Rescue Chain Research Articles

Abdominal gunshot injury with perforation of both iliac arteries

A 15-year-old youngster was hit in the abdomen by a 22 caliber rifle bullet. After a short, symptom-free interval, he collapsed and was transported rapidly to the nearest medical center. He showed severe shock and anemia. An explorative laparotomy was performed immediately and an extended retroperitoneal hematoma is discovered, originating from perforation of both common iliac arteries. The lesions and an additional perforation of the ileum were sutured directly. The bullet was excised. The wound healed without complications and the patient recovered completely. The short duration of the rescue chain and the prompt laparotomy with clamping of the aorta are probably what saved this young patient's life. The particular vascular reconstruction in this case, the excision of the bullet, sufficient drainage, and prophylactic administration of antibiotics helped avoid septic complications. Fortunately, it was not a high velocity penetration, which would have demanded a very different treatment. Exact information about the rifle and cartridge, as well as the right strategy in treatment are mandatory for successful management of such dangerous injuries.

Investigations of Vital Functions of Severely Injured Patients in the Early Period after Trauma

The main aim of the primary treatment of polytraumatized patients at the accident site is the stabilization and maintenance of vital functions, especially the cardiocirculatory and the respiratory systems. The next step in the rescue chain is rapid transport to the nearest hospital with the ability to manage critically injured patients. Because of the difficulty in carrying out measurements in such critical situations, very little reliable data concerning trauma induced changes in respiratory function and metabolism is available. Clinical experience has shown that even after successfully recovering from the acute stress phase, a trauma related progressive respiratory distress syndrome can nevertheless develop during the first few days following injury.Recent studies led to the conclusion that the late development of respiratory distress syndrome is already induced during the early shock phase. Early discovery and adequate treatment of trauma related metabolic and respiratory dysfunctions have a decisive influence on current status and outcome.