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Erstversorgung Bei Thoraxtrauma

U. Klein, R. Laubinger, A. Malich, A. Hapich, W. Gunkel
Published 2006 · Medicine

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ZusammenfassungDas Thoraxtrauma, zumeist im Rahmen eines Polytraumas, ist die hauptsächliche Todesursache bei Menschen unter 45 Jahren. Dabei stellen thorakale Traumen bei Mehrfachverletzen durch zumeist stumpfe Gewalteinwirkung über die letzten 3 Jahrzehnte hinweg mit ziemlich konstant 80% die häufigste relevante Verletzung dar. Isolierte Thoraxtraumen machen dagegen nur 25% aller Verletzungen aus. Mehr als 90% sind stumpfe Thoraxtraumen, 5–10% penetrierende Verletzungen. Die Überlebenschancen sind dabei z. T. unmittelbar bzw. mit einer etwa 25%igen Letalität maßgeblich durch das thorakale Trauma bestimmt. Das Verletzungsmuster beim Thoraxtrauma ist sehr vielgestaltig. Es betrifft den knöchernen Thorax mit Diaphragma, das Lungenparenchym, einschließlich der Atemwege, und das Mediastinum. Dabei sind vielfältige Kombinationen möglich. Anhand dieser Arbeit soll das diagnostisch und therapeutisch streng parallel ablaufende Vorgehen in der Primärphase der Behandlung vor Ort, in der Notaufnahme bis zur Erstversorgung dargestellt werden. Schwerpunkte sind die präklinischen Maßnahmen, das Schockraummanagement, einschließlich der apparativen Diagnostik durch Computertomographie, Sonographie und Endoskopie, sowie das prinzipielle klinisch-anästhesiologische Behandlungskonzept.AbstractThoracic trauma, most often associated with other serious injuries, is the main cause of death in the first 45 years of life. The percentage of chest injuries in multiple trauma, mainly from blunt impact, has remained relatively constant at 80% during the last 30 years. Isolated thoracic injuries comprise only 25% of all trauma cases, 90% of chest injuries are due to blunt impact, while penetrating injuries make up 5–10%. Since 25% of deaths from trauma are attributable to chest injuries, they determine the survival rate in multiple trauma to a significant extent. The pattern of chest injuries is variable, frequently in different combinations comprising rib cage and diaphragm, lung parenchyma, airway and mediastinal organs. This article details the immediate simultaneous diagnostic and therapeutic procedures in the prehospital phase, management in the emergency room, the relative importance of computed tomography, ultrasound examination and endoscopy in the primary diagnostic evaluation and the principles of anaesthetic management of thoracic trauma.
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