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Fürst B, Thiaener A, Schroll A, Adler D, Gradl G. Erfolgreiche innerklinische Clamshell-Thorakotomie bei einem jungen polytraumatisierten (ISS 57) Patienten. Unfallchirurg 2022; 126:316-321. [PMID: 35499763 DOI: 10.1007/s00113-022-01183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Life-threatened injured patients who suffer a cardiovascular arrest after a trauma are still enormously challenging for both the paramedics and the trauma team in the clinic. This case illustrates the treatment of a 16-year-old boy who suffered a blunt abdominal trauma with a traumatic cardiac arrest followed by an open resuscitation after clamshell thoracotomy. Subsequently, the treatment after damage control is discussed regarding the current literature and recommendations for treatment.
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Affiliation(s)
- Benedikt Fürst
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland.
| | - Axel Thiaener
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
| | - Andreas Schroll
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
| | - Daniel Adler
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
| | - Georg Gradl
- München Klinik Harlaching, München Klinik gGmbH, Sanatoriumsplatz 2, 81545, München, Deutschland
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Schmitz J, Battenberg T, Drinhaus H, Eifinger F, Ries C, Hinkelbein J. Auswirkung der Implementierung eines Schockraumkoordinators auf Prozessparameter der Polytraumaversorgung im Schockraum eines Maximalversorgers. Anaesthesist 2020; 69:497-505. [DOI: 10.1007/s00101-020-00776-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/04/2020] [Accepted: 03/18/2020] [Indexed: 12/01/2022]
Abstract
Zusammenfassung
Hintergrund
In der Altersgruppe bis 40 Jahre stellt das schwere Trauma die häufigste Todesursache in Deutschland dar. Entsprechend der S3-Leitlinie „Polytrauma/Schwerverletztenbehandlung“ ist seit 2011 die Anwesenheit eines Schockraumkoordinators in Erwägung zu ziehen, der durch optimierte Versorgungs- und Behandlungsabläufe das Überleben der Patienten verbessern kann. Ziel der vorliegenden Untersuchung war die Analyse unterschiedlicher Prozessparameter zur Schockraumversorgung polytraumatisierter Patienten vor und nach Implementierung eines Schockraumkoordinators für die Polytraumaversorgung.
Material und Methoden
Um einen ausreichenden zeitlichen Abstand zum Zeitpunkt der Neueinführungen (2011) einzuhalten, wurden die Jahre 2009 und 2012 zum Vergleich herangezogen: Alle eingescannten Schockraumprotokolle der Jahre 2009 (01.01.2009–31.12.2009) und 2012 (01.01.2012–31.12.2012) wurden gesichtet und ausgewertet.
Ergebnisse
Aus dem Jahr 2009 wurden 213 und aus dem Jahr 2012 wurden 420 Schockraumeinsätze in die Auswertung einbezogen. Die durchschnittliche Schockraumanzahl lag im Jahr 2009 bei 17,8/Monat und im Jahr 2012 bei 35/Monat. Die mittlere Anzahl der Schockraumeinsätze hat sich nahezu verdoppelt (p < 0,001). Die mittlere Schockraumdauer lag im Jahr 2012 im Durchschnitt 5,8 min unter der im Jahr 2009 (p = 0,56).
Schlussfolgerungen
Die Patientenversorgung war in Anwesenheit eines Schockraumkoordinators bzw. nach Implementierung der SOP weder statistisch signifikant noch klinisch relevant verkürzt.
