Fallbericht: Von der Nachforderung zur Analgesie zur Polytrauma-Reanimation in der Häuslichkeit

Zusammenfassung

Der vorliegende Fallbericht beschreibt, wie eine anfänglich harmlos anmutende Nachforderung zur Analgesie bei Sturz in der Häuslichkeit in einer erfolglosen Polytrauma-Reanimation mit erweiterten invasiven Maßnahmen mündet. Was hat das Rettungsteam zu beachten? Wurden alle therapeutischen Mittel ausgenutzt? Liegt gegebenenfalls eine unklare/nicht natürliche Todesart vor? Es erfolgt eine rechtsmedizinische Obduktion zur Klärung der offenen Fragen.

Abstract

This case report illustrates how a “harmless” request for an emergency physician by paramedics for analgesia after a collapse at home leads to an unsuccessful polytrauma resuscitation with advanced medical procedures. What do the emergency team members have to consider? Have all therapeutic means been used? Is there an unclear/non-natural cause of death? A forensic autopsy takes places to clarify the open questions.

Schlüsselwörter

Reanimation nach Sturz - Antikoagulation - präklinische Versorgung - Hämatothorax - ungeklärte/nicht natürliche Todesursache

Keywords

resuscitation after fall - anticoagulation - preclinical care - hämatothorax - unexplained cause of death

Publication History

Received: 10 December 2021

Accepted after revision: 26 June 2022

Article published online:
15 August 2022

• Literatur

• 1 Fischer M, Wnent J, Gräsner J-T. et al. Jahresbericht des Deutschen Reanimationsregisters: Außerklinische Reanimation 2019. Anästh Intensivmed 2020; 61: V89-V93
• 2 Gräsner J-T, Wnent J, Herlitz J. et al. Survival after out-of-hospital cardiac arrest in Europe – Results of the EuReCa TWO study. Resuscitation 2020; 148: 218-226 DOI: 10.1016/j.resuscitation.2019.12.042. (PMID: 32027980)
• 3 Escutnaire J, Genin M, Babykina E. et al. Traumatic cardiac arrest is associated with lower survival rate vs. medical cardiac arrest – Results from the French national registry. Resuscitation 2018; 131: 48-54 DOI: 10.1016/j.resuscitation.2018.07.032. (PMID: 30059713)
• 4 Kleber C, Giesecke MT, Lindner T. et al. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation 2014; 85: 405-410 DOI: 10.1016/j.resuscitation.2013.11.009. (PMID: 24287328)
• 5 Lott C, Truhlář A, Alfonzo A. et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation 2021; 161: 152-219 DOI: 10.1016/j.resuscitation.2021.02.011. (PMID: 34479028)
• 6 Clemency BM, Tanski CT, Rosenberg M. et al. Sufficient catheter length for pneumothorax needle decompression: a meta-analysis. Prehosp Disaster Med 2015; 30: 249-253 DOI: 10.1017/S1049023X15004653. (PMID: 25857267)
• 7 Hecker M, Hegenscheid K, Völzke H. et al. Needle decompression of tension pneumothorax: Population-based epidemiologic approach to adequate needle length in healthy volunteers in Northeast Germany. J Trauma Acute Care Surg 2016; 80: 119-124 DOI: 10.1097/TA.0000000000000878. (PMID: 26683398)
• 8 Bouillion B, Pieper D, Flohé S, Rucholtz S, Eikermann M, Stürmer K-M, Waydhas C, Trentzsch H, Lendemans S, Huber-Wagner S, Rixen D, Hildebrand F. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. 01.07.2016 Accessed September 11, 2021 at: https://www.awmf.org/leitlinien/detail/ll/012–019.html
• 9 Schneider NRE, Weilbacher F, Maurer T. et al. Präklinische Bluttransfusion bei lebensbedrohlicher Blutung – erweiterte lebensrettende Therapieoptionen durch das Konzept Medical Intervention Car. Notfall Rettungsmed 2021; DOI: 10.1007/s10049-021-00897-7.
• 10 Roberts I, Shakur H, Coats T. et al. The CRASH-2 trial: a randomised controlled trial and economic evaluation of the effects of tranexamic acid on death, vascular occlusive events and transfusion requirement in bleeding trauma patients. Health Technol Assess 2013; 17: 1-79 DOI: 10.3310/hta17100. (PMID: 23477634)
• 11 Soar J, Böttiger BW, Carli P. et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation 2021; 161: 115-151 DOI: 10.1016/j.resuscitation.2021.02.010. (PMID: 34482004)