[Omitted spinal X-ray examination after a fall from a height of 3 m]. / Keine Röntgenuntersuchung der Wirbelsäule nach Sturz aus 3 m Höhe.

A 59-year-old patient with right-sided chest pains after a fall from a height of 3 m was referred to hospital by an emergency physician. The chest x-rays showed fractures of the third and seventh ribs on the right side. Inpatient analgesic therapy was initiated and after 3 days the patient was discharged from hospital for further outpatient treatment. As the pain persisted the patient consulted a surgeon 5 weeks later and the first X-ray examination of the spine was carried out which revealed the formation of several wedge-shaped thoracolumbar vertebral bodies. Further magnetic resonance imaging (MRI) diagnostics also revealed alterations to T10, T12, L1 and L3 as well as radiological signs of Scheuermann's disease; however, a definite statement differentiating these findings from older spinal fractures as a result of the accident was no longer possible. The patient claimed that the hospital failed to perform spinal X-ray investigations leading to prolonged pain and limitations in the quality of life. An external expert stated that the distracting injury of the ribs and the pain medication might have veiled the additional vertebral fractures. Thus, an earlier diagnosis of the apparently stable vertebral fractures would not have changed the conservative therapy approach. The decision of the arbitration board differed from the expert opinion as additional imaging techniques of the spine should have been initially performed due to the mechanism of injury. Although no irreversible damage to health resulted an earlier targeted treatment could have reduced the overall length of therapy.

[Cardiac post-resuscitation care. An indication for trauma whole-body CT?]. / Zustand nach Reanimation. Eine Indikation für die "Traumaspirale"?

We report the case of a 51-year-old male patient who sustained a liver rupture following mechanical cardiopulmonary resuscitation (CPR) with the LUCAS® system. The patient was under anticoagulation and developed an abdominal compartment syndrome. Although the use of mechanical CPR devices, such as the LUCAS® system and the load distributing band (Autopulse®), is becoming more common, there are specific complications described in the literature, which are associated with mechanical CPR. It is important to differentiate between general complications associated with CPR and those which can be attributed to the application of mechanical CPR devices. Using the example of the presented case, this article outlines and discusses these points based on the currently available literature. It should also be noted that mechanical CPR can act in a similar way to chest trauma and can necessitate an investigation with contrast enhanced computed tomography.