Achatz Gerhard, Franke Axel, Friemert Benedikt, Hoth Patrick, Hube Philipp, Bieler Dan
Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive und Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
Zentrales Klinisches Management, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland.
Unfallchirurgie (Heidelb). 2024 Jul;127(7):500-508. doi: 10.1007/s00113-024-01443-z. Epub 2024 Jun 12.
Current political and social developments have brought the topics of violence, in this context attributable to terrorism and sabotage, and since February 2022 awareness of war in particular has again greatly increased. This article aims to present the contextualized dealing with penetrating injuries in terms of initial in-hospital treatment.
The question remains to be answered as to what extent penetrating injuries require special attention and to what extent the treatment priorities, options and strategies as well as surgical treatment require adaptation of the usual approach in routine clinical practice in Germany.
The experience of the authors in this field from military operations in Afghanistan, Iraq, the Republic of Mali, Kosovo and Georgia as well as the core content of the Terror and Disaster Surgical Care (TDSC®) course on this topic, have been contextualized and incorporated. In addition, aspects of a comprehensive systematic literature review and current data from a national evaluation on the topic of preparing hospitals in Germany for such scenarios are taken into account.
The clinical systems need to be well-prepared for such casualties, especially if they require treatment in large numbers. This is precisely so because the majority of patients are in a relevantly threatening situation (usually in the sense of a hemorrhage), treatment must be very urgently provided and in such scenarios a lack of resources must always be overcome, at least temporarily, especially for example for blood transfusions.
当前的政治和社会发展使暴力问题成为焦点，在这种背景下，暴力主要归因于恐怖主义和破坏活动，自2022年2月以来，人们对战争的认知尤其再次大幅提高。本文旨在从医院初始治疗的角度介绍穿透伤的情境化处理。
穿透伤在何种程度上需要特别关注，以及在德国常规临床实践中，治疗优先级、选择和策略以及手术治疗在何种程度上需要调整常规方法，这些问题仍有待回答。
作者在阿富汗、伊拉克、马里共和国、科索沃和格鲁吉亚的军事行动中在该领域的经验，以及关于这一主题的恐怖与灾难外科护理（TDSC®）课程的核心内容，都已进行情境化并纳入其中。此外，还考虑了全面系统文献综述的各个方面以及德国关于医院应对此类情况准备工作的全国性评估的当前数据。
临床系统需要为这类伤员做好充分准备，特别是如果需要大量治疗时。之所以如此，正是因为大多数患者处于相关威胁状况（通常是出血的情况），必须非常紧急地进行治疗，而且在这种情况下，必须始终克服资源短缺问题，至少是暂时克服，例如输血方面的资源短缺。
