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Akutversorgung des Patienten mit schwerem Schadel-Hirn-Trauma

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Weiterbildung Anästhesiologie

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Zusammenfassung

Hintergrund. Das Schädel-Hirn-Trauma (SHT) ist weltweit eine der führenden Ursachen für Tod und bleibende neurologische Schäden. Dabei haben die sekundären Hirnschädigungen einen wesentlichen Anteil an der erhöhten Morbidität und Letalität der Patienten.

Methode. Der Schwerpunkt dieser Arbeit liegt auf aktuellen evidenzbasierten Konzepten der präklinischen Behandlung von Patienten mit schwerem SHT mit dem Ziel, sekundäre Hirnschäden zu verhindern bzw. zu minimieren.

Ergebnisse und Diskussion. Besondere Bedeutung hat die Vermeidung bzw. Behandlung von Hypoxie, Hypotonie und Hyperkapnie. Die Indikation zur präklinischen Intubation sollte kritisch und im Rahmen einer Einzelfallentscheidung gestellt werden. Da grundsätzlich von einer schwierigen Intubation auszugehen ist, muss ein alternatives Verfahren zur Atemwegssicherung vorhanden sein. Bei hämodynamischer Instabilität eignet sich die Kombination von Ketamin und Benzodiazepinen zur Narkoseeinleitung. Zur neuromuskulären Blockade wird entweder ein schnell wirksames nichtdepolarisierendes Muskelrelaxans oder Succinylcholin verwendet. Bei erhöhtem intrakraniellem Druck („intracranial pressure“, ICP) ist eine Osmotherapie mit Mannitol oder hypertoner Kochsalzlösung indiziert. Wann immer möglich sollte ein überregionales Traumazentrum bevorzugt werden. Die bei isoliertem SHT häufig auftretenden Gerinnungsstörungen sollten durch eine „Point-of-care“-Diagnostik zügig erkannt und therapiert werden.

Schlussfolgerung. Die präklinisch begonnene konsequente Therapie von Hypoxie, Hyperkapnie und Hypotonie ist für die neurologische Prognose des SHT Patienten von elementarer Bedeutung. Die Indikation zur Intubation sollte anhand einer Einzelfallentscheidung gestellt werden. Als Zielklinik sollte ein überregionales Traumazentrum gewählt werden.

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Authors and Affiliations

  1. Klinik und Poliklinik für Neurochirurgie, Carl Gustav Carus Universitätsklinikum, Technische Universität Dresden, Dresden

    T.A. Juratli & S.B. Sobottka

  2. Freiberuflicher Notarzt, Köln

    S.E. Stephan

  3. Klinik für Anästhesiologie,, Universitätsklinikum Heidelberg, Heidelberg

    A.E. Stephan

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  1. T.A. Juratli
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  2. S.E. Stephan
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  4. S.B. Sobottka
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Editors and Affiliations

  1. Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum Augsburg, Augsburg, Deutschland

    H. Forst

  2. Centre Hospitalier Universitaire de Nancy, Hopitaux de Brabois, Vandoeuvre-Les-Nancy, Frankreich

    T. Fuchs-Buder

  3. Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland

    A. R. Heller

  4. Anästhesiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    M. Weigand

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Juratli, T., Stephan, S., Stephan, A., Sobottka, S. (2016). Akutversorgung des Patienten mit schwerem Schadel-Hirn-Trauma. In: Forst, H., Fuchs-Buder, T., Heller, A., Weigand, M. (eds) Weiterbildung Anästhesiologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-49559-9_2

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