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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(06): 408-421
DOI: 10.1055/s-0042-118056
Topthema
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Der Patient mit Thoraxtrauma: präklinische Versorgung

Thoracic Trauma – Prehospital Treatment
Michael Hansen
,
Thomas Hachenberg
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Publication History

Publication Date:
14 June 2017 (online)

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Zusammenfassung

Etwa jeder 10. Traumapatient in den Notaufnahmen weist ein stumpfes Thoraxtrauma auf, aus dem lebensbedrohliche Verletzungen wie Spannungspneumothorax oder Perikardtamponade resultieren können. Zeitkritische Diagnostik und Therapie stehen bei der Versorgung im Vordergrund. Die Durchführung lebensrettender therapeutischer Maßnahmen muss jedem Notarzt geläufig sein, und das Verletzungsmuster entscheidet über die Auswahl der Zielklinik.

Abstract

Penetrating thoracic injuries are rare in Germany and common in urban regions. 10 percent of the patients in Emergency Departments suffer from blunt thoracic trauma. Mechanism of trauma can predict the severity of the injuries. Very fast life-threatening injuries with hemodynamic problems like tension pneumothorax or cardiac tamponade have to be diagnosed. Prehospital emergency physicians need skills in ultrasound for diagnosis and in invasive therapy like chest tube or pericardium drainage tube. The application of an algorithm in exploration of a thoracic trauma seems to be useful. The selection of trauma center depends on the severity of the trauma, if necessary with the availability of extracorporeal circulation.

Kernaussagen

  • Die Berücksichtigung des Unfallmechanismus und der Richtung der einwirkenden kinetischen Energien lassen nicht nur Rückschlüsse auf ein Thoraxtrauma, sondern auch auf die Schwere des Traumas zu.

  • In Westeuropa überwiegen stumpfe Verletzungsmechanismen.

  • Lebensbedrohliche Verletzungen wie ein Spannungspneumothorax oder eine Perikardtamponade müssen im Primary Survey erkannt und sofort therapiert werden.

  • Die häufigste Folge eines stumpfen Thoraxtraumas ist eine Lungenkontusion.

  • Die Indikation zur Intubation und mechanischen Beatmung ergibt sich, wenn trotz Sauerstoffzufuhr der SpO2 90% nicht überschreitet. Eine nichtinvasive Beatmung kann versucht werden.

  • Bei der Beatmung sollten hohe Beatmungsdrücke und ein FiO2 > 80% vermieden werden, um einem Barotrauma oder Atelektasenbildung vorzubeugen. Ein PEEP von 6 – 8 mmHg ist anzuwenden.

  • Die Komplexität der Verletzung entscheidet über die Auswahl der Zielklinik. Die Möglichkeit einer extrakorporalen Zirkulation muss bei Verletzungen der großen intrathorakalen Gefäße oder des Herzens verfügbar sein.

Schlüsselwörter

stumpfes Thoraxtrauma - penetrierendes Thoraxtrauma - Perikardtamponade - Spannungspneumothorax

Key words

blunt thoracic trauma - penetrating thoracic trauma - pericardium tamponade - tension pneumothorax
 

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