function occurs early in recovery after trauma, which is the key time in transition to home placement.53, Early mobilization is required to gain mobility and minimize morbidity especially in obese patients as higher Body Mass Index (BMI) increases the risk of longer hospital stays and systemic complications in polytrauma patients.54, A recent analysis of Dutch trauma registry data of more than 25,000 polytrauma patients showed that older patients had poor outcome and are at a higher risk of morality than younger patients despite sustaining less high-energy accidents. Early identification of coagulopathy in trauma victims in ED itself helps in decision making for further management and the outcome.35 Platelet counts activated partial thromboplastin time (APTT), the prothrombin time (PT), International normalized ratio (INR) are the standard parameters to diagnose coagulation abnormalities. Purpose The definition and use of the term "polytrauma" is inconsistent and lacks validation. Farkash U., Lynn M., Scope A. Kommt es zu einem Spannungspneumothorax, liegt ein potenziell lebensbedrohlicher Zustand vor, der eine sofortige Therapie erfordert. Bei der Beatmung hingegen wird der intrathorakale Druck während der Inspiration erhöht (z.B. Diese Dysregulation ist maßgeblich für die Entstehung eines Multiorganversagens als Folge eines Polytraumas verantwortlich. Led to exacerbation of ‘Second Hit’ in a subset of patients with haemodynamic instability e.g. This can include neurosurgeons, orthopedists, cardiologists, physiotherapists and many other specialists. It focuses on five different topics, 1. Jaicks R.R., Cohn S.M., Moller B.A. ©1996-2021 MedicineNet, Inc. All rights reserved. Polytrauma is defined as “a significant injury of 3 or more points in 2 or more body regions with one or more variables from five physiological parameters namely age, consciousness, hypotension, coagulopathy and acidosis". VA's Polytrauma System of Care (PSC) is an integrated network of specialized rehabilitation programs dedicated to serving Veterans and Service Members with both combat and civilian related Traumatic Brain Injury (TBI) and polytrauma. Die häufigste Ursache für ein Polytrauma ist ein Autounfall. 2013 Sep; [PubMed PMID: 23877268], Moss R,Porter K,Greaves I, Minimal patient handling: a faculty of prehospital care consensus statement. de Vries R., Reininga I.H.F., Pieske O., Lefering R., El Moumni M., Wendt K. Injury mechanisms, patterns and outcomes of older polytrauma patients-An analysis of the Dutch Trauma Registry. Military medicine. 75) Punkten. A normal initial exam is critical to document, so consequent deterioration can be identified and properly managed. 1990 Dec; [PubMed PMID: 2253122]. It replaced the earlier concept of ETC because patients were “too sick not to operate”. This type of interprofessional teamwork is essential in polytrauma emergencies. Simmons J.W., Powell M.F. CT scans or MRIs may also be needed to provide more detailed information about certain injuries. skull fracture. Immediate and early deaths account for nearly 80% of trauma deaths occurring within the first few hours of injury, usually as a result of traumatic brain injury or major exsanguination. The late deaths occur within days or weeks of the initial injury and are generally secondary to multiorgan failure or sepsis.[3]. Internal bleeding is a serious consequence of trauma and can be life-threatening, requiring immediate medical attention. Pape H.C., Remmers D., Rice J., Ebisch M., Krettek C., Tscherne H. Appraisal of early evaluation of blunt chest trauma: development of a standardized scoring system for initial clinical decision making. Es existieren verschiedene Definitionen. Definitive control of hemorrhage is essential rather than aggressive and continued volume resuscitation as this can increase mortality and morbidity. Once resuscitation was started, the secondary assessment was done and patients were divided into 4 groups-stable (Grade I), borderline (Grade II), unstable (Grade III), and extremis (Grade IV) based on CGS. Sobald einer der anwesenden Ärzte eine lebensbedrohende Verletzung gefunden hat, wird nicht weiter untersucht. The concept of damage control resuscitation, dynamic analyses of coagulopathy, and lactate clearance as critical pillars in the management of polytrauma. and transmitted securely. Bryant M.K., Parrish M., Roy S. Inferior clinical outcomes after femur fracture in the obese are potentially preventable. Blutungen im Gehirn machen sich dadurch bemerkbar, dass die Pupillen unterschiedlich groß sind und nicht adäquat auf Licht reagieren. The concept of damage control came to the medical field from the United States (US) naval war term of the same name. Stein P., Studt J.D., Albrecht R. The impact of prehospital tranexamic acid on blood coagulation in trauma patients. The impact of disability on the quality of life and functionality in this younger population is worrisome. National Library of Medicine mehr, Alle Beiträge anzeigen: Allgemeinchirurgie » Polytrauma, 2098 Fragen & 3131 Antworten Forum Polytrauma », NOTFALL aber irgendwie läuft hier was schief. Evidence suggests that a ratio of 1:1:1 for packed red cells, fresh frozen plasma, and platelets may provide the greatest survival advantage. Mann K.G., Butenas S., Brummel K. The dynamics of thrombin formation. 2019 Mar; [PubMed PMID: 30711232], Kress TD,Balasubramaniam S, Cricothyroidotomy.