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Laue F, Ramadanov N, Matthes G. Schockraummanagement beim Schwerverletzten. Notf Rett Med 2019. [DOI: 10.1007/s10049-018-0552-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Palm HG, Kulla M, Wettberg M, Lefering R, Friemert B, Lang P. Changes in trauma management following the implementation of the whole-body computed tomography: a retrospective multi-centre study based on the trauma registry of the German Trauma Society (TraumaRegister DGU ®). Eur J Trauma Emerg Surg 2017; 44:759-766. [PMID: 29101416 DOI: 10.1007/s00068-017-0870-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/30/2017] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Whole-body computed tomography (WBCT) plays an increasingly important role in the diagnostic assessment of trauma room patients. It is still unclear whether its use has led to changes of trauma room procedures and patient outcomes. METHODS In a retrospective multi-centric study based on the trauma registry of the German Trauma Society (TraumaRegister DGU®), we analysed patients with an ISS ≥ 9 between 2002 and 2013. Two periods of time, i.e. up to 3 years preceding (pre-WBCT) and up to 3 years following the introduction of the WBCT (WBCT-group), were assessed separately for every hospital (TR-DGU Project ID 2014-020). RESULTS 19,838 patients underwent treatment in 77 hospitals. Of these, 5621 were assigned to the pre-WBCT group and 11,307 to the WBCT group. Basic data did not differ relevantly. The time spent in the trauma room decreased from 77.9 min (pre-WBCT) to 63.3 min (WBCT). Following the introduction of the trauma scan, the number of diagnoses per patient increased from 4.6 to 5.1. The percentage of patients who underwent surgery immediately after the completion of trauma room procedures decreased from 44.5 to 39.1%. There was an increase in mortality from 15.7 to 15.9%. CONCLUSIONS Routine use of WBCT is not superior to a combination of conventional radiography, ultrasound and focused CT in terms of mortality. The entire process involving the introduction of the trauma scan and the further development of algorithms has caused changes that can be observed in the trauma room setting.
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Affiliation(s)
- H-G Palm
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - M Kulla
- Department of Anaesthesiology and Intensive Care Medicine, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - M Wettberg
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - B Friemert
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany
| | - P Lang
- Trauma Research Group, Department of Orthopaedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports Traumatology, Bundeswehrhospital Ulm, Oberer Eselsberg 40, 89081, Ulm, Germany.
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Abstract
Sliding-gantry computed tomography offers an interesting variety of treatment options for emergency radiology and clinical routine. The Frankfurt 2-room installation provides an interdisciplinary, multifunctional, and cost-effective concept. It is based on a magnetically sealed rail system for the permanent movement of the gantry between 2 adjacent rooms with fixed-mounted tables. In case of emergency or intensive care patients, routine scanning can be performed in room 1 until computed tomography diagnosis is required in room 2 and can then be continued in room 1 again. Moreover, this concept allows the simultaneous handling of 2 emergency patients.
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Mand C. In reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:504. [PMID: 24000300 PMCID: PMC3752583 DOI: 10.3238/arztebl.2013.0504b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Carsten Mand
- *Klinik für Unfall-, Hand- und, Wiederherstellungschirurgie, Universitätsklinikum Giessen und Marburg GmbH, Standort Marburg,
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Hinkelbein J. Obvious structural deficiencies. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:504. [PMID: 24000299 PMCID: PMC3752582 DOI: 10.3238/arztebl.2013.0504a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Jochen Hinkelbein
- *Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln,
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Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA. A comparison of the treatment of severe injuries between the former East and West German States. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:203-10. [PMID: 23589743 DOI: 10.3238/arztebl.2013.0203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 12/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The annual number of persons killed in road-traffic accidents in Germany declined by 36% from 2001 to 2008, yet official traffic statistics still reveal a marked difference in fatalities between the federal states of the former East and West Germany twenty years after German reunification. METHODS We retrospectively analyzed data from the Trauma Registry of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; TR-DGU). Patients receiving primary treatment that had an Injury Severity Score (ISS) of 9 or above were analyzed separately depending on whether they were treated in the former East Germany or the former West Germany. RESULTS Data were obtained from a total of 26 866 road-accident trauma cases. With Berlin excluded, 2597 cases (10.2%) were from the former East Germany (EG), and 22 966 (89.9%) were from the former West Germany (WG). The percentage of the population living in these two parts of the country is 16.7% and 83.3%, respectively. The two groups did not differ significantly in either the mortality of injuries (EG 15.8%, WG 15.7%) or in the standardized mortality rate (0.89 [EG] vs. 0.88 [WG]). Over the years 2002-2008, the mean time to arrival of the emergency medical services on the scene was 19 minutes (EG) vs. 17 minutes (WG), and the mean time to arrival in hospital was 76 minutes (EG) vs. 69 minutes (WG). CONCLUSION Among the hospitals whose cases are included in the TR-DGU, there is no significant difference between the former East and West Germany with respect to mortality or any other clinically relevant variable. Hypothetically, the higher rate of death from road-traffic accidents in the former East Germany, as revealed by national traffic statistics, might be attributable to a difference in the quality of care received by trauma patients, but no such difference was found. Other potential reasons for it might be poorer road conditions, more initially fatal accidents, and lower accessibility of medical care in less densely populated areas.
