Anästhesiol Intensivmed Notfallmed Schmerzther 2016; 51(04): 226-237
DOI: 10.1055/s-0042-105016
Fachwissen
Notfallmedizin
© Georg Thieme Verlag Stuttgart · New York

Die akute traumatische Querschnittslähmung – Wie ist präklinisch vorzugehen?

Pre-hospital care management of acute spinal cord injury
Thorsten Hess
,
Sven Hirschfeld
,
Roland Thietje
,
Stefan Lönnecker
,
Thoralf Kerner
,
Markus Stuhr
Further Information

Publication History

Publication Date:
12 April 2016 (online)

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Zusammenfassung

Die akute Verletzung von Wirbelsäule und Rückenmark kann sowohl isoliert als auch im Rahmen von Mehrfachverletzungen auftreten. Während die Ursache einer Querschnittslähmung vor wenigen Jahrzehnten noch fast ausschließlich traumatisch war, ist das Verhältnis von traumatischen zu nicht traumatischen Ursachen in Deutschland derzeit nahezu gleich. Bei der Akutbehandlung der Querschnittslähmung stehen die Wiederherstellung und der Erhalt der Vitalfunktionen, eine gezielte Steuerung der Kreislaufparameter sowie eine Vermeidung eines lagerungs- oder transportbedingten Zusatzschadens im Vordergrund. Dieser Artikel informiert über die leitliniengerechte Notfallbehandlung von Patienten mit akuter Verletzung von Wirbelsäule und Rückenmark in der präklinischen Phase.

Abstract

Acute injury to the spine and spinal cord can occur both in isolation as also in the context of multiple injuries. Whereas a few decades ago, the cause of paraplegia was almost exclusively traumatic, the ratio of traumatic to non-traumatic causes in Germany is currently almost equivalent. In acute treatment of spinal cord injury, restoration and maintenance of vital functions, selective control of circulation parameters, and avoidance of positioning or transport-related additional damage are in the foreground. This article provides information on the guideline for emergency treatment of patients with acute injury of the spine and spinal cord in the preclinical phase.

Kernaussagen

  • Die traumatische Querschnittslähmung (TQSL) wird häufig durch Verkehrsunfälle, Stürze, oder Freizeit- und Sportaktivitäten verursacht. Ein mechanisches Trauma bedingt eine primäre Rückenmarksschädigung, eine sekundäre Schädigung hat multifaktorielle Ursachen (z. B. Durchblutungsstörungen, Ödem, Azidose). Hypoxämie und Hypotonie müssen zur Vermeidung konsequent behandelt werden.

  • Zervikale Rückenmarksverletzungen sind besonders häufig und können zu einer Tetraplegie führen. Noch vor einer technischen Rettung sollte bei vital Stabilen als erste präklinische Maßnahme eine „In-Line“-Immobilisierung der HWS erfolgen.

  • Höher gelegene Läsionen können frühzeitig zu einer schweren Beeinträchtigung der Atemfunktion führen. Eine präklinische Intubation ist bei immobilisierter HWS als schwierig anzusehen. Wird die Indikation für eine Beatmungstherapie gestellt, können eine schonende Intubation unter Verwendung der Videolaryngoskopie oder extraglottische Atemwegshilfen erwogen werden.

  • Eine Schocksymptomatik kann allein durch den neurogenen Schock bedingt sein. Nach hämorrhagischen Begleitverletzungen muss aber immer gefahndet werden.

  • Ein neurogener Schock (relative Hypovolämie) kann einen echten Volumenmangel erheblich aggravieren. Noch am Unfallort sind eine adäquate Infusions- und ggf. Katecholamintherapie geboten.

  • Die Rettung, Lagerung und Umlagerung sollte achsengerecht und möglichst schonend erfolgen. Ein Patient sollte en bloc gelagert und transportiert werden. Als besonders geeignetes Transportmittel kann ein Rettungshubschrauber erwogen werden.

Schlüsselwörter:

Querschnittslähmung - spinaler Schock - Notfallmedizin - Polytrauma - Rettung

Keywords:

paraplegia - spinal shock - emergency medicine - polytrauma - rescue

Ergänzendes Material

 

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