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2017 ; 114
(29-30
): 497-503
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Multiple Trauma and Emergency Room Management
#MMPMID28818179
Frink M
; Lechler P
; Debus F
; Ruchholtz S
Dtsch Arztebl Int
2017[Jul]; 114
(29-30
): 497-503
PMID28818179
show ga
BACKGROUND: The care of severely injured patients remains a challenge. Their
initial treatment in the emergency room is the essential link between first aid
in the field and definitive in-hospital treatment. METHODS: We present important
elements of the initial in-hospital care of severely injured patients on the
basis of pertinent publications retrieved by a selective search in PubMed and the
current German S3 guideline on the care of severely and multiply traumatized
patients, which was last updated in 2016. RESULTS: The goal of initial emergency
room care is the rapid recognition and prompt treatment of acutely
life-threatening injuries in the order of their priority. The initial assessment
includes physical examination and ultrasonography according to the FAST concept
(Focused Assessment with Sonography in Trauma) for the recognition of
intraperitoneal hemorrhage. Patients with penetrating chest injuries, massive
hematothorax, and/or severe injuries of the heart and lungs undergo emergency
thoracotomy; those with signs of hollow viscus perforation undergo emergency
laparotomy. If the patient is hemo - dynamically stable, the most important
diagnostic procedure that must be performed is computerized tomography with
contrast medium. Therapeutic decision-making takes the patient's physiological
parameters into account, along with the overall severity of trauma and the
complexity of the individual injuries. Depending on the severity of trauma, the
immediate goal can be either the prompt restoration of organ structure and
function or so-called damage control surgery. The latter focuses, in the acute
phase, on hemostasis and on the avoidance of secondary damage such as
intra-abdominal contamination or compartment syndrome. It also involves the
temporary treatment of fractures with external fixation and the planning of
definitive care once the patient's organ functions have been securely stabilized.
CONCLUSION: The care of the severely injured patient should be performed in
structured fashion according to the A-B-C-D-E scheme, which involves the securing
of the airway, breathing, and circulation, the recognition of neurologic
deficits, and whole-body examination by the interdisciplinary team.
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