Blutungen am Körperstamm - Wo abdrücken nicht hilft

Abstract:

Anders als bei Blutungen aus Extremitäten sind bei inneren und äußeren Blutungen des Körperstamms die Möglichkeiten von Druckverbänden oder der Kompression zuführender Gefäße sehr begrenzt. Hier sind andere Versorgungsstrategien notwendig.

Schlüsselwörter:

innere Blutungen - Höhlenblutung - Beckengurt - Beckenschlinge - Wundpacking - Druckverband - Hämostyptika

• Literatur

• 1 [Anonym] Battlefield Advanced Trauma Life Support (BATLS). J R Army Med Corps 2000; 146: 110-114
• 2 Raum M, Waydhas C. Präklinische Volumentherapie bei Trauma. Notf Rett Med 2009; 12: 188-192
• 3 Brohi K, Singh J, Heron M et al. Acute traumatic coagulopathy. J Trauma 2003; 54: 1127-1130
• 4 Martinowitz U, Michaelson M. Guidelines for the use of recombinant activated factor VII (rFVIIa) in uncontrolled bleeding: a report by the Israeli Multidisciplinary rFVIIa Task Force. J Thromb Haemost 2005; 3: 640-648
• 5 Shakur H, Roberts I, Bautista R et al. Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial. Lancet 2010; 376: 23-32
• 6 Roberts I, Perel P, Prieto-Merino D et al. Effect of tranexamic acid on mortality in patients with traumatic bleeding: prespecified analysis of data from randomised controlled trial. BMJ 2012; 345: e5839
• 7 Morrison JJ, Dubose JJ, Rasmussen TE et al. Military Application of Tranexamic Acid in Trauma Emergency Resuscitation (MATTERs) Study. Arch Surg 2012; 147: 113-119
• 8 Spahn DR, Bouillon B, Cerny V et al. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 2013; 17: R76
• 9 Schochl H, Maegele M, Solomon C et al. Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med 2012; 20: 15
• 10 Kluge S, Markewitz A, Jorch G et al. DIVI Jahrbuch 2015/2016. Berlin: MWV Medizinisch Wissenschaftliche Verlagsgesellschaft; 2016
• 11 Knops SP, Schep NW, Spoor CW et al. Comparison of three different pelvic circumferential compression devices: a biomechanical cadaver study. J Bone Joint Surg Am 2011; 93: 230-240
• 12 Scott I, Porter K, Laird C et al. The prehospital management of pelvic fractures: initial consensus statement. Emerg Med J 2013; 30: 1070-1072
• 13 Pehle B, Nast-Kolb D, Oberbeck R et al. [Significance of physical examination and radiography of the pelvis during treatment in the shock emergency room]. Unfallchirurg 2003; 106: 642-648
• 14 Fischer C, Josse F, Lampl L et al. „Stop the bleeding“! Neue Aspekte der Blutstillung aus dem zivilen und militärischen Bereich. Notfall Rettungsmed 2010; 13: 384-392
• 15 DGU. S3 – Leitlinie Polytrauma/ Schwerverletzten-Behandlung. AWMF Register Nr 012/019 2011
• 16 Granville-Chapman J, Jacobs N, Midwinter MJ. Pre-hospital haemostatic dressings: a systematic review. Injury 2011; 42: 447-459
• 17 Aranaz I, Mengibar M, Harris R et al. Functional characterization of chitin and chitosan. Curr Chem Biol 2009; 3: 203-230
• 18 Waibel KH, Haney B, Moore M et al. Safety of chitosan bandages in shellfish allergic patients. Mil Med 2011; 176: 1153-1156
• 19 Millner R, Lockhart AS, Marr R. Chitosan arrests bleeding in major hepatic injuries with clotting dysfunction: an in vivo experimental study in a model of hepatic injury in the presence of moderate systemic heparinisation. Ann R Coll Surg Engl 2010; 92: 559-561
• 20 Wedmore I, McManus JG, Pusateri AE et al. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma 2006; 60: 655-658
• 21 Muzzi L, Tommasino G, Tucci E et al. Successful use of a military haemostatic agent in patients undergoing extracorporeal circulatory assistance and delayed sternal closure. Interact Cardiovasc Thorac Surg 2012; 14: 695-698
• 22 Arul GS, Bowley DM, DiRusso S. The use of Celox gauze as an adjunct to pelvic Packing in otherwise uncontrollable pelvic haemorrhage secondary to penetrating trauma. J R Army Med Corps 2012; 158: 331-333 discussion 333-334
• 23 Littlejohn LF, Devlin JJ, Kircher SS et al. Comparison of Celox-A, ChitoFlex, WoundStat, and combat gauze hemostatic agents versus standard gauze dressing in control of hemorrhage in a swine model of penetrating trauma. Acad Emerg Med 2011; 18: 340-350
• 24 Rall JM, Cox JM, Songer AG et al. Comparison of novel hemostatic dressings with QuikClot combat gauze in a standardized swine model of uncontrolled hemorrhage. J Trauma Acute Care Surg 2013; 75: S150-156
• 25 Josse F, Helm M, Kulla M et al. Präklinische Blutstillungsmaßnahmen: Hämostyptika. Notarzt 2015; 31: 153-157
• 26 Josse F, Hossfeld B, Lampl L et al. Anwendung von Tourniquets zum Stoppen kritischer Extremitätenblutungen. Notfallmed up2date 2014; 9: 7-13