[Emergency room management of multiple injured patients. A multislice computed tomography orientated treatment algorithm].
BACKGROUND
In the treatment of the seriously injured patient, time is crucial. Clarke et al. showed that in the hypotensive patient with blunt abdominal trauma and bleeding a delay in the surgical treatment over 90 min increases mortality of 1 % every 3 minutes. So called trauma algorithms are used as systematic approach to the seriously injured patient that can be easily reviewed and practiced. One impact of this algorithm is to shorten time in the emergency room and may improve outcome of the patient. The patient outcome is directly related to the length of time between the injury and the beginning to proper definitive care.


OBJECTIVE
Are improvements still necessary and possible in the care of the seriously injured patient? New technical developments like multislice-CT are able to shorten time until definitive care. The practicability of an multislice-CT orientated treatment algorithm was evaluated.


METHODS
After integration of an multislice-CT into the emergency room the treatment of the seriously injured patient (ISS >16) was changed. Therefore an algorithm which puts the CT diagnostics in the first minutes of the clinical care was developed.


RESULTS
50 patients were treated following the new algorithm. The time in the emergency room decreased from 87 min to 36 min.


CONCLUSIONS
This algorithm requires a differing from previous surgical standards, but it proved to be timesaving, effective and practicable. It makes the beginning of the definitive care possible within the first 40 min after patient arrival in the emergency room.
Hilbert
P
P
Klinik für Anästhesiologie, Intensiv- und Notfallmedizin BG-Kliniken Bergmannstrost Halle. Peter.Hilbert@bergmannstrost.com
Hoeller
J
J
Wawro
W
W
Zur Nieden
K
K
Ruppmann
B
B
Koch
R
R
Braunschweig
R
R
Hofmann
G O
GO
Stuttmann
R
R
D000465:Algorithms; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006757:Hospital Units / Q000458:organization & administration*; D006801:Humans; D009104:Multiple Trauma / Q000175:diagnosis* / Q000628:therapy*; D017748:Time Management; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome