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Manchmal ist es nur ein kleiner Hinweis, sozusagen das „Kleingedruckte“, das dem Einsatzteam eine vollig neue Differenzialdiagnose liefert – so wie in diesem Fall, in dem alles im wahrsten Sinne des Wortes nicht so ist, wie es normalerweise sein sollte.

Der Einsatz invasiver Techniken am Notfallort – z. B. die Koniotomie, die Thoraxdrainage, die intraossare Punktion oder in seltenen Fallen die Notamputation – ist bei bestehender Indikation alternativlos und fur jeden Notarzt gleichermasen eine grose Herausforderung. Personelle, zeitliche und ortliche Rahmenbedingungen sind haufig ungunstig. Selbst bei regelmasiger Teilnahme am Notarztdienst bleiben Ultima-Ratio-Masnahmen am Notfallort, insbesondere im Rahmen padiatrischer Notfalle, eine Seltenheit. Neben der theoretischen Ausbildung sind praxisorientierte Kurskonzepte erforderlich, um eine hohe Qualitat dieser Masnahmen zu erreichen. Dieser Artikel stellt die Notamputation hinsichtlich Indikation, Durchfuhrung, Problemen und Risiken vor. Er ist Teil einer Serie von insgesamt vier Artikeln zum Thema „Invasive Notfalltechniken“.

Der Einsatz invasiver Techniken am Notfallort – z.B. die Koniotomie, die Thoraxdrainage, die intraossare Punktion oder in seltenen Fallen die Notamputation – ist bei bestehender Indikation alternativlos und fur jeden Notarzt gleichermasen eine grose Herausforderung. Personelle, zeitliche und ortliche Rahmenbedingungen sind haufig ungunstig. Selbst bei regelmasiger Teilnahme am Notarztdienst bleiben Ultima-Ratio-Masnahmen am Notfallort, insbesondere im Rahmen padiatrischer Notfalle, eine Seltenheit. Neben der theoretischen Ausbildung sind praxisorientierte Kurskonzepte erforderlich, um eine hohe Qualitat dieser Masnahmen zu erreichen. Dieser Artikel stellt die Entlastung des Pleuraraumes hinsichtlich Indikation, Durchfuhrung, Problemen und Risiken bei der Anwendung an Erwachsenen und Kindern vor. Er ist der zweite Teil einer Serie von insgesamt vier Artikeln zum Thema „Invasive Notfalltechniken“.

Rescue helicopters are used for emergency care and transport of emergency patients. The dimension of the cabin is clearly limited. A transport is carried out under spatial narrowness and high noise levels. Acoustic alarms or noises caused by the patient are hardly to be perceived, so that the view at optical alarms is necessary. Environmental conditions affect the concentration on the patient. Rearrangement maneuvers represent the most critical phases. Always the whole apparative monitoring and respirator must be in the field of view of the emergency doctor, drugs to the care must be handy to be quickly administered, the quantity of oxygen has to be observed. Infusions and option of airway management are ready to set in advance. Standardized work with the aid of algorithms and knowledge of treatment recommendations and guidelines help to prevent errors. To optimize the care of emergency patients, special training courses for the crew of rescue helicopters are offered. A training simulator to practice different scenarios and the establishment of a CIRS system are recommended.

This case report describes the prehospital care of a 42-year-old person damaged by a severe motorcycle accident in a rural scene. The injured person was unconscious, one pupil was dilated and rib fractures were palpable. Purposeful therapy without delay was necessary. The prehospital therapy took 35 minutes in total. The time benefit by using a rescue helicopter is illustrated: time to initial treatment is minimized and duration of transport as well - direct transport to a trauma center is possible.

On the basis of a case report the prehospital management of a newborn child with deep accidental hypothermia (22oC) is discussed. The child was found in a garbage can. The continuous resuscitation during the transport into the clinic is done in an incubator and the child survives without neurologic damages. The used measures of the resuscitation are discussed on the basis of the therapy.

On the basis of a case report the prehospital management of severely burned patients is discussed. The prevention of hypovolemia, hypothermia or hypoxemia are the primary targets. It is necessary to estimate the burn size and depth. The burn shock fluid resuscitation, prevention of hypothermia, pain- and airway management are described as well as the transport from the scene of accident to a proximal emergency unit or to a specialized burn intensive care unit.

This case report describes the prehospital care of a person with severe polytrauma due to being jammed in a vehicle in a traffic accident. After understanding the forces involved in causing the trauma, the therapy of impaired vital functions is demonstrated with particular regard to time management. Use of a rescue helicopter allowed for minimizing the delay to initial treatment as well as the duration of transport.

Rescue helicopters are used for emergency care and transport of emergency patients. The dimension of the cabin is clearly limited. A transport is carried out under spatial narrowness and high noise levels. Acoustic alarms or noises caused by the patient are hardly to be perceived, so that the view at optical alarms is necessary. Environmental conditions affect the concentration on the patient. Rearrangement maneuvers represent the most critical phases. Always the whole apparative monitoring and respirator must be in the field of view of the emergency doctor, drugs to the care must be handy to be quickly administered, the quantity of oxygen has to be observed. Infusions and option of airway management are ready to set in advance. Standardized work with the aid of algorithms and knowledge of treatment recommendations and guidelines help to prevent errors. To optimize the care of emergency patients, special training courses for the crew of rescue helicopters are offered. A training simulator to practice different scenarios and the establishment of a CIRS system are recommended.

This case report describes the prehospital care of a 42-year-old person damaged by a severe motorcycle accident in a rural scene. The injured person was unconscious, one pupil was dilated and rib fractures were palpable. Purposeful therapy without delay was necessary. The prehospital therapy took 35 minutes in total. The time benefit by using a rescue helicopter is illustrated: time to initial treatment is minimized and duration of transport as well - direct transport to a trauma center is possible.

This case report describes the prehospital care of a person after an occupational accident. The amputation of whole extremities is rare and needs a standardized procedure: at first lifesaving procedures are necessary before saving the limb. The work at a conveyor belt resulted in taking of an arm. On the basis of this case report the prehospital management is discussed focalizing the complete treatment of the patient and his amputated extremity as well as the transport from the scene of accident to a suitable hospital.

On the basis of a case report the prehospital management of a newborn child with deep accidental hypothermia (22oC) is discussed. The child was found in a garbage can. The continuous resuscitation during the transport into the clinic is done in an incubator and the child survives without neurologic damages. The used measures of the resuscitation are discussed on the basis of the therapy.

On the basis of a case report the prehospital management of severely burned patients is discussed. The prevention of hypovolemia, hypothermia or hypoxemia are the primary targets. It is necessary to estimate the burn size and depth. The burn shock fluid resuscitation, prevention of hypothermia, pain- and airway management are described as well as the transport from the scene of accident to a proximal emergency unit or to a specialized burn intensive care unit.

This case report describes the prehospital care of a person with severe polytrauma due to being jammed in a vehicle in a traffic accident. After understanding the forces involved in causing the trauma, the therapy of impaired vital functions is demonstrated with particular regard to time management. Use of a rescue helicopter allowed for minimizing the delay to initial treatment as well as the duration of transport.