Prehospital Intubation in Severe Thoracic Trauma without Respiratory Insufficiency: A Matched-Pair Analysis Based on the Trauma Registry of the German Trauma Society

Ruchholtz, Steffen; Waydhas, Christian; Ose, Claudia; Lewan, Ulrike; Nast-Kolb, D.

doi:10.1097/00005373-200205000-00010

Cited by 50 publications

(27 citation statements)

References 16 publications

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“…Die Indikation zur ETI beim Thoraxtrauma wird kontrovers diskutiert [79]. Hypoxie und respiratorisches Versagen sind Folgen eines schweren Thoraxtraumas.…”

Section: Thoraxtraumaunclassified

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

et al. 2011

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Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). With the availability of ketamine as a viable alternative, the use of etomidate is not encouraged due to its side effects on adrenal function. An electrocardiogram (ECG), blood pressure measurement and pulse oximetry are needed to monitor the emergency anesthesia and the secured airway. Capnography is absolutely mandatory to confirm correct placement of the endotracheal tube and to monitor tube dislocations as well as ventilation and oxygenation in the prehospital and hospital setting. Because airway management is often complicated in trauma patients, alternative devices and a fiber-optic endoscope need to be available within the hospital. Use of these alternative measures for airway management and ventilation should be considered at the latest after a maximum of three unsuccessful intubation attempts. Emergency medical service (EMS) physicians should to be trained in emergency anesthesia, ETI and alternative methods of airway management on a regular basis. Within hospitals ETI, emergency anesthesia and ventilation are to be conducted by trained and experienced anesthesiologists. When a difficult airway or induction of anesthesia is expected, endotracheal intubation should be supervised or conducted by an anesthesiologist. Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.

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“…Die Indikation zur ETI beim Thoraxtrauma wird kontrovers diskutiert [79]. Hypoxie und respiratorisches Versagen sind Folgen eines schweren Thoraxtraumas.…”

Section: Thoraxtraumaunclassified

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

et al. 2011

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“…Der positive Effekt einer frühen Intubation beim Traumapatienten konnte bereits in früheren Arbeiten belegt werden [22,23] und ließe sich mit den hier gezeigten Daten in Einklang bringen. Hingegen konnten Ruchholtz et al [20] keinen Effekt hinsichtlich Mortalität und Organversagen nachweisen, wenn Patienten ohne Zeichen einer respiratorischen Insuffizienz präklinisch intubiert wurden.…”

Section: Intubationunclassified

Unterschiedliche Letalitätsraten an deutschen Traumazentren

2010

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“…Nur beim isolierten Thoraxtrauma ohne respiratorische Insuffizienz bzw. ohne schwere Begleitverletzungen wird unter Sauerstoffapplikation, ausreichender Analgesie und einem schonenden Transport mit erhöhtem Oberkörper auf eine Intubation verzichtet [61]. Ein zü-giger Transport im Sinne des "treat-andrun"-Konzeptes wird in jedem Fall empfohlen.…”

Section: Wirbelsäulen-und Rückenmarkverletzungenunclassified

Pr�klinisches Management des Polytraumas

et al. 2004

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Approximately 8000 patients with multiple trauma are admitted annually to an emergency room in Germany. The prognosis of these severely injured patients is influenced in particular by concomitant craniocerebral injury, an abdominal wound, or thoracic trauma. Hypoxia and hypotension subsequent to shock induced by hemorrhagic-traumatic effects are of prime importance. Preclinical management thus includes examining the injured patient, immobilizing the spine, ensuring airway patency, stabilizing cardiovascular status suitting the approach to the injury pattern, commensurate care of partial injuries, pain therapy, as well as rapid and careful transportation to the nearest qualified trauma center. Management of patients with multiple trauma poses a particular challenge to the responding team. This article in the continuing education series deals with current algorithms for preclinical management of patients with multiple injuries with particular focus on the significant factor of time.

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Prehospital Intubation in Severe Thoracic Trauma without Respiratory Insufficiency: A Matched-Pair Analysis Based on the Trauma Registry of the German Trauma Society

Cited by 50 publications

References 16 publications

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

Notfallnarkose, Atemwegsmanagement und Beatmung beim Polytrauma

Unterschiedliche Letalitätsraten an deutschen Traumazentren

Pr�klinisches Management des Polytraumas

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