Trendelenburg position
The Trendelenburg position or pelvic elevation is the position of a patient on a table inclined by about 45 °, in such a way that the head is down, the pelvis is high and legs and feet hang over the edge of the table.
The surgeon Friedrich Trendelenburg used the positioning from 1880 for bladder and gynecological operations. He left the first publication in 1885 to his assistant Willy Meyer. Originally, the positioning required an assistant: “The head lies low down, the hindquarters and pelvis raised high on the edge of the head piece (the operating table). A guard, who turns his back to the operating table, holds the patient's legs apart and bent at the knees, thus ensuring that the position remains unchanged. How easily comprehensible do the intestines sink now, following the gravity, towards the diaphragm, the opened bladder gapes ... and allows not only a completely free view into the interior, but also ... the most convenient introduction of the necessary for extirpation (of tumors) and other manipulations Instruments…. In this way one can make observations that are not possible in the usual supine position…. This position can best be described as a pelvic elevation . ”Later the helper was replaced by a special operating table .
In the commemorative publication on Trendelenburg's 70th birthday in 1914, Meyer, now a surgeon in New York, recalled: “Since the writer of these lines was allowed to work at Trendelenburg's side when the pelvic elevation was being worked out at the Bonn surgical clinic, as he was furthermore the rare favor was granted to be allowed to publish the discovery of the revered chief in words and pictures, so it may be permissible for him today to evoke the memory of that time of the development of the high camps…. Over the past 30 years, Trendelenburg's elevated pelvic position has become an indispensable common property of all surgeons. "
To this day, storage is important. Today it is understood more as a shock position in which the patient's head is significantly lower than the body's center of gravity. However, the effectiveness of the Trendelenburg position in shock is controversial. Some authors even describe negative effects on lung function and intracranial pressure through the use of positioning . In the current recommendations of the DIVI commission, in addition to simply elevating the legs, positioning is still recommended in the context of shock control in the event of absolute volume deficiency shock, anaphylactic and septic-toxic shock.
The currently valid standard EN 60601-2-52 for nursing and hospital beds defines the Trendelenburg position as a lying surface tilted by at least 12 °.
See also
- Trendelenburg operation for varicose veins
- Trendelenburg operation for pulmonary embolism
- Trendelenburg test
- Trendelenburg sign
literature
- Wilhelm Iff: Contribution to the history of pelvic elevation. In: Janus 41, 1937, pp. 153-166.
Web links
Individual evidence
- ↑ a b Willy Meyer: About the follow-up treatment of the high stone incision as well as about its usability for the operation of bladder vaginal fistulas. In: Archives for surgery 1885; 31: 494-525
- ↑ Willy Meyer: The triumphant advance of the pool elevation . In: German journal for surgery 1914; 129: 306-320
- ^ M. Thiery: Friedrich Trendelenburg (1844-1924) and the trendelenburg position . In: Gynecological Surgery 2009; 6: 295-297
- ↑ The use of the shock position in the preclinical setting for acute hypotension. November 20, 2012. Retrieved November 21, 2012 .
- ^ S. Johnson, S. Henderson: Myth: The Trendelenburg position improves circulation in cases of shock . In: Canadian Journal of Emergency Medicine 2004; Archived copy ( memento of the original from March 8, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Adams HA et al. Statement by the DIVI “Shock” section on the shock situation. Emergency doctor. 2012; 28: 12-16.
