Hanging trauma

from Wikipedia, the free encyclopedia
Classification according to ICD-10
R57 shock
R57.1 Hypovolemic shock
R57.8 Other forms of shock
R57.9 Shock, unspecified
ICD-10 online (WHO version 2019)

The term hanging trauma describes a potentially life-threatening state of shock that can occur during prolonged motionless free hanging in a belt system . The forced upright posture ( orthostasis ) causes the blood to "sink" into the hanging parts of the body due to gravity . The hanging trauma has only been known as a disease since the 1970s.

root cause

Hanging motionless for long periods of time can lead to hanging trauma.

Nowadays, the causes are mostly accidents in which the patient then hangs upright in a belt system without moving for a long time. Possible causes for a motionless pause can be, for example, exhaustion , hypoglycaemia , hypothermia , technical or psychological problems or even a traumatic brain injury . Not only parachutists , mountaineers or paragliders or hang-gliders are at risk , but above all those who work at height and use PPE .

Disease emergence

Normal orthostatic response

If a person changes his body position from lying down to standing, up to 600 ml of blood (if varicose veins are present , significantly more) “sink” into the venous capacity vessels of the legs due to gravity .

This briefly reduces the cardiac output and arterial blood pressure . The counter-regulation of the body ( orthostasis reaction ) consists of a narrowing of the blood vessels , an increase in heart rate and catecholamine release, as well as an activation of the renin-angiotensin-aldosterone system with the aim of increasing blood pressure again. The stimulation of the muscle pumps in the legs when standing or walking has a synergistic effect . Local self-regulation mechanisms in the blood vessels of the brain compensate for a critical drop in blood flow. However, if the effect of this counter-regulation is insufficient and the blood flow to the brain is severely reduced, dizziness or even fainting (orthostatic syncope ) occurs. Under normal conditions, the person concerned leaves the upright body position immediately and sits down or falls, which significantly reduces the changes caused by gravity in the short term. The occurrence of an orthostatic shock is not to be expected under these conditions.

Development of the hanging trauma

When hanging freely in a belt system, on the one hand, in the event of excessive stress ( decompensation ) of the orthostatic counter-regulation mechanisms (occurrence of orthostatic syncope ), a change in the upright body position and thus a regression of the changes caused by gravity is generally not possible and, on the other hand, there is also no "counter pressure" on the feet to improve the venous return by stimulating the muscle pump and thus to increase the heart rate. As the process progresses, the blood increasingly “sinks” into the drooping parts of the body, causing a life-threatening (orthostatic) shock and a persistent lack of oxygen to the brain within half an hour at the most .

Gravity-related constrictions of the extremities by the belt system in the sense of bloodless bloodletting or even tourniquet syndrome and varicosis can make things more difficult .

Ultimately, a redistribution of the blood develops, which initially only leads to excessive demands on the body's orthostatic counter-regulation mechanisms, but in the further course of which a functional lack of volume develops that is so relevant