Notfallmedizin im alpinen Gelände – Schock-, Schmerztherapie und Atemwegssicherung

Zusammenfassung

Rettungseinsätze im alpinen Gelände stellen das Rettungsteam vor besondere Herausforderungen und unterscheiden sich oft wesentlich von urbanen Rettungseinsätzen. Angesichts der zunehmenden Sport- und Freizeitaktivitäten in den Bergen ist mit einer weiteren Zunahme von alpinen Notfällen zu rechnen. Nachfolgend wird auf spezielle Aspekte der alpinen Notfallmedizin wie die Therapie des hämorrhagischen Schocks, die Analgesie sowie das Atemwegsmanagement eingegangen.

Abstract

Rescue operations in mountain and remote areas pose special challenges for the rescue team and often differ substantially from rescue missions in the urban environment. Given the growing sports and leisure activities in mountains, incidence of alpine emergencies is expected to rise further. The following article describes the treatment of haemorrhagic shock, analgesic therapy and airway management in mountain rescue.

Kernaussagen

• Ein Unfall im alpinen Gelände kann das Rettungsteam vor besondere Herausforderungen stellen und unterscheidet sich oft wesentlich von urbanen Einsätzen.

• Eine „small volume resuscitation“ mit hypertonen Lösungen zur Therapie des hämorrhagischen Schocks bietet in der alpinen Notfallmedizin mehrere Vorteile.

• Beim hämorrhagischen Schock kann der Einsatz von Katecholaminen zusätzlich zur Volumentherapie sinnvoll sein.

• Systemisch verabreichte Opioide sowie Ketamin sind in der Therapie mittelstarker und starker Schmerzen in der alpinen Notfallmedizin sinnvoll. Die Anwendung einer Regionalanästhesie durch den geübten Anwender bietet für längere und technisch fordernde Einsätze Vorteile.

• Ketamin nimmt aufgrund seiner pharmakologischen Eigenschaften in der Analgesie und Narkoseeinleitung eine positive Sonderstellung ein.

• Die Möglichkeit, einen intubierten Patienten während eines terrestrischen Transports kontinuierlich zu ventilieren und monitorisieren, kann eingeschränkt sein. Die Indikation zur Notfallnarkose, Intubation und Beatmung sollte mit Berücksichtigung der Ressourcen, Transportdauer und -risiken zurückhaltend estellt werden.

Schlüsselwörter:

alpines Gelände - Atemwegsmanagement - Bergrettung - Schmerztherapie - Schock - Trauma

Key words:

airway management - analgesia - mountain area - mountain rescue - shock - trauma

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