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Management des Polytraumas

Management of polytrauma

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Zusammenfassung

Die ersten Stunden nach Trauma sind entscheidend für die Prognose. Das Behandlungsvorgehen erfordert daher ein stringentes zeit- und prioritätenorientiertes Konzept unter dem Gesichtspunkt eines modernen Qualitätsmanagements. Dies beginnt bereits mit der schnellstmöglichen und zielgerichteten Einlieferung Schwerverletzter in eine geeignete Klinik, welche über ständige Schockraumbereitschaft, alle notwendigen diagnostischen Möglichkeiten, eventuell erforderliche chirurgische Disziplinen sowie operative und intensivmedizinische Kapazitäten verfügen sollte. Effizientes Schockraummanagement bedeutet standardisierte Maßnahmenabfolgen mit einem Nebeneinander diagnostischer und therapeutischer Maßnahmen. An die Erfassung und Therapie unmittelbar lebensbedrohender Verletzungen (Sofortmaßnahmen/Notoperationen/“damage control surgery“) schließen sich in der Frühphase weitere Operationen an (Weichteilverletzungen/Frakturen). Dabei setzt sich wegen der potenziellen Gefährdung der Vitalfunktionen durch traumabedingte pro- und antiinflammatorische Reaktionen und durch operationsbedingte additive Traumata die Damage-control-orthopedics-Strategie immer mehr durch. Die zunächst mit Fixateur externe stabilisierten Frakturen können dann sekundär gefahrlos definitiv versorgt werden. Durch die Implementierung von Therapieprotokollen, die von allen beteiligten Disziplinen erarbeitet und akzeptiert wurden, sowie durch standardisierte Systeme des Qualitätsmanagement mit internen und externen Rückkopplungsmechanismen konnte zudem eine erhebliche Verbesserung der Behandlungsqualität erreicht werden.

Abstract

The first hours after trauma are decisive. Therefore the treatment chosen demands very strict planning according to concepts of modern quality management. This begins with the fastest possible and most efficient delivery of injured patients to the applicable clinic. Such institutions are permanently ready and have at their service all the necessary diagnostic techniques and surgical and intensive care methods. Effective shock treatment entails standardized procedures accompanied by up-to-date diagnostic and therapeutic measures. After admittance and therapy of life-threatening injuries (immediate measures, damage control surgery), early-stage surgery will follow (soft tissue injuries and fractures). Strategy of damage control orthopedics is growing in acceptance because of the potential danger to life functions due to pro- and anti-inflammatory response induced additional trauma caused by following surgery. Fractures initially stabilized by external fixation can consecutively be treated safely by secondary conversion osteosynthesis. A considerable improvement in quality can be attained through therapeutic procedures approved by all concomitant disciplines and standardized systems with internal and external control methods.

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  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 , Essen, Deutschland

    D. Nast-Kolb, S. Ruchholtz, C. Waydhas & G. Taeger

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  1. D. Nast-Kolb
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  2. S. Ruchholtz
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  3. C. Waydhas
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  4. G. Taeger
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Correspondence to D. Nast-Kolb.

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Nast-Kolb, D., Ruchholtz, S., Waydhas, C. et al. Management des Polytraumas. Chirurg 77, 861–873 (2006). https://doi.org/10.1007/s00104-006-1231-2

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  • DOI: https://doi.org/10.1007/s00104-006-1231-2

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