SpringerLink
Log in

Notfallmedizinische Versorgung von Schuss- und Stichverletzungen

Pathophysiologie − Wundballistik − Grundsätze der Behandlung

Emergency medical care of gunshot and stab wounds

Pathophysiology, wound ballistics, and principles of treatment

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

A Correction to this article was published on 17 January 2018

This article has been updated

Zusammenfassung

Schuss- und Stichverletzungen kommen in Deutschland insgesamt selten vor. Oberstes Ziel der notfallmedizinischen Akutversorgung ist die rasche Identifizierung potenziell lebensbedrohlicher Verletzungen und deren zielgerichtete Behandlung. Die Einschätzung, ob ein Patient mit dem Verdacht auf eine präklinisch nicht beherrschbare Körperhöhlenblutung von einem schnellen Transport in die nächstgelegene geeignete Klinik profitiert, stellt für das Rettungsdienstpersonal eine besondere Herausforderung dar. Notwendige und indizierte Interventionen sollten vor Ort durchgeführt werden, während aufschiebbare Maßnahmen auf den Transport („en route“) oder die Schockraumphase verschoben werden können. Der Zeitbedarf für eine effiziente Versorgung des Patienten kann durch strukturiertes Arbeiten mithilfe eines prioritätenorientierten Algorithmus (z. B. PHTLS) sowie horizontalen Vorgehens im Team („jeder kennt seine Aufgabe“, „alle arbeiten parallel“) optimiert werden.

Abstract

Gunshot and stab wounds are seldom in Germany. The primary goal of acute emergency medical care consists of identifying potentially life-threatening injuries and treating them in a targeted manner. Determination of whether a patient suffering from uncontrolled internal bleeding will benefit from rapid transfer to the nearest suitable hospital is a special challenge for emergency services personnel. Required interventions should be carried out on site, while measures that can be taken care of during transport (en route) or in the emergency room should be postponed. The time required for effective treatment can be optimized by (1) working in a structured manner using a priority-based algorithm (e.g. PHTLS) and (2) a horizontal approach in a team (“everyone knows his own task”, “all working in parallel”).

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

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

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
Abb. 11

Change history

  • 17 January 2018

    Correction:

Literatur

  1. Bundeskriminalamt (2015) Polizeiliche Kriminalstatistik Bundesrepublik Deutschland. Jahrbuch. Bundeskriminalamt, Wiesbaden

    Google Scholar 

  2. TraumaRegister Der Deutschen Gesellschaft Für Unfallchirurgie (DGU): Jahresbericht 2015. Sektion Intensiv- & Notfallmedizin, Schwerverletztenversorgung (NIS) Und AUC – Akademie Der Unfallchirurgie GmbH.

  3. TraumaRegister DGU, Bieler D, Franke AF et al (2014) Schuss- und Stichverletzungen in Deutschland – Epidemiologie und Outcome. Unfallchirurg 117(11):995–1004

    Article  Google Scholar 

  4. Canturk G, Canturk N, Odabasi AB, Erkol Z, Bosgelmez M (2009) Autopsy findings of suicidal deaths committed by firearms in Ankara, Turkey. Med Sci Law 49(3):207–212

    Article  PubMed  Google Scholar 

  5. Karger B (2004) Schussverletzungen. Handbuch gerichtliche Medizin. Springer-Verlag

    Book  Google Scholar 

  6. Chapman J, Milroy CM (1992) Firearm deaths in Yorkshire and Humberside. Forensic Sci Int 57(2):181–191

    Article  CAS  PubMed  Google Scholar 

  7. Karger B, Brinkmann B (1997) Multiple gunshot suicides: potential for physical activity and medico-legal aspects. Int J Legal Med 110(4):188–192

    Article  CAS  PubMed  Google Scholar 

  8. Karlsson T, Isaksson B, Ormstad K (1993) Gunshot fatalities in Stockholm, Sweden with special reference to the use of illegal weapons. J Forensic Sci 38(6):1409–1421

