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NOTARZT 2017; 33(03): 120-131
DOI: 10.1055/s-0043-108968
CME-Fortbildung
Georg Thieme Verlag KG Stuttgart · New York

Schussverletzungen – Diagnostik und Therapie in der Präklinik

Gunshot Wounds – Preclinical Diagnostics and Therapy
Falk von Lübken
1    Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive/Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm
,
Thorsten Holsträter
2   Klinik für Anästhesiologie und Intensivmedizin, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm
,
Hans-Georg Palm
1    Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive/Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm
,
Torsten Andres
1    Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive/Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm
,
Hans-Joachim Riesner
1    Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive/Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm
,
Benedikt Friemert
1    Klinik für Unfallchirurgie und Orthopädie, Rekonstruktive/Septische Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081 Ulm
,
aus der AG Einsatz-, Katastrophen- und Taktische Chirurgie der Deutschen Gesellschaft für Unfallchirurgie › Author Affiliations
Further Information

Publication History

Publication Date:
22 June 2017 (online)

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Zusammenfassung

In der Notfallmedizin tätige Ärzte in Deutschland haben, verglichen mit den USA, nur relativ geringe Erfahrungen mit Schussverletzungen. Dieser Beitrag vermittelt Basiswissen über die verschiedenen Schusswaffen und die damit hervorgerufenen unterschiedlichen Verletzungen, um bereits präklinisch eine gezielte Diagnostik und erste therapeutische Schritte einleiten zu können.

Abstract

In spite of the gunshot rampages in Germany in the recent years, gunshot wounds are rare in Germany and cannot be compared to the high number of nonfatal gunshot wounds in the United States of America.
To understand the injury caused by bullets hitting a human body some facts about wound ballistics have to be known. The grade of injury depends on the bullet properties as well as the properties of the hidden tissue. The higher the amount of energy the bullet is transferring to the body, the higher is the damage caused in the human tissue. All gunshot wounds are contaminated. But even though this is a well-known fact, there is no consensus about the surgical treatment in literature. While most authors recommend a debridement and an antibiotic therapy, in some areas of the world uncomplicated gunshot wounds are treated with sterile wound dressing and a single shot of antibiotics.
In a preclinical setting the main goal to go for with gunshot wounds is to stop the bleeding. In recent years the tourniquet became a routine tool in the preclinical stage to achieve this. New haemostyptic wound dressings show promising results in the treatment of bleeding wounds as well, even though there are still some unanswered questions. Beside that the preclinical treatment should follow the military-modified PHTLS algorithm.

Kernaussagen

  • Schusswunden, verursacht durch Faustfeuerwaffen wie Pistolen und Revolver, erzeugen häufiger ausschließlich einen permanenten Schusskanal.

  • Schusswunden, verursacht durch Gewehre, weisen zusätzlich oft auch noch eine temporäre Wundhöhle auf, auf deren Ausmaß allein durch die Betrachtung des Ein- und Ausschusses am Körper keine eindeutigen Rückschlüsse gezogen werden kann.

  • Beim aufgesetzten Schuss kann durch das Gas aus der Treibladung der Patrone im Zielkörper ebenfalls eine Wundhöhle entstehen.

  • Alle Schusswunden müssen als kontaminiert betrachtet werden und bedürfen einer antibiotischen Therapie sowie meistens eines chirurgischen Débridements.

  • Präklinisch kommt zur Therapie der Blutung neben dem Druckverband, der Tamponade bzw. dem Packing sowie dem Tourniquet an den Extremitäten auch der Einsatz von Hämostyptika in Betracht.

  • Die präklinische Versorgung erfolgt nach dem prioritätenorientierten, symptombasierten <C>ABCDE-Schema.

Schlüsselwörter

Präklinik - Schussverletzungen - Wundballistik - temporäre Wundhöhle - Projektil

Key words

preclinic - gunshot wound - wound ballistic - temporary cavity - bullets
 

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