Innerklinisches Traumamanagement – Diagnostik im Schockraum

Zusammenfassung

Die Ganzkörper-CT (syn. Traumascan, Polytraumaspirale) hat sich in den letzten Jahren als Goldstandard der allgemeinen Traumadiagnostik im Schockraum etabliert. Bislang existieren jedoch keine Leitlinien für ihre Indikation. Das Schockraumteam (Unfallchirurgie/Viszeralchirurgie, Anästhesie, Radiologie) sollte interdisziplinär unter Verwendung standardisierter Triagekriterien die Indikation zur Ganzkörper-CT stellen. Ihre individuelle Planung wird vom Radiologen an die klinischen und bildmorphologischen Befunde angepasst, ihre Durchführung ist im Schockraumalgorithmus zwischen Reanimations- und Versorgungsphase eingebettet. Eine schnelle Bildanalyse durch einen erfahrenen Radiologen (Facharztstandard) sowie die interdisziplinäre Befunddiskussion sind essenziell. Die zunehmende Bedeutung endovaskulärer minimalinvasiver Therapieansätze in der Versorgung aktiver Blutungen sowie lazerierter parenchymatöser Organe kann das Hinzuziehen eines interventionellen Radiologen als Teil des erweiterten Schockraumteams erforderlich machen. In einem modernem Schockraum sollten zusätzlich zum CT konventionelles Röntgen und Ultraschall zur Verfügung stehen, um auch einem konventionellem Algorithmus aus Sonografie, Projektionsradiografie und regionenspezifischer CT in der Diagnostik leichter Verletzter gerecht zu werden. Bei Kindern muss ein besonderes Augenmerk auf Strahlenschutz gelegt werden. Modalitäten ohne Strahlenexposition (Ultraschall, MRT) spielen hierbei eine große Rolle. Ziel muss sein, in der „golden hourofshock“ alle relevanten Traumafolgen unter Einhaltung strahlenhygienischer Aspekte (ALARA-Prinzip) und rechtlicher Vorgaben (rechtfertigende Indikation) rasch zu erkennen und zügig einen Therapieplan zu erstellen.

Abstract

Whole-body CT is considered gold standard for diagnosis of the multiple injured patient in the trauma suite. So far, no guidelines exist concerning its indication. The trauma team (Trauma Surgery/Visceral Surgery, Anaesthesiology, Radiology) should use standardized triage-criteria for the indication of whole-body CT. The radiologist is responsible for its individual planning, taking clinical and morphological imaging results into consideration, embedding its implementation between assessment and treatment stage. Fast image analysis by an experienced radiologist (specialist or at least 3 years professional experience) as well as interdisciplinary discussion of all findings is essential. The increased importance of endovascular minimally invasive therapy strategies in the treatment of active bleeding or laceration of solid organs may require the consultation of an interventional radiologist as part of the extended trauma team. In addition to CT, a modern trauma suite should be equipped with conventional x-rays and ultrasound in order to comply with a conventional algorithm consisting of sonography, plain film radiography and region specific CT for diagnosis of less severely injured patients. In children, specific attention must be paid to radiation protection. In these cases, modalities without radiation exposure (ultrasound, MRI) play a major role. Detecting all relevant injuries and evolving a therapy strategy in compliance with aspects of radiation protection (ALARA-principle) and legal guidelines (justifiying indication) during the 'golden hour of shock' should be the aim.

Schlüsselwörter:

Schockraumdiagnostik - Polytrauma - Ganzkörper CT - Schockraumtriage - pädiatrisches Polytrauma

Keywords:

trauma suite diagnostics - multiple injured patients - whole-body CT - trauma suite triage,pediatricpolytrauma

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