Die kritischen Blutungen nach Trauma im Notarztdienst

 

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Zusammenfassung

Als „kritisch“ werden Blutungen bezeichnet, die für den Traumapatienten akut vital bedrohlich sind. Entsprechende Einsatzsituationen haben in der prähospitalen Notfallversorgung zwar eine geringe Inzidenz, gehen jedoch mit einer sehr hohen Letalität einher. Ein nicht unerheblicher Teil hämorrhagisch bedingter Todesfälle scheint durch den Einsatz geeigneter Algorithmen und vor allem durch Training in der Anwendung von Tourniquets, Beckenschlingen und Hämostyptika vermeidbar zu sein. Die reine Vorhaltung dieser Materialien ohne Schulung des Personals reicht jedoch nicht aus. Notarzt und rettungsdienstliches Fachpersonal müssen den Gebrauch dieser Hilfsmittel im Verbund mit Kompression (z. B. Druckverband) und Frakturschienung üben. Der prähospitale Einsatz systemischer Antifibrinolytika (z. B. Tranexamsäure) ist inzwischen Teil einer europäischen Leitlinie.

Abstract

Critical bleeding is a potential life-threatening factor for the severely injured patient. On one side the critical bleeding has a low incidence in the civilian setting, but is on the other side associated with a high lethality. A relevant proportion of early deaths caused by critical bleeding may be prevented, if all health care providers are trained in the use of tourniquets, pelvic binders and hemostyptic dressings. But procurement of this material and devices is not enough. Firstly the rescue-team has to be familiarized with the different devices; secondly the application must be trained in the context of the out-of-hospital treatment of severely injured patients as a whole. It is important to emphasize that these new options should be seen as an additional option to the classic measures such as compression bandage, or splinting of fractures. In addition to these local measurements to stop the critical bleeding, systemic use of tranexamic acid is part of an European guideline.

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