Der Unfallchirurg
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Practice Guideline
[Emergency anesthesia, airway management and ventilation in major trauma. Background and key messages of the interdisciplinary S3 guidelines for major trauma patients].
Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate < 6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2) < 90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS) < 9], trauma-associated hemodynamic instability [systolic blood pressure (SBP) < 90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate > 29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). ⋯ Normoventilation should be the goal of mechanical ventilation. After arrival in the resuscitation room the ventilation will be controlled and guided with the help of arterial blood gas analyses. After temporary removal of a cervical collar, the cervical spine needs to be immobilized by means of manual in-line stabilization when securing the airway.
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The training of medical school students at the University of Heidelberg seems to be improvable regarding prehospital trauma treatment compared to an established anaesthesiology-based training for medical emergencies. This study addresses the current situation and possibilities for advancing this training. ⋯ Especially the treatment of multiply injured patients is a challenge for young medical professionals. However, there is a high motivation to learn and train in emergency medicine. The students long for a practical trauma course compared to the advanced medical CPR course provided by the Department of Anaesthesiology of the University of Heidelberg. Those algorithm-based trauma courses do exist with PHTLS® and ATLS®. Based on these courses we developed the PHTLS® TEAM course.
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Mobile C-arms with the option of 3D imaging like the Iso-C(3D) allow for intraoperative 3D visualization of anatomical areas with complex three-dimensional structures like articular surfaces. In an 8-year period we performed 1,841 intraoperative control scans following osteosynthesis. Among these patients we registered the number of intraoperative adjustments of fracture reduction and implant position in correlation to the area of surgery. ⋯ Intraoperative need for revision of reduction or implant position is not a rare phenomenon in our experience. Intraoperative 3D imaging is a valid tool to recognize and adjust suboptimal reduction or implant positioning. Intraoperative 3D imaging can improve the quality of osteosynthesis especially in fractures of joints and complex anatomical areas.
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Clinical Trial
[Treatment results after cemented hemiprosthesis for care of unstable pertrochanteric femoral fractures in the elderly].
The optimal treatment strategy for unstable trochanteric fractures in the elderly is still controversial because of the frequent failure of osteosynthesis. ⋯ Cemented hemiarthroplasty is a safe treatment strategy for unstable trochanteric fractures in the elderly, which allows early full weight bearing. Because of frequent general complications, more interdisciplinary units and centres of excellence are needed to handle this challenging cohort.
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Computer-assisted systems are used frequently in pelvis and spine surgery but are still rare in general trauma and hardly ever used in shoulder surgery. The major limitation is the use of rigid markers and the problem of obtaining navigable images in the complex shoulder region. The aim of this study was to evaluate the use of a new image-based guidance system in shoulder traumatology. ⋯ The number of trials to implant the guide wire was less in the image-guided group compared to the conventional group (1 vs 2, p=0.02). For the first time image-based guidance was used in shoulder traumatology. The system holds high potential to assist surgeons without disturbing the workflow in assuring guide wire positioning, reduce the number of dangerous mistrials and reduce the emission of radiation.