Skip to main content
SpringerLink
Log in

Bildgebung im Schockraum

Imaging in the emergency room

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Ein erfolgreiches Schockraummanagement erfordert die interdisziplinäre Zusammenarbeit eines Teams aus Anästhesisten, Chirurgen und Radiologen. Die Herausforderung, den Körper des polytraumatisierten Patienten in kürzester Zeit auf Traumafolgen hin zu untersuchen, ist dank moderner Multidetektor-Computertomographie-Systeme möglich geworden und hat sich zum Kernstück der radiologischen Schockraumdiagnostik entwickelt.

Methode

Recherche und Auswertung aktueller Literatur.

Ergebnisse und Schlussfolgerungen

Die sonographische Untersuchung des Abdomens nach dem FAST-Protokoll („focussed assessment with sonography for trauma“) mit dem vordringlichen Ziel des Nachweises von freier intraabdomineller Flüssigkeit hat jedoch – trotz der herausragenden Sensitiviät und Spezifität der Computertomographiediagnostik und insbesondere beim hämodynamisch instabilen Patienten – weiterhin eine hohe Relevanz im Schockraumalgorithmus. Ebenfalls hat die konventionelle Bildgebung von Thorax und Becken, v. a. aufgrund der hohen und schnellen Verfügbarkeit, seinen Stellenwert im Managementkonzept des schwerverletzten Patienten beibehalten. Die interventionelle Radiologie hat sich mittlerweile ebenfalls zu einem festen Bestandteil im Management Schwerverletzter entwickelt und kommt v. a. bei Verletzungsmustern wie Beckenfrakturen, Wirbelkörperfrakturen oder auch Verletzung großer arterieller Gefäße zum Einsatz. Im Vordergrund steht die vaskuläre Diagnostik mittels Angiographie und ggf. nachgeschalteter Embolisation bzw. Stentimplantation. Die temporäre Ballonokklusion der infrarenalen Aorta abdominalis bzw. der A. ilica interna steht als Ultima Ratio bei unstillbaren Blutungen besonders im Bereich des Beckens und der unteren Extremitäten zur Verfügung.

Abstract

Background

Successful emergency room management requires an interdisciplinary approach of a team of anesthesiologists, surgeons, and radiologists. Modern multidetector computed tomography (CT) scan systems have become the centerpiece in the radiological diagnosis and allow the body of multiply injured patients to be examined in the shortest possible time

Method

Research and analysis of the current literature.

Results and conclusions

Sonographic examination of the abdomen according to the FAST protocol (“focussed assessment with sonography for trauma”) has the main objective to detect free intra-abdominal fluid and remains of high relevance in the emergency room algorithm despite the outstanding sensitivity and specificity of CT diagnosis. Likewise, the conventional imaging of the chest and pelvis remains of high importance in the management concept of severely injured patients, mainly due to its rapid availability. Interventional radiology has become an integral part in the management of trauma patients and is mainly used in injury patterns such as pelvic fractures, vertebral body fractures or lacerations of large arterial vessels. In these instances, the main tool is a diagnostic angiography and, if required, subsequent embolization or stent implantation. The temporary balloon occlusion of the infrarenal abdominal aorta or the internal iliac artery is considered as the last therapeutic option in uncontrollable bleeding in pelvic ring fractures and lower extremity injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8
Abb. 9
Abb. 10

Literatur

  1. Agolini SF, Shah K, Jaffe J et al (1997) Arterial embolization is a rapid and effective technique for controlling pelvic fracture hemorrhage. J Trauma 43:395–399

    Article  CAS  PubMed  Google Scholar 

  2. Bandi R, Shetty PC, Sharma RP et al (2001) Superselective arterial embolization for the treatment of lower gastrointestinal hemorrhage. J Vasc Interv Radiol 12:1399–1405

