Schussverletzungen – Diagnostik und Therapie in der Präklinik

Falk von Lübken; Thorsten Holsträter; Hans-Georg Palm; Torsten Andres; Hans-Joachim Riesner; Benedikt Friemert; aus der AG Einsatz-, Katastrophen- und Taktische Chirurgie der Deutschen Gesellschaft für Unfallchirurgie

doi:10.1055/s-0043-119445

retten!, Inhaltsverzeichnis

retten! 2017; 6(05): 408-420
DOI: 10.1055/s-0043-119445

Fachwissen

Schussverletzungen – Diagnostik und Therapie in der Präklinik

Falk von Lübken

,

Thorsten Holsträter

,

Hans-Georg Palm

,

Torsten Andres

,

Hans-Joachim Riesner

,

Benedikt Friemert

,

aus der AG Einsatz-, Katastrophen- und Taktische Chirurgie der Deutschen Gesellschaft für Unfallchirurgie

Abstract

Alle Artikel dieser Rubrik

In der Notfallmedizin tätige Ärzte in Deutschland haben, verglichen mit den USA, nur relativ geringe Erfahrungen mit Schussverletzungen. Dieser Beitrag vermittelt Basiswissen über die verschiedenen Schusswaffen und die damit hervorgerufenen unterschiedlichen Verletzungen, um bereits präklinisch eine gezielte Diagnostik und erste therapeutische Schritte einleiten zu können.

