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Schuss- und Explosionsverletzungen der Gefäße

Präklinische und klinische Versorgung von traumatischen Gefäßverletzungen

Vascular injuries from firearms and explosive devices

Preclinical and clinical care of vascular trauma

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Zusammenfassung

Festnahmen von potenziellen Attentätern in Deutschland in den letzten Monaten legen die Vermutung nahe, dass Terroranschläge wie in Paris (2015) und Brüssel (2016) unter Einsatz von Schusswaffen und Explosivstoffen zu befürchten sind. Dies sind Situationen, in denen die individualmedizinischen Behandlungsansätze den Grundsätzen der Versorgung eines Massenanfalls von Verletzten weichen. Neuere Untersuchungen der Versorgung von gefäßverletzten, polytraumatisierten Patienten zeigen jedoch auch, dass selbst unter individualmedizinischen Aspekten die Schwere des Gefäßtraumas und damit die mit gängigen Trauma-Scoring-Systemen erwartete Prognose unterschätzt wird. Die im Sommer 2016 erschienene S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung der federführenden Deutschen Gesellschaft für Unfallchirurgie widmet sich durch Modifikation geltender Empfehlungen und Aufnahme von neuen Erkenntnissen in großen Teilen der Versorgung von kritischen Blutungen. Der Artikel befasst sich mit dem durch Einsatz von Schusswaffen und Explosivstoffen gefäßtraumatisierten Patienten. Neben dem Pathomechanismus von Schuss- und Explosionsverletzungen der Gefäße werden prä- und innerklinische Behandlungsoptionen auf Basis der S3-Leitlinie dem Leser vermittelt.

Abstract

The arrest of several potential assassins in Germany in recent months leads to the assumption that terror attacks with firearms and explosive devices like those that happened in Paris (2015) and Brussels (2016) could also take place in German cities. In such situations, the well-known treatment fundamentals in mass casualty incidents (MASCAL) take priority over the well-known fundamentals of individual medical treatment approaches. New research results emphasize that even under optimal treatment circumstances the outcome of vascular traumatized patients is underestimated when the mortality rate is calculated using established trauma score systems. The 2016 revised S3 clinical guideline Polytrauma‑/Schwerverletzten-Behandlung from the Deutsche Gesellschaft für Unfallchirurgie (Polytrauma/severe injury treatment from the German Trauma Society) addresses the modification of existing recommendations and the inclusion of new findings in the treatment of critical bleeding. The following article focuses on vascular traumatized patients with gunshot wounds and injuries from explosive devices. In addition to the pathomechanism of shooting and explosion injuries, preclinical and clinical treatment options for critical bleeding are presented based on the S3 guidelines.

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Authors and Affiliations

  1. Abteilung für Allgemein‑, Thorax- und Viszeralchirurgie, Sektion Gefäßchirurgie, Bundeswehrkrankenhaus Hamburg, Lesserstraße 180, 22049, Hamburg, Deutschland

    D. Hinck & U. Unkelbach

  2. Klinik und Poliklinik für Gefäßmedizin, Universitäres Herzzentrum GmbH, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    E. S. Debus

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  1. D. Hinck
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  2. U. Unkelbach
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  3. E. S. Debus
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Correspondence to D. Hinck.

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Interessenkonflikt

D. Hinck, U. Unkelbach und E.S. Debus geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Dieser aktualisierte Beitrag erschien ursprünglich in der Zeitschrift Notfall+Rettungsmedizin 10.1007/s10049-017-0294-6.

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Hinck, D., Unkelbach, U. & Debus, E.S. Schuss- und Explosionsverletzungen der Gefäße. Gefässchirurgie 22, 271–284 (2017). https://doi.org/10.1007/s00772-017-0279-2

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