Manejo de pacientes con trauma múltiple
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The treatment of patients with severe and multiple traumatic injuries.
Neugebauer EA, Waydhas C, Lendemans S, Rixen D, Eikermann M, Pohlemann T. Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke, Germany. edmund.neugebauer@uni-wh.de Dtsch Arztebl Int. 2012 Feb;109(6):102-8. doi: 10.3238/arztebl.2012.0102. Epub 2012 Feb 10. Abstract BACKGROUND:The care of severely and multiply injured patients is an interdisciplinary challenge. The only existing German-language guideline up to now has been the S1-guideline issued in 2002 by the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU). In this article, we present a new, comprehensive, evidence and consensus based S3-guideline for the treatment of severely and multiply injured patients in the pre-hospital and early in-hospital phases which has been developed with the aim of structural and procedural quality optimization. Its implementation should lower these patients' mortality and improve their quality of life. METHODS: The guideline was developed by a panel consisting of 18 delegates from 11 specialty societies under the lead of the DGU, with designated coordinators for each of three phases of treatment: the pre-hospital phase, the emergency-room phase, and the emergency surgery phase. The key questions to be answered were determined by vote, and then the relevant literature (in English and German, 1995-2010) was systematically searched and evaluated. Key recommendations with explanatory texts were formulated and agreed upon in a nominal group process (NGP) with five consensus conferences and three further Delphi rounds. RESULTS:264 recommendations were issued: 66 for the pre-hospital phase, 102 for the emergency-room phase, and 96 for the emergency surgery phase. The three phases were subcategorized according to organizational and anatomical considerations. Topics of major emphasis were, in the pre-hospital phase, the establishment and implementation of correct priorities for treatment; in the emergency-room phase, the creation of clear structures and processes; and, in the emergency surgery phase, the avoidance of secondary injury (i.e., the principle of damage control). CONCLUSION: This guideline can only improve outcomes if it is implemented in routine practice. Aside from the guideline itself, the DGU trauma network (www.dgu-traumanetzwerk.de) has issued a set of directions as an aid to its implementation. |
ATLS (R) y control de daños en trauma de columna
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ATLS(R) and damage control in spine trauma.
Schmidt OI, Gahr RH, Gosse A, Heyde CE. Leipzig University, Department of Orthopaedic Surgery, Spine Unit, Liebigstrasse 20, 04103 Leipzig, Germany. christoph-eckhard.heyde@medizin.uni-leipzig.de. World J Emerg Surg. 2009 Mar 3;4:9. doi: 10.1186/1749-7922-4-9. Abstract Substantial inflammatory disturbances following major trauma have been found throughout the posttraumatic course of polytraumatized patients, which was confirmed in experimental models of trauma and in vitro settings. As a consequence, the principle of damage control surgery (DCS) has developed over the last two decades and has been successfully introduced in the treatment of severely injured patients. The aim of damage controlsurgery and orthopaedics (DCO) is to limit additional iatrogenic trauma in the vulnerable phase following major injury. Considering traumatic brain and acute lung injury, implants for quick stabilization like external fixators as well as decided surgical approaches with minimized potential for additional surgery-related impairment of the patient's immunologic state have been developed and used widely. It is obvious, that a similar approach should be undertaken in the case of spinal trauma in the polytraumatized patient. Yet, few data on damage control spine surgery are published to so far, controlled trials are missing and spinal injury is addressed only secondarily in the broadly used ATLS(R) polytrauma algorithm. This article reviews the literature on spine trauma assessment and treatment in the polytrauma setting, gives hints on how to assess the spine trauma patient regarding to the ATLS(R) protocol and recommendations on therapeutic strategies in spinal injury in the polytraumatized patient. |
Control de daños en el paciente lesionado
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Damage control in the injured patient.
Hsu JM, Pham TN.
Int J Crit Illn Inj Sci [serial online] 2011 [cited 2013 Oct 23];1:66-72.
Abstract
The damage control concept is an essential component in the management of severely injured patients. The principles in sequence are as follows: (1) abbreviated surgical procedures limited to haemorrhage and contamination control; (2) correction of physiological derangements; (3) definitive surgical procedures. Although originally described in the management of major abdominal injuries, the concept has been extended to include thoracic, vascular, orthopedic, and neurosurgical procedures, as well as anesthesia and resuscitative strategies.
Keywords: Damage control, management, principles, surgery, trauma
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