Taktisches Vorgehen bei der Therapie polytraumatisierter Kinder

Abstract

In the management of multiply injured children, especially those with lesions of abdominal organs and of the great vessels, effective stoppage of bleeding takes precedence over operative correction of gastric- or intestinal-rupture, and the treatment of soft-tissue wounds or fractures. Where the spleen is ruptured, an accompanying injury of the pancreas should be sought. Procedure in dealing with liver trauma (direct suture, resection) depends on the findings in situ. Tearing of the great vessels, occasionally seen when the patient has been run over, requires reconstructive measures, giving preference to autologous transplants (veins). Intracranial haemorrhage should be attacked only after stoppage of potentially lethal bleeding from parenchymatous organs (in the abdomen) and from blood vessels. The maximal length of operation (4-5 hrs) should not, if possible, be superceded. For this reason, any osteosyntheses necessary are performed at an interval of 5-7 days.