Symposium
Emergency Room Management in Severely Injured Patients -
The MSCT shock room concept
G. Lenz, F. Rothmeier, A. Grünes, D. Vorwerk
Department of Anesthesiology and Intensive Care Medicine 555f56f
(Head: Prof. Dr. Gunther
Lenz, D.E.A.A.)
Early clinical treatment of severe trauma requires a systematic and coordinated approach of different medical professions (anaesthesiology, radiology, surgery) including precise timing and organisation in order to achieve an efficient diagnostic and therapeutic process.
Conventional concepts in emergency room (ER) trauma care basically require different imaging diagnostics situated in different locations (ultrasound, conventional x-ray, computed tomography) and are associated with transports and additional positionings of seriously compromised patients. According to medical literature management of trauma patients between hospitalisation at the ER and surgical care in the operation room (OR) or alternatively treatment at the intensive care unit (ICU) takes 70 to 90 min.
In order to improve the efficiency of early clinical trauma treatment we developed a new trauma management concept which was implemented in 2004. Key points are:
(1) Implementation of a mobile whole-body multislice computed tomography with sliding gantry (16-row-MSCT, Somatom/Siemens) used as the primary diagnostic tool in all multiple trauma patients
(2) Concentration of all diagnostic and therapeutic ER processes to one single room (MSCT shock room)
(3) Usage of a carbon-slide for CT-positioning as well as further transport to the OR or ICU with a specially designed shuttle system
(4) Employment of a life support trolley as integrated anesthesia workstation (monitoring, mobile ICU-ventilator , iv- and fluid-management) in the MSCT shock room as well as for further transport to OR or ICU
(5) Implementation of adjusted treatment-guidelines (MSCT polytrauma algorithm)
As a result the ER trauma management could be significantly improved, the average time of early clinical treatment was halved for each patient (34 min median).
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