Management des Polytraumas

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.

A multidisciplinary approach to management of extensive facial injuries resulting from the use of an angle grinder

“…As stated, a methodological approach -ALS/ATLS goes some way to improve the quality and sequence of treatment received in these circumstances. 2,11 This case also demonstrates the key role played by interventional radiologists. Whilst many injuries, including those involving the face and facial skeleton can lead to damage of blood vessels and persistent haemorrhage, most can be managed by either applying direct pressure or ligating and suturing those vessels involved.…”

“…In cases involving serious trauma, a methodological approach and training in relation to the traumatised patient (ABCDE's) has been shown to have a significant positive effect on patient survival/outcome, 2,12,1 and the multidisciplinary approach to acute care in the severely traumatised patient has also been shown to benefit patients as far as functional and aesthetic recovery, and general outcomes are concerned. 11,18 This case also highlights the importance of airway preservation and haemodynamic resuscitation by the first attending personnel where severe mutilating facial injuries could prove a distraction and cause unnecessary delay in life saving treatment. As stated, a methodological approach -ALS/ATLS goes some way to improve the quality and sequence of treatment received in these circumstances.…”

Five years experience of trauma care in a German urban level I university trauma center

“…One important aspect of early trauma care known to be closely correlated with survival is time [12,[17][18][19]. In this context, we believe that our time intervals correspond to current quality management criteria, e.g., the completion of an MSCT within 25 ± 12 min or the completion of the secondary survey within 41 ± 23 min.…”

Polytrauma—pathophysiology and management principles

“…In the future, functional ex vivo testing of danger recognizing and defending immune cells might become an important tool for surgeons to assess the polytraumatized patient's systemic danger reaction-followed by a precisely adjusted surgical response. Finally, the base of an effective surgical management of the multiple injured patient with the complex underlying pathophysiology is a well-organized and structured extraand intramural trauma center, with well-defined algorithms and tasks of the personnel acting in an interdisciplinary approach [53][54][55][56][57][58][59][60][61].…”