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Pädiatrisches stumpfes thorakoabdominales Trauma

Damage-Control-Resuscitation-Therapie

Pediatric blunt thoracoabdominal trauma

Damage control resuscitation therapy

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Trauma und Berufskrankheit

Zusammenfassung

Die Primärversorgung von Kindern mit schwerem stumpfem Bauchtrauma und begleitender Azidose, Koagulopathie und Hypothermie (letale Trias) erfordert ein effizientes multidisziplinäres Therapieregime zur Reduktion der Mortalität. Ein 5,5 Jahre alter Junge wurde auf einem Bergbauernhof zwischen Traktorhinterrad und Hoftorumrandung im Torsobereich eingequetscht. Es kam zu einer Milzruptur Grad IV, einer Leberruptur Grad III, einer Pankreaslazeration Grad III, einer beidseitigen Lungenkontusion und einem begleitenden Weichteiltrauma mit Rhabdomyolyse. Aufgrund des schweren Traumas mit Auftreten einer Koagulopathie und einer kombinierten metabolisch-respiratorischen Azidose erfolgten die Gabe von Blutprodukten anstelle der von Kristalloiden, Akzeptanz einer permissiven Hypotension, Stabilisierung der Körpertemperatur im Sinne einer Damage-Control-Resuscitation-Strategie sowie eine Milz erhaltende operative Versorgung mittels Laparotomie. Es wird ein mögliches Therapieregime für das pädiatrische schwere Trauma mit Massentransfusion (MT) diskutiert.

Abstract

Primary resuscitation and therapeutic management of children with severe blunt abdominal trauma with accompanying acidosis, coagulopathy and hypothermia (lethal triad) necessitate an efficient multidisciplinary regimen to minimize mortality. A boy aged 5.5 years presented with severe abdominal trauma, including splenic rupture grade IV, hepatic rupture grade III, pancreatic laceration grade III, bilateral pulmonary contusions and abdominal wall contusion with rhabdomyolysis. He had been crushed between the rear wheel of a tractor and the frame of a gate at a mountain farm. Because severe trauma with coagulopathy and metabolic-respiratory acidosis were present, primary blood products were given instead of crystalloids. Permissive hypotension was tolerated, the body temperature was corrected in accordance with damage control resuscitation guidelines and spleen-preserving surgery was performed. This case report discusses a possible therapeutic strategy including massive transfusion in severe abdominal trauma in a child.

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Mayr, J., Lagreze, S. & Frech-Dörfler, M. Pädiatrisches stumpfes thorakoabdominales Trauma. Trauma Berufskrankh 14, 292–298 (2012). https://doi.org/10.1007/s10039-012-1917-2

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  • DOI: https://doi.org/10.1007/s10039-012-1917-2

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