Schnoor J, Reindl M, Wein B B, Petersen P F, Erli H
Klinik für Anästhesiologie, Universitätsklinikum, Pauwelsstrasse 30, 52074 Aachen.
Unfallchirurg. 2006 Sep;109(9):797-800. doi: 10.1007/s00113-006-1107-4.
Priorities in the diagnosis and treatment of a multiple trauma with injuries to the thorax and pelvis are usually determined by the pattern and the severity of the injury sustained. In this case a haemodynamically unstable patient with severest pelvic trauma and a moderate thoracic trauma developed progressive haemodynamic instability during an intervention to the pelvis, resulting in a lethal outcome for the patient. The cause only became obvious when computed tomography of the thorax (CTT) was performed which was able to demonstrate venous pulmonary bleeding compressing the left atrium. In haemodynamically unstable patients with a major pelvic trauma combined with a moderate thoracic trauma, early CTT should therefore be a main priority in the initial management of such patients in the resuscitation room. The time spent on such a diagnostic procedure seems to be worth the information gained, which can significantly influence the initial choices and priorities in treatment.
胸部和骨盆损伤的多发伤患者的诊断和治疗优先级通常由所受损伤的类型和严重程度决定。在该病例中，一名血流动力学不稳定的患者，骨盆创伤严重，胸部创伤中度，在骨盆干预过程中出现了进行性血流动力学不稳定，导致患者死亡。只有在进行胸部计算机断层扫描（CTT）时，病因才变得明显，CTT能够显示静脉性肺出血压迫左心房。因此，对于血流动力学不稳定且伴有严重骨盆创伤和中度胸部创伤的患者，早期CTT应是复苏室对此类患者进行初始管理的主要优先事项。花在这种诊断程序上的时间似乎值得所获得的信息，这些信息可以显著影响治疗的初始选择和优先级。
