Hussmann Bjoern, Lendemans Sven
Department of Trauma Surgery, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Department of Trauma Surgery, University Hospital Essen, Hufelandstr. 55, D-45122 Essen, Germany.
Injury. 2014 Oct;45 Suppl 3:S39-42. doi: 10.1016/j.injury.2014.08.016.
The pre-hospital and early in-hospital management of most severely injured patients has dramatically changed over the last 20 years. In this context, the factor time has gained more and more attention, particularly in German-speaking countries. While the management in the early 1990s aimed at comprehensive and complete therapy at the accident site, the premise today is to stabilise trauma patients at the accident site and transfer them into the hospital rapidly. In addition, the introduction of training and education programmes such as Pre-hospital Trauma Life Support (PHTLS(®)), Advanced Trauma Life Support (ATLS(®)) concept or the TEAM(®) concept has increased the quality of treatment of most severely injured trauma patients both in the preclinical field and in the emergency trauma room. Today, all emergency surgical procedures in severely injured patients are generally performed in accordance with the Damage Control Orthopaedics (DCO) principle. The advancements described in this article provide examples for the improved quality of the management of severely injured patients in the preclinical field and during the initial in-hospital treatment phase. The implementation of trauma networks, the release of the S3 polytrauma guidelines, and the DGU "Weißbuch" have contributed to a more structured management of most severely injured patients.
在过去20年里，大多数重伤患者的院前和早期院内管理发生了巨大变化。在这种背景下，时间因素越来越受到关注，尤其是在德语国家。20世纪90年代初的管理目标是在事故现场进行全面彻底的治疗，而如今的前提是在事故现场稳定创伤患者并迅速将其转运至医院。此外，诸如院前创伤生命支持（PHTLS(®)）、高级创伤生命支持（ATLS(®)）概念或TEAM(®)概念等培训和教育项目的引入，提高了重伤创伤患者在临床前领域和急诊创伤室的治疗质量。如今，重伤患者的所有急诊外科手术一般都按照损伤控制骨科（DCO）原则进行。本文所述的进展为临床前领域和初始院内治疗阶段重伤患者管理质量的提高提供了实例。创伤网络的实施、S3多发伤指南的发布以及德国创伤外科学会（DGU）的“白皮书”有助于对大多数重伤患者进行更有条理的管理。
