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Akutmanagement des schweren Beckentraumas

Emergency management of severe pelvic trauma

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Zusammenfassung

Schwere Beckentraumata sind selten und mit einer hohen Mortalität verbunden. Dies stellt die behandelnden Ärzte selbst in Traumazentren vor große Herausforderungen. In der Akutphase steht die Behandlung von Blutungen im Vordergrund. Präklinisch muss die Beckenverletzung zunächst erkannt werden. Stehen andere Verletzungen im Vordergrund, werden sie leicht übersehen. Die Stabilität des Beckenrings muss bei entsprechendem Unfallmechanismus in jedem Fall untersucht werden. Der rasche und zielgerichtete Transport in ein Schwerpunktkrankenhaus unter entsprechender Schockbekämpfung kann lebensrettend sein. In der frühen klinischen Phase helfen abgestimmte Algorithmen, Verzögerungen und Fehler in Diagnostik und Therapie zu vermeiden. Wichtige Elemente der Behandlung stellen eine angemessene Schockbekämpfung, eine externe Stabilisierung des Beckenrings mit Beckengurt, Beckenzwinge oder Fixateur externe sowie eine gezielte Blutstillung entweder interventionell durch intraarterielle Embolisation oder operativ durch Tamponade („pelvic packing“) dar.

Abstract

Severe pelvic injuries are infrequent, but mortality is high. Therefore, even in trauma centers a critical level of experience to successfully manage these patients may not exist. Control of pelvic bleeding is paramount in the acute management. In the prehospital phase, it is essential to be aware of pelvic trauma even in the presence of more obvious concomitant injuries. After high energy trauma a short clinical examination including the assessment of pelvic stability is mandatory. Immediate transport under maximum shock therapy to a trauma center experienced in the management of severe pelvic trauma may save the patients life. Clinical management should be performed according to algorithms in order to avoid mistakes and delays. This includes adequate shock therapy, external stabilization of the pelvic ring (external fixation, C-clamp, pelvic sheet) and hemostasis either interventionally by arterial embolization or surgically by pelvic packing.

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Authors and Affiliations

  1. Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich

    D. Krappinger MD PhD & M. Blauth

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  1. D. Krappinger MD PhD
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  2. M. Blauth
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Correspondence to D. Krappinger MD PhD.

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Krappinger, D., Blauth, M. Akutmanagement des schweren Beckentraumas. Notfall Rettungsmed 11, 393–398 (2008). https://doi.org/10.1007/s10049-008-1086-9

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