    Article  CAS  PubMed  Google Scholar 

  3. Brown CV, Kasotakis G, Wilcox A et al (2005) Does pelvic hematoma on admission computed tomography predict active bleeding at angiography for pelvic fracture? Am Surg 71:759–762

    PubMed  Google Scholar 

  4. Clarke JR, Trooskin SZ, Doshi PJ et al (2002) Time to laparotomy for intra-abdominal bleeding from trauma does affect survival for delays up to 90 minutes. J Trauma 52:420–425

    Article  PubMed  Google Scholar 

  5. DGU TraumaRegister, Jahresbericht 2013. Sektion NIS der Deutschen Gesellschaft für Unfallchirurgie (DGU/AUC-Akademie der Unfallchirurgie GmbH)

  6. Dolich MO, Mckenney MG, Varela JE et al (2001) 2,576 ultrasounds for blunt abdominal trauma. J Trauma 50:108–112

    Article  CAS  PubMed  Google Scholar 

  7. Duane TM, Dechert T, Wolfe LG et al (2008) Clinical examination is superior to plain films to diagnose pelvic fractures compared to CT. Am Surg 74:476–479 (discussion 479–480)

    PubMed  Google Scholar 

  8. Grieser T, Buhne KH, Hauser H et al (2001) Significance of findings of chest X-rays and thoracic CT routinely performed at the emergency unit: 102 patients with multiple trauma. A prospective study. Rofo 173:44–51

    Article  CAS  PubMed  Google Scholar 

  9. Hoffmann R, Nerlich M, Muggia-Sullam M et al (1992) Blunt abdominal trauma in cases of multiple trauma evaluated by ultrasonography: a prospective analysis of 291 patients. J Trauma 32:452–458

    Article  CAS  PubMed  Google Scholar 

  10. Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461

    Article  PubMed  Google Scholar 

  11. Kessel B, Sevi R, Jeroukhimov I et al (2007) Is routine portable pelvic X-ray in stable multiple trauma patients always justified in a high technology era? Injury 38:559–563

    Article  PubMed  Google Scholar 

  12. Kloth JK, Kauczor HU, Hosch W (2011) Imaging in the emergency room. Med Klin Intensivmed Notfmed 106:82–88

    Article  CAS  PubMed  Google Scholar 

  13. Korner M, Krotz MM, Degenhart C et al (2008) Current role of emergency US in patients with major trauma. Radiographics 28:225–242

    Article  PubMed  Google Scholar 

  14. Lindner T, Bail HJ, Manegold S et al (2004) Shock trauma room diagnosis: initial diagnosis after blunt abdominal trauma. A review of the literature. Unfallchirurg 107:892–902

    Article  CAS  PubMed  Google Scholar 

  15. Loewenhardt B, Buhl M, Gries A et al (2012) Radiation exposure in whole-body computed tomography of multiple trauma patients: bearing devices and patient positioning. Injury 43:67–72

    Article  PubMed  Google Scholar 

  16. Marzi I, Lustenberger T (2014) Management of bleeding pelvic fractures. Scand J Surg 103:104–111

    Article  CAS  PubMed  Google Scholar 

  17. Miller MT, Pasquale MD, Bromberg WJ et al (2003) Not so FAST. J Trauma 54:52–59 (discussion 59–60)

    Article  PubMed  Google Scholar 

  18. Nast-Kolb D, Trupka A, Ruchholtz S et al (1998) Abdominal trauma. Unfallchirurg 101:82–91

    Article  CAS  PubMed  Google Scholar 

  19. Nunes LW, Simmons S, Hallowell MJ et al (2001) Diagnostic performance of trauma US in identifying abdominal or pelvic free fluid and serious abdominal or pelvic injury. Acad Radiol 8:128–136

    Article  CAS  PubMed  Google Scholar 

  20. Nusbaum M, Baum S, Blakemore WS et al (1965) Demonstration of intra-abdominal bleeding by selective arteriography. Visualization of celiac and superior mesenteric arteries. JAMA 191:389–390

