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Massiver Blutverlust bei Polytrauma

Stellenwert der suffizienten Nasentamponade bei komplexen Mittelgesichtsfrakturen

Massive hemorrhage in polytrauma. Value of adequate nasal tamponade in complex midfacial fractures

  • Kieferchirurgie
  • Published:
Trauma und Berufskrankheit

Zusammenfassung

Anhand der Fallbeschreibung einer 51-jährigen Patientin mit massivem Blutverlust nach Verkehrsunfall wird auf die Notwendigkeit suffizienter Nasentamponaden hingewiesen. Nach Wundversorgung, Einleitung der Massentransfusion und Transport in die Klinik wurden die vom Notarzt eingebrachten Epistaxistuben beidseits durch großlumige Rüsch-Tamponaden der Größe III ersetzt, worunter die Blutung persistierte. Die volumetrischen Untersuchungen der Tuben ergaben eine therapierelevante Differenz zwischen dem Volumen der aufgeblähten Tuben und dem geforderten Kompressionsvolumen der Nasenhöhle. Dieses Missverhältnis kann zu dem erheblichen Blutverlust beigetragen haben. Auf die Versorgung mit ausreichend großen Tuben bei nasopharyngealen Blutungen polytraumatisierter Patienten wird verwiesen.

Abstract

Using the case report of a 51 year old patient with massive hemorrhage sustained from a polytrauma, the necessity of a sufficient nasal tamponade is presented. The patient was involved in a vehicular accident being a passenger. Initially she was responsive and orientated. The rescue endeavour turned out to be most difficult, with a duration of 1.5 hours. Because of the multitude of injuries the patient was intubated and sedated. Due to the nasal hemorrhage epistaxis tubes were inserted in both nostrils. With this procedure the bleeding could not be contained. Following the wound treatment and blood transfusions the epistaxis tubes were replaced by so called Ruesch tamponades (size 3) which facilitated adequate blood stasis.

The subsequent volumetric analysis of the different tubes and nasal cavity, revealed marked differences between the volume of the inflated nasal tube and the necessary volume which would develop sufficient compression. This discordance may have contributed to the massive blood loss.

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Wedl, J. Massiver Blutverlust bei Polytrauma. Trauma Berufskrankh 4, 279–282 (2002). https://doi.org/10.1007/s10039-002-0583-1

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  • DOI: https://doi.org/10.1007/s10039-002-0583-1

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