    Article  CAS  PubMed  Google Scholar 

  9. Giese A, Koops E, Lohmann F, Nehlsen M, Püschel K (2002) Verletzungsmuster und klinische Prognose penetrierender Schädelhirntraumen durch Schusswaffen. Rechtsmedizin 12(1):13–23

    Article  Google Scholar 

  10. Kühne DCA, Zettl RP, Baume B et al (2007) Penetrierende Schädel-Hirn-Verletzungen durch Schusswaffen. Unfallchirurg 110(4):341–350

    Article  PubMed  Google Scholar 

  11. Krug EG, Powell KE, Dahlberg LL (1998) Firearm-related deaths in the United States and 35 other high- and upper-middle-income countries. Int J Epidemiol 27(2):214–221

    Article  CAS  PubMed  Google Scholar 

  12. Pereira C, Boyd JB, Dickenson B, Putnam B (2012) Gunshot wounds to the face: level I urban trauma center: a 10-year level I urban trauma center experience. Ann Plast Surg 68(4):378–381

    Article  CAS  PubMed  Google Scholar 

  13. Krug EG, Mercy JA, Dahlberg LL, Zwi AB (2002) The world report on violence and health. Lancet 360(9339):1083–1088

    Article  PubMed  Google Scholar 

  14. Kunz SN, Meyer HJ, Kraus S (2013) Gerichtsmedizinische Aspekte suizidaler Schussverletzungen – eine Übersichtsarbeit am Beispiel Deutschlands. Wien Med Wochenschr 163(23–24):541–548

    Article  PubMed  Google Scholar 

  15. Buschmann PDCT, Fricke A, Tsokos PDM, Hartwig DS (2015) Schusstodesfälle im Land Berlin von 2000 bis 2009. Rechtsmedizin 25(2):130–138

    Article  Google Scholar 

  16. National Association of Emergency Medical Technicians (NAEMT) (2015) PHTLS: Prehospital Trauma Life Support, 8. Aufl. Jones & Bartlett Learning, Burlington

    Google Scholar 

  17. Demetriades D, Rabinowitz B (1987) Indications for operation in abdominal stab wounds. A prospective study of 651 patients. Ann Surg 205(2):129–132

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Kneubuehl B, Coupland R, Rothschild M, Thali M (2008) Wundballistik – Grundlagen Und Anwendungen, Abschnitt 3.2.5 Gesetzmäßigkeiten Beim Knochenschuss, 3. Aufl. Springer, Berlin Heidelberg, S 138

    Google Scholar 

  19. Gerber AM, Moody RA (1972) Craniocerebral missile injuries in the monkey: an experimental physiological model. J Neurosurg 36(1):43–49. doi:10.3171/jns.1972.36.1.0043

    Article  CAS  PubMed  Google Scholar 

  20. Crockard HA (1975) Early intracranial pressure studies in gunshot wounds of the brain. J Trauma 15(4):339–347

    Article  CAS  PubMed  Google Scholar 

  21. Aldrich EF, Eisenberg HM, Saydjari C et al (1992) Predictors of mortality in severely head-injured patients with civilian gunshot wounds: a report from the NIH Traumatic Coma Data Bank. Surg Neurol 38(6):418–423

    Article  CAS  PubMed  Google Scholar 

  22. Böhm E (1967) Die Handlungsfähigkeit nach Schädel-Hirn-Traumen. Dtsch Z Gesamte Gerichtl Med 60(3):98–102

    PubMed  Google Scholar 

  23. Klages U, Weithoener D, Frössler H, Terwort H (1975) Überlebenszeit, Handlungsfähigkeit und röntgenologische Diagnostik bei Schußverletzungen des Schädels. Z Rechtsmed 76(4):307–319

    Article  CAS  PubMed  Google Scholar 

  24. Crockard HA, Brown FD, Johns LM, Mullan S (1977) An experimental cerebral missile injury model in primates. J Neurosurg 46(6):776–783

