[Polytrauma Management - Treatment of Severely Injured Patients in ER and OR]. / Polytraumamanagement ­ Behandlung des Schwerverletzten in Schockraum und OP.

The adequate treatment of severely injured patients is challenging and can only be successfully executed when it starts at the accident site and is continued in all treatment phases including the early rehabilitation phase. Treatment should be performed by an interdisciplinary team guided by a trauma surgeon in order to adequately manage the severe injuries some of which are life-threatening. Treatment of polytrauma patients is a key task of certified trauma centers and must follow standardized guidelines. For a successful therapy of severely injured patients lifetime training at regular intervals in well-established polytrauma concepts is a mandatory requirement.

[Burns and scalds in children]. / Verbrennungen und Verbrühungen im Kindesalter.

BACKGROUND: Since pediatric emergencies and burn injuries are rare in prehospital emergency medicine, emergency teams can hardly develop routine in emergency care. OBJECTIVES: How to effectively treat burn injuries and avoid common errors? MATERIALS AND METHODS: A simple and severity-based therapy concept based on the current literature using the example of a case report is presented. RESULTS: About 80% of burns and scalds in children are not severe cases-in these patients an effective analgesia by intranasal administration is important and further invasive treatments are generally not necessary. The emergency care of children with severe burn injuries should start with intranasally administered analgesia and/or sedation. After an intravenous or intraosseous access is gained, moderate fluid therapy is started, which should be complemented by a fluid bolus only if signs of a shock are present. Additional administration of analgesia and/or sedation may be necessary. Estimation of the burned body surface area is best determined with the palm rule; the severity of the burn appears after a latency period. Induction of anesthesia and intubation are not required in the majority of cases. CONCLUSIONS: By applying a modified ABCDE scheme, all emergency teams can provide effective emergency care in children with burn injuries.

[Shotgun injuries--epidemiological and clinical aspects]. / Obrazenia ciala w nastepstwie postrzalów--aspekty epidemiologiczne i kliniczne.

Shotgun injuries constitute an increasing surgical problem as they frequently lead to severe trauma disease and even to death. These injuries are mainly diagnosed in young people and are localized in limbs. Human life is in danger in case of shotgun injuries of the head (CNS), abdominal and thoracic cavities. Prognosis is worse in multiple shotgun lesions. The dominating cause of death in shotgun victims is hemorrhagic shock. Patient's life is potentially in a real danger and necessitates precise diagnostic and therapeutic management in the early stages following shotgun trauma, in the operating room and in the postoperative phase.

[Pre-clinical management of shock patients]. / Präklinische Versorgung des Patienten mit Schock.

The preclinical diagnosis of shock is still based on the patient's history, the physical examination, the injury pattern and a few hemodynamic parameters available in the emergency set-up. The clinical picture is characterised by hypotension and tachycardia, tachypnoe and dyspnoea as well as cerebral impairment. Results from recent clinical trials indicate, that a adapted and specific therapeutic approach for the various shock forms is necessary. In case of traumatic hypovolemic-hemorrhagic shock it is of particular relevance if penetrating trauma and/or uncontrolled bleeding exists. Under these conditions an immediate definite surgical treatment is required ("scoop and run") and a moderate hypotension should be tolerated. ("treat and run"). Fluid substitution and therapy with catecholamines should be used conservatively. In all other forms of shock the treatment approach can and should be more aggressive in order to improve microvascular perfusion as early as possible. Besides adequate fluid resuscitation in a combination of crystalloid and colloid solutions catecholamines and-under specific circumstances-also vasopressin should be used. Of utmost importance in the pre-clinical management of patients in shock is the optimal selection of the centre that the patient is referred to in order to establish the fastest and best possible definite treatment for the patient.

[The treatment procedure in victims with combined and multiple craniocerebral injuries]. / Likuval'na taktika u poterpilykh z poiednanymy ta chyslennymy cherepno-mozkovymy travmamy.

The experience of estimation of the state and the results of treatment of 300 patients with the combined craniocerebral trauma (CCT) is summarized. The injured persons with severe CCT and severe outcranial injuries were included in the 1st group, with severe CCT and nonsevere outcranial injuries--in the 2nd group, with nonsevere CCT and severe outcranial injuries--in the 3d group, with nonsevere CCT and nonsevere outcranial injuries--in the 4th group. The dominating, competing and accompanying injuries, determining the surgical treatment tactics, were marked out in every group. The differentiative therapy general principles were marked out.

[An algorithm for management of shock in polytrauma]. / Algorithmus für das Schockraummanagement beim Polytrauma.

The initial management of patients with multiple trauma requires a well-defined plan of action for immediate and adequate therapy, that ensures fast recognition of life-threatening conditions and injuries. While treatment protocols for specific situations and injuries are fairly well defined, there are few such concepts for the overall management process. Therefore, we designed a comprehensive algorithm for in-hospital trauma care to give priority-based guidelines to the trauma room physician. The full management plan (diagnostic and therapeutic interventions in sequence) is implemented in seven flow charts. The first algorithm starts with the initial assessment of immediate life-threatening disorders of A (airways), B (breathing) and C (circulation) and is followed by the early stabilization and maintenance of vital functions. It is followed by six interrelated flow charts, based on disturbed physiological functions (respiration, circulation) and anatomical injuries (thorax, abdomen, head/brain, spine/pelvic girdle/extremities), which are worked up simultaneously and repeatedly. This algorithm is not only intended as an overall guideline for use the management of severely injured patients, but is also indispensable for quality assurance.

Forecasting of the course and outcome of shock in severe mechanical traumas.

The ability to forecast the course and outcome of severe mechanical trauma would aid clinicians in making decisions concerning the treatment of patients. Multifactorial regression models, developed from data obtained from 933 patients with polytrauma and shock, have a high predictive value. A two-part data sheet was developed to give a rating system that predicts the duration of shock in patients that survive and the life span in patients that eventually die. Factors considered in developing the rating system include systemic hemodynamics, hematocrit number, blood density, arteriovenous difference in oxygen saturation, and rectocutaneous temperature gradient, among others.

[Theoretical and practical aspects of the concept of traumatic disease]. / Teoreticheskie i prakticheskie aspekty kontseptsii travmaticheskoi bolezni.

The authors consider that the conception of "trauma disease" from the standpoint of practical medicine is of significance only for critical mainly associated injuries followed by acute alterations of vitally important functions. The basis of cause--effect relations forming the trauma disease as a nosological unit is the interrelationship of such pathogenetic factors as blood loss, respiratory and primary circulatory hypoxia, alteration of the central mechanisms of the regulation system, synchronous pathological impulsation from multiple foci of the injuries, hypodynamia and early endotoxicosis. The basis of treatment of the trauma disease is the early (within the first two days) elimination of these factors, performed by surgical measures and methods of pathogenetic intensive therapy.

[Various nosologic aspects of traumatic disease]. / Nekotorye nozologicheskie aspekty travmaticheskoi bolezni.

Trauma disease (TD) is a nosological unit which should be mentioned in diagnosis under the heading of combined main disease at the second place after trauma as a complex of local injuries. It has specific etiology, pathogenesis, semiotics and pathomorphology. Syndromes of insufficiency of different organs and systems are included in the typical plan of the TD course and should be considered as its manifestations. They characterize specificity of TD in the given patient and should be taken into consideration in developing a clinical classification.