Volltext

Referenzen

Literatur
1 US Centers for Disease Control & Prevention (CDC). Web-Based Injury Statistics Query & Reporting System (WISQARS). Atlanta: Nonfatal Injury Reports; 2016
2 Stefanopoulos PK, Pinialidis DE, Hadjigeorgiou GF. et al. Wound ballistics 101: the mechanisms of soft tissue wounding by bullets. Eur J Trauma Emerg Surg 2015;
3 Coupland R. Clinical and legal significance of fragmentation of bullets in relation to size of wounds: retrospective analysis. BMJ 1999; 319: 403-406
4 Fackler ML, Dougherty PJ. Theodor Kocher and the scientific foundation of wound ballistics. Surg Gynecol Obstet 1991; 172: 153-160
5 von See C, Stuehmer A, Gellrich NC. et al. Wound ballistics of injuries caused by handguns with different types of projectiles. Mil Med 2009; 174: 757-761
6 Hauer T, Huschitt N, Kulla M. et al. Bullet and shrapnel injuries in the face and neck regions. Current aspects of wound ballistics. HNO 2011; 59: 752-764
7 Fackler ML. Gunshot wound review. Ann Emerg Med 1996; 28: 194-203
8 Kneubuehl B. Wound Ballistics: Basics and Applications. Translation of the 3rd german edition. Berlin: Springer; 2011
9 Breeze J, Sedman AJ, James GR. et al. Determining the wounding effects of ballistic projectiles to inform future injury models: a systematic review. J R Army Med Corps 2014; 160: 273-278
10 Payne LD. Military wound ballistics: history and renaissance. J R Army Med Corps 2013; 159: 256-258
11 Riddez L. Wounds of war in the civilian sector: principles of treatment and pitfalls to avoid. Eur J Trauma Emerg Surg 2014; 40: 461-468
12 Bluman EM, Ficke JR, Covey DC. War wounds of the foot and ankle: causes, characteristics, and initial management. Foot Ankle Clin 2010; 15: 1-21
13 Giannou C, Baldan M. War Surgery: Working with limited Resources in armed Conflict and other Situations of Violence. Vol. 1. Geneva: ICRC; 2010
14 Albreht M, Scepanovic D, Ceramilac A. et al. Experimental soft tissue wounds caused by standard military rifles. Acta Chir Scand Suppl 1979; 489: 185-198
15 Fackler ML, Bellamy RF, Malinowski JA. A reconsideration of the wounding mechanism of very high velocity projectiles – importance of projectile shape. J Trauma 1988; 28: S63-S67
16 King KF. Orthopaedic aspects of war wounds in South Vietnam. J Bone Joint Surg Br 1969; 51: 112-117
17 Suneson A, Hansson HA, Seeman T. Pressure wave injuries to the nervous system caused by high-energy missile extremity impact: Part II. Distant effects on the central nervous system – a light and electron microscopic study on pigs. J Trauma 1990; 30: 295-306
18 Weinstein J, Putney E, Egol K. Low velocity gunshot wounds result in significant contamination regardless of ballistic characteristics. Am J Orthop (Belle Mead NJ) 2014; 43: E14-E18
19 Hopkinson DA, Marshall TK. Firearm injuries. Br J Surg 1967; 54: 344-353
20 Dickey RL, Barnes BC, Kearns RJ. et al. Efficacy of antibiotics in low-velocity gunshot fractures. J Orthop Trauma 1989; 3: 6-10
21 Woloszyn JT, Uitvlugt GM, Castle ME. Management of civilian gunshot fractures of the extremities. Clin Orthop Relat Res 1988; 226: 247-251
22 Wright DG, Levin JS, Esterhai JL. et al. Immediate internal fixation of low-velocity gunshot-related femoral fractures. J Trauma 1993; 35: 678-681
23 Kobbe P, Frink M, Oberbeck R. et al. Treatment strategies for gunshot wounds of the extremities. Unfallchirurg 2008; 111: 247-254
24 NAEMT. American College of Surgeons Committee on Trauma. PHTLS Prehospital Trauma Life Support: military Edition. 7th ed. Burlington: Jones & Bartlett Learning; 2010
25 Hodgetts TJ, Mahoney PF, Russell MQ. et al. ABC to <C>ABC: redefining the military trauma paradigm. Emerg Med J 2006; 23: 745-746
26 Deutsche Gesellschaft für Unfallchirurgie. S3-Leitlinie Polytrauma-/Schwerverletzten-Behandlung 2016. Im Internet: http://www.awmf.org/leitlinien/detail/ll/012-019.html Stand: 15.05.2017
27 Kue RC, Temin ES, Weiner SG. et al. Tourniquet use in a civilian emergency medical services setting: a descriptive analysis of the Boston EMS Experience. Prehosp Emerg Care 2015; 19: 399-404
28 Scerbo MH, Mumm JP, Gates K. et al. Safety and appropriateness of tourniquets in 105 civilians. Prehosp Emerg Care 2016; 20: 712-722
29 McEwen JA, Kelly DL, Jardanowski T. et al. Tourniquet safety in lower leg applications. Orthopaedic Nursing 2002; 21: 55-62
30 Swan Jr KG, Wright DS, Barbagiovanni SS. et al. Tourniquets revisited. J Trauma 2009; 66: 672-675
31 Josse F, Helm M, Kulla M. et al. Präklinische Blutstillungsmaßnahmen: Hämostyptika. Notarzt 2015; 31: 153-157
32 Lechner R, Helm M, Mueller M. et al. Efficacy of hemostatic agents in humans with rotational thromboelastometry: an invitro study. Mil Med 2016; 181: 907-912
33 Travers S, Lefort H, Ramdani E. et al. Hemostatic dressings in civil prehospital practice: 30 uses of QuikClot Combat Gauze. Eur J Emerg Med 2016; 23: 391-394
34 Gegel BT, Austin PN, Johnson AD. An evidence-based review of the use of a combat gauze (QuikClot) for hemorrhage control. AANA J 2013; 81: 453-458
35 Bieler D, Franke AF, Hentsch S. et al. Gunshot and stab wounds in Germany – epidemiology and outcome: analysis from the TraumaRegister DGU®. Unfallchirurg 2014; 117: 995-1004
36 Bretschneider I, Hossfeld B, Helm M. et al. Präklinisches Atemwegsmanagement beim Erwachsenen. Notarzt 2011; 27: 270-286
37 Schubl SD, Robitsek RJ, Sommerhalder C. et al. Cervical spine immobilization may be of value following firearm injury to the head and neck. Am J Emerg Med 2016; 34: 726-729
38 Clemency BM, Tanski CT, Rosenberg M. et al. Sufficient catheter length for pneumothorax needle decompression: a metaanalysis. Prehosp Disaster Med 2015; 30: 249-253
39 Helm M, Hossfeld B, Schlechtriemen T. et al. Use of intraosseus infusion in the German air rescue service: nationwide analysis in the time period 2005 to 2009. Anaesthesist 2011; 60: 1119-1125
40 Harris T, Thomas GO, Brohi K. Early fluid resuscitation in severe trauma. BMJ 2012; 345: e5752
41 Hasler RM, Nuesch E, Juni P. et al. Systolic blood pressure below 110 mmHg is associated with increased mortality in penetrating major trauma patients: multicentre cohort study. Resuscitation 2011; 83: 476-481