    Article  CAS  PubMed  Google Scholar 

  25. Kaufman HH, Makela ME, Lee KF, Haid RW, Gildenberg PL (1986) Gunshot wounds to the head: a perspective. Neurosurgery 18(6):689–695

    Article  CAS  PubMed  Google Scholar 

  26. Grahm TW, Williams FC, Harrington T, Spetzler RF (1990) Civilian gunshot wounds to the head: a prospective study. Neurosurgery 27(5):696–700

    Article  CAS  PubMed  Google Scholar 

  27. Kennedy F, Gonzalez P, Dang C, Fleming A, Sterling-Scott R (1993) The Glasgow Coma Scale and prognosis in gunshot wounds to the brain. J Trauma 35(1):75–77

    Article  CAS  PubMed  Google Scholar 

  28. Byrnes DP, Crockard HA, Gordon DS, Gleadhill CA (1974) Penetrating craniocerebral missile injuries in the civil disturbances in Northern Ireland. Br J Surg 61(3):169–176

    Article  CAS  PubMed  Google Scholar 

  29. Hubschmann O, Shapiro K, Baden M, Shulman K (1979) Craniocerebral gunshot injuries in civilian practice – prognostic criteria and surgical management: experience with 82 cases. J Trauma 19(1):6–12

    Article  CAS  PubMed  Google Scholar 

  30. Doll DD, Lenz S, Lieber A et al (2006) Was tun bei nicht komprimierbaren Stichkanalblutungen in Rettungsdienst und Notfallraum? Unfallchirurg 109(10):898–900

    Article  CAS  PubMed  Google Scholar 

  31. LoCicero J, Mattox K (1989) Epidemiology of chest trauma. Surg Clin North Am 69(1):15–19

  32. Miller DL, Mansour KA (2007) Blunt traumatic lung injuries. Thorac Surg Clin 17(1):57–61–vi

    Article  PubMed  Google Scholar 

  33. Demetriades D, Kimbrell B, Salim A et al (2005) Trauma deaths in a mature urban trauma system: is “trimodal” distribution a valid concept? J Am Coll Surg 201(3):343–348

    Article  PubMed  Google Scholar 

  34. Mollberg NM, Tabachnik D, Farjah F et al (2013) Utilization of cardiothoracic surgeons for operative penetrating thoracic trauma and its impact on clinical outcomes. Ann Thorac Surg 96(2):445–450

    Article  PubMed  Google Scholar 

  35. Poon H, Morrison JJ, Apodaca AN, Khan MA, Garner JP (2013) The UK military experience of thoracic injury in the wars in Iraq and Afghanistan. Injury 44(9):1165–1170

    Article  CAS  PubMed  Google Scholar 

  36. Ivey KM, White CE, Wallum TE et al (2012) Thoracic injuries in US combat casualties: a 10-year review of Operation Enduring Freedom and Iraqi Freedom. J Trauma Acute Care Surg 73(6 Suppl 5):514–S519

    Google Scholar 

  37. Keneally R, Szpisjak D (2013) Thoracic trauma in Iraq and Afghanistan. J Trauma Acute Care Surg 74(5):1292–1297

    Article  PubMed  Google Scholar 

  38. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons. Committee on Trauma (2001) Practice management guidelines for emergency department thoracotomy. J Am Coll Surg 193(3):303–309

    Article  Google Scholar 

  39. Grace S et al (1999) The Role of Ultrasound in Patients with Possible Penetrating Cardiac Wounds: A Prospective Multicenter Study. J Trauma Acute Care Surgery. Wolters Kluwer, Lippincott Williams & Wilkins

  40. Kong VY, Sartorius B, Clarke DL (2015) The selective conservative management of penetrating thoracic trauma is still appropriate in the current era. Injury 46(1):49–53

    Article  PubMed  Google Scholar 

  41. Degiannis E, Smith MD (2008) Pot pouri of heuristics in penetrating trauma to the chest. ANZ J Surg 78(12):1103–1105

    Article  PubMed  Google Scholar 

  42. Baldt MM, Bankier AA, Germann PS, Pöschl GP, Skrbensky GT, Herold CJ (1995) Complications after emergency tube thoracostomy: assessment with CT. Radiology 195(2):539–543