    Article  CAS  PubMed  Google Scholar 

  21. Ohnesorge B, Flohr T, Schaller S et al (1999) The technical bases and uses of multi-slice CT. Radiologe 39:923–931

    Article  CAS  PubMed  Google Scholar 

  22. Peytel E, Menegaux F, Cluzel P et al (2001) Initial imaging assessment of severe blunt trauma. Intensive Care Med 27:1756–1761

    Article  CAS  PubMed  Google Scholar 

  23. Pieri S, Agresti P, Morucci M et al (2004) Percutaneous management of hemorrhages in pelvic fractures. Radiol Med 107:241–251

    PubMed  Google Scholar 

  24. Shanmuganathan K, Mirvis SE, Sherbourne CD et al (1999) Hemoperitoneum as the sole indicator of abdominal visceral injuries: a potential limitation of screening abdominal US for trauma. Radiology 212:423–430

    Article  CAS  PubMed  Google Scholar 

  25. Spahn DR, Bouillon B, Cerny V et al (2013) Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 17:R76

    Article  PubMed Central  PubMed  Google Scholar 

  26. Stengel D, Bauwens K, Sehouli J et al (2001) Systematic review and meta-analysis of emergency ultrasonography for blunt abdominal trauma. Br J Surg 88:901–912

    Article  CAS  PubMed  Google Scholar 

  27. Stewart BG, Rhea JT, Sheridan RL et al (2002) Is the screening portable pelvis film clinically useful in multiple trauma patients who will be examined by abdominopelvic CT? Experience with 397 patients. Emerg Radiol 9:266–271

    PubMed  Google Scholar 

  28. Subhani SS, Muzaffar MS, Siddiqui FR (2014) Blunt thoracic trauma – an analysis of 264 patients in Rawalpindi, Pakistan. J Pak Med Assoc 64:375–378

    PubMed  Google Scholar 

  29. Totterman A, Dormagen JB, Madsen JE et al (2006) A protocol for angiographic embolization in exsanguinating pelvic trauma: a report on 31 patients. Acta Orthop 77:462–468

    Article  PubMed  Google Scholar 

  30. Trupka A, Kierse R, Waydhas C et al (1997) Shock room diagnosis in polytrauma. Value of thoracic CT. Unfallchirurg 100:469–476

    Article  CAS  PubMed  Google Scholar 

  31. Westhoff J, Laurer H, Wutzler S et al (2008) Interventional emergency embolization for severe pelvic ring fractures with arterial bleeding. Integration into the early clinical treatment algorithm. Unfallchirurg 111:821–828

    Article  CAS  PubMed  Google Scholar 

  32. Xenos ES, Abedi NN, Davenport DL et al (2008) Meta-analysis of endovascular vs open repair for traumatic descending thoracic aortic rupture. J Vasc Surg 48:1343–1351

    Article  PubMed  Google Scholar 

  33. Young JW, Burgess AR, Brumback RJ et al (1986) Pelvic fractures: value of plain radiography in early assessment and management. Radiology 160:445–451

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. K.E. und T.L. Lustenberger erhielten Vortragshonorare der Firma B Braun. S.W. erhielt Vortragshonorare der Firmen B Braun und CSL Behring. Der Beitrag enthält keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    T. Lustenberger, S. Wutzler & I. Marzi

  2. Klinik für Unfallchirurgie, Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland

    F. Walcher

  3. Institut für Diagnostische und Interventionelle Radiologie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland

    T.T. Vogl & K. Eichler

Authors
  1. T. Lustenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Wutzler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Marzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. F. Walcher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T.T. Vogl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Eichler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Lustenberger.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lustenberger, T., Wutzler, S., Marzi, I. et al. Bildgebung im Schockraum. Notfall Rettungsmed 17, 584–592 (2014). https://doi.org/10.1007/s10049-014-1865-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-014-1865-4

Schlüsselwörter

Keywords

Search

Navigation