Aktive Blutungen im Kopf- und Halsbereich sind nicht selten ein Grund, den Rettungsdienst
zu alarmieren, und können für Rettungskräfte herausfordernd sein. In diesem Artikel
soll es um die
häufigsten Blutungen in der HNO-Heilkunde gehen, die einer notfallmedizinischen Behandlung
bedürfen, und die adäquaten präklinischen Maßnahmen bis zum erfolgreichen Transport
in die
Klinik.
Abstract
Hemorrhagic events in the head and neck area are a common incident when an ambulance
is needed and are often challenging for the rescue team. This article illustrates
the most common causes
of hemorrhagic events, starting with prehospital medical attention leading to the
successful transport to a specialized clinic.
Massive bleedings that might need the urgent attention of an emergency physician and
occur in the field of otorhinolaryngology are mostly caused by epistaxis, secondary
bleeding after
adenotonsillary surgery and erosive bleeding caused by cancerous lesions of the pharynx.
All those hemorrhagic events have two urgent life-threatening events in common: the
potentially hypovolemic event and the threat of aspiration of a larger amount of blood,
that leads to
airway obstruction and asphyxia.
In the treatment of patients with hemorrhagic events the upper body elevation of the
patient is essential. To estimate the amount of blood loss it is recommended to collect
the bleeding in
a kidney dish. Large i.v. lines should be placed immediately, as well as the continuous
monitoring of vital parameters, controlling an elevated blood pressure by i.v. medication
should be
considered.
To control the bleeding, it is necessary to apply compression, for example with a
swab or specialized tool like a nasal packing device; also drug administered bleeding
control like
tranexamic acid is an option. To prevent aspiration a protective intubation might
be needed, with the surgical airway as ultima ratio.
Schlüsselwörter
Epistaxis - Tumorarrosion - Magill-Zange - Nachblutungen - Tonsillen - pharynx bleeding
Keywords
epistaxis - hemorrhagic event - erosive bleeding