    Article  CAS  PubMed  Google Scholar 

  43. Peters S, Wolter D, Schultz JH (1996) Dangers and risks of thoracic drainage at the accident site. Unfallchirurg 99(12):953–957

    Article  CAS  PubMed  Google Scholar 

  44. Schmidt U, Stalp M, Gerich T, Blauth M, Maull KI, Tscherne H (1998) Chest tube decompression of blunt chest injuries by physicians in the field: effectiveness and complications. J Trauma 44(1):98–101

    Article  CAS  PubMed  Google Scholar 

  45. Spanjersberg WR, Spanjersberg W, Ringburg AN et al (2005) Prehospital chest tube thoracostomy: effective treatment or additional trauma? J Trauma 59(1):96–101

    Article  PubMed  Google Scholar 

  46. McAnena OJ, Moore EE, Marx JA (1990) Initial evaluation of the patient with blunt abdominal trauma. Surg Clin North Am 70(3):495–515

    Article  CAS  PubMed  Google Scholar 

  47. Nicholas JM, Rix EP, Easley KA et al (2003) Changing patterns in the management of penetrating abdominal trauma: the more things change, the more they stay the same. J Trauma 55(6):1095–1108 (discussion 1108–1110)

    Article  PubMed  Google Scholar 

  48. Nagy K, Roberts R, Joseph K, An G, Barrett J (1999) Evisceration after abdominal stab wounds: is laparotomy required? J Trauma 47(4):622–624 (discussion 624–626)

    Article  CAS  PubMed  Google Scholar 

  49. Committee on Tactical Combat Casualty Care. Tactical Combat Casualty Care Guidelines for Medical Personnel. http://www.naemt.org/education/TCCC/guidelines_curriculum. Zugegriffen: 30 Aug 2016

  50. Najibi S, Dougherty PJ, Morandi MM (2006) Management of gunshot wounds to the joints. Tech Orthop 21(3):200–204

    Article  Google Scholar 

  51. Norman J, Gahtan V, Franz M, Bramson R (1995) Occult vascular injuries following gunshot wounds resulting in long bone fractures of the extremities. Am Surg 61(2):146–150

    CAS  PubMed  Google Scholar 

  52. Howe HR, Poole GV, Hansen KJ et al (1987) Salvage of lower extremities following combined orthopedic and vascular trauma. A predictive salvage index. Am Surg 53(4):205–208

    PubMed  Google Scholar 

  53. American College of Surgeons C, ed. Advanced Trauma Live Support (ATLS) Student Course Manual 2012. 9 ed.

  54. National Association of Emergency Medical Technicians (NAEMT) (2016) Tactical Field Care. In: NAEMT (Hrsg.) PHTLS: Prehospital Trauma Life Support, Military Edition, 8. Aufl. Bd. 26. Jones & Bartlett Publ., S 685. http://www.jblearning.com/catalog/9781284041750/

  55. Sauaia A, Moore FA, Moore EE et al (1995) Epidemiology of trauma deaths: a reassessment. J Trauma 38(2):185–193

    Article  CAS  PubMed  Google Scholar 

  56. Holcomb JB (2004) Methods for improved hemorrhage control. Crit Care 8(Suppl 2):57–60

    Article  Google Scholar 

  57. Kauvar DS, Wade CE (2005) The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care 9(Suppl 5):1–9

    Article  Google Scholar 

  58. Cothren CC, Moore EE, Hedegaard HB, Meng K (2007) Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg 31(7):1507–1511

    Article  PubMed  Google Scholar 

  59. Eastridge BJ, Mabry RL, Seguin P et al (2012) Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg 73(6 Suppl 5):S431–S437

    Article  PubMed  Google Scholar 

  60. Ramasamy A, Midwinter M, Mahoney P, Clasper J (2009) Learning the lessons from conflict: pre-hospital cervical spine stabilisation following ballistic neck trauma. Injury 40(12):1342–1345

