[Current concepts of polytrauma management: from ATLS to "damage control"].
In recent years, the implementation of standardized protocols for polytrauma management has led to a significant improvement in trauma care as well as to a decrease in post-traumatic morbidity and mortality. As such, the "Advanced Trauma Life Support" (ATLS) protocol of the American College of Surgeons for the acute management of severely injured patients has been established as a gold standard in most European countries since the 1990s. Continuative concepts to the ATLS program include the "Definitive Surgical Trauma Care" (DSTC) algorithm and the concept of "damage control" surgery for polytraumatized patients with immediate life-threatening injuries. These phase-oriented therapeutic strategies appraise the injured patient of the whole extent of the sustained injuries and are in sharp contrast to previous modalities of "early total care" which advocate immediate definitive surgical intervention. The approach of "damage control" surgery takes into account the influence of systemic post-traumatic inflammatory and metabolic reactions of the organism and is aimed at reducing both the primary and the secondary, delayed, mortality in severely injured patients. The present paper provides an overview of the current state of management algorithms for polytrauma patients, with a focus on the standard concepts of ATLS and "damage control".
Stahel
P F
PF
Klinik für Unfall- und Wiederherstellungschirurgie, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. pfstahel@aol.com
Heyde
C E
CE
Wyrwich
W
W
Ertel
W
W
D000328:Adult; D000465:Algorithms; D003422:Critical Care; D005260:Female; D015600:Glasgow Coma Scale; D006491:Hemothorax / Q000628:therapy; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D009460:Neurologic Examination; D011379:Prognosis; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D012774:Shock, Traumatic / Q000209:etiology / Q000628:therapy; D013997:Time Factors; D014057:Tomography, X-Ray Computed