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Affiliation(s)
- Carsten Mand
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg GmbH, Campus Marburg, Germany
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[Kidney injury and multiple trauma: outcome, course and treatment algorithm. An organ-specific evaluation of 835 patients from the trauma register of the DGU]. Unfallchirurg 2013; 115:700-7. [PMID: 21161149 DOI: 10.1007/s00113-010-1909-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The relevance of renal trauma in severely injured patients within a large collective has not yet been thoroughly reviewed. This study aimed at assessing the prevalence of renal trauma in relation to the outcome and the currently established method of treatment. PATIENTS AND METHODS Altogether data of 35,664 patients of the TraumaRegister of the German Society of Trauma Surgery (DGU) (1996-2007) were interpreted retrospectively. All patients with an injury severity score (ISS) ≥16, direct admission to a trauma center and an age of ≥16 years were included. All patients with abdominal trauma (AIS(Abdomen) ≥2) were compared with patients with abdominal and renal trauma (AIS(Kidney) ≥2). RESULTS A total of 18,416 patients fulfilled the inclusion criteria of which 6,218 (34.1%) had abdominal injuries. Of these patients with abdominal injury 835 (13.3%) additionally showed a kidney injury (AIS(Abdomen) ≥2, AIS(Kidney) 2-5) and were analyzed according to the classification of the American Association for the Surgery of Trauma (AAST) organ-severity-score. AAST kidney: II°: 45.5%, III°: 31.1%, IV°: 15.6%, V°: 7.8%. Patients with leading kidney injury (grade IV and V) thereby showed a significant increase in mortality (IV: 32.3% and V: 40.0%) and an increase in the need for surgical intervention (IV: 61.5 and V: 81.5%). With an increasing grade of renal injury, however, the ISS is also increased but mortality was not increased over the expected mortality rate (RISC score) due to the additional renal injury. Dialysis rate in the surviving patients showed an increased rate depending on the degree of the kidney injury (II: 5.5%, III: 7.6%, IV: 18.8%, V: 8.3%). CONCLUSION The results presented here show the prevalence and the outcome of kidney injury in a large collective within the TraumaRegister of the DGU for the first time. Based on the current literature and the findings a treatment algorithm has been developed.
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Abdominal vascular trauma in 760 severely injured patients. Eur J Trauma Emerg Surg 2012; 39:47-55. [PMID: 26814923 DOI: 10.1007/s00068-012-0234-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/07/2012] [Indexed: 12/26/2022]
Abstract
PURPOSE The relevance of abdominal vascular injuries in polytraumatic patients within a large collective has not yet been thoroughly analyzed. This study aimed at assessing the prevalence of traumatic injuries in relation to outcome and currently established treatment options. METHODS 51,425 patients from the Trauma Registry of the German Society of Trauma Surgery (TR DGU) (1993-2009) were analyzed retrospectively. All patients who had an Injury Severity Score (ISS) of ≥16, were directly admitted to a trauma center and subsequently received treatment for at least three days, were ≥16 years old, and had an abdominal injury (AISabdomen ≥2) were included. Patients with abdominal trauma (AISabdomen ≥2) were compared with patients with additional vascular trauma (AISvascular 2-5). RESULTS 10,530 (20.5 %) of the 51,425 patients had documented abdominal injury. 760 (7.2 %) of the patients with abdominal injury additionally showed abdominal vascular injury (AISabdomen ≥2, AISvascular 2-5) and were analyzed based on the classification of the American Association for the Surgery of Trauma (AAST) organ severity score (AAST vascular injury grade: II, 2.4 %; III, 2.7 %; IV, 1.8 %; V, 0.2 %. Patients with high-grade abdominal vascular injury (grades IV and V) showed a significant increase in mortality (IV, 44.6 %; V, 60 %) and consequently a decrease in the need for surgical intervention (IV, 67.4 %; V, 64 %). CONCLUSIONS The results presented here show the prevalence and outcome of abdominal vascular injuries in a large collective within the TR DGU for the first time. Based on the current literature and these findings, a treatment algorithm has been developed.
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Heuer M, Hussmann B, Lefering R, Taeger G, Kaiser GM, Paul A, Lendemans S. Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm. Langenbecks Arch Surg 2011; 396:1067-76. [DOI: 10.1007/s00423-011-0836-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 08/03/2011] [Indexed: 12/26/2022]
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