    Article  PubMed  Google Scholar 

  61. Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE (2011) Prehospital spine immobilization for penetrating trauma – review and recommendations from the prehospital trauma life support executive committee. J Trauma 71(3):763–770

    Article  PubMed  Google Scholar 

  62. Butler FK, Dubose JJ, Otten EJ et al (2013) Management of open pneumothorax in tactical combat casualty care: TCCC guidelines change 13-02. J Spec Oper Med 13(3):81–86

    PubMed  Google Scholar 

  63. Fachgesellschaften A. S3-Leitlinie 012/019 „Polytrauma/Schwerverletzten-Behandlung “.

  64. Hager DN, Krishnan JA, Hayden DL, Brower RG (2012) Tidal volume reduction in patients with acute lung injury when plateau pressures are not high. Am J Respir Crit Care Med 172(10):1241–1245

    Article  Google Scholar 

  65. Willy C, Hauer T, Huschitt N, Palm H‑G (2011) „Einsatzchirurgie“ – experiences of German military surgeons in Afghanistan. Langenbecks Arch Surg 396:507–522. doi:10.1007/s00423-011-0760-4

    Article  PubMed  Google Scholar 

  66. Boldt J (2004) Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence. Can J Anaesth 51(5):500–513

    Article  PubMed  Google Scholar 

  67. Haut ER, Kalish BT, Cotton BA et al (2011) Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a national trauma data bank analysis. Ann Surg 253(2):371–377

    Article  PubMed  Google Scholar 

  68. Werner PDC, Geldner G, Koch T (2013) Hydroxyäthylstärke. Anaesthesist 62(8):595–596

    Article  CAS  PubMed  Google Scholar 

  69. Roessler PDM, Bode K, Bauer M (2014) Volumentherapie bei Hämorrhagie. Anaesthesist 63(10):730–744

    Article  CAS  PubMed  Google Scholar 

  70. Spahn DR, Bouillon B, Cerny V et al (2013) Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care 17(2):R76

    Article  PubMed  PubMed Central  Google Scholar 

  71. CRASH-2 collaborators, Roberts I, Shakur H et al (2011) The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet 377(9771):1096–1101.e1–2

    Article  Google Scholar 

  72. Lipsky AM, Abramovich A, Nadler R et al (2014) Tranexamic acid in the prehospital setting: Israel Defense Forces’ initial experience. Injury 45(1):66–70

    Article  PubMed  Google Scholar 

  73. Notfallnarkose ADWANAP (2015) Prähospitale Notfallnarkose beim Erwachsenen. Anaesth Intensivmed 56:317–335

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Abteilung für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland

    T. Hauer & N. Huschitt

  2. Universität der Bundeswehr München, Neubiberg, Deutschland

    S. Grobert

  3. Institut für Rechtsmedizin, Ludwig-Maximilians-Universität München, München, Deutschland

    S. Grobert

  4. bpk Consultancy GmbH, Ballistik, Physik Kriminalistik, Thun, Schweiz

    B. Kneubuehl

  5. Abteilung für Anästhesie, Intensivmedizin, Notfallmedizin und Rettungsdienst, Bundeswehrkrankenhaus Berlin, Berlin, Deutschland

    W. Schmidbauer

Authors
  1. T. Hauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. Huschitt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Grobert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Kneubuehl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Schmidbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Hauer.

Ethics declarations

Interessenkonflikt

T. Hauer, N. Huschitt, S. Grobert, B. Kneubuehl und W. Schmidbauer geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

M. Kulla, Ulm

F. Walcher, Magdeburg

A correction to this article is available online at https://doi.org/10.1007/s10049-017-0405-4.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hauer, T., Huschitt, N., Grobert, S. et al. Notfallmedizinische Versorgung von Schuss- und Stichverletzungen. Notfall Rettungsmed 19, 427–441 (2016). https://doi.org/10.1007/s10049-016-0215-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-016-0215-0

Schlüsselwörter

Keywords

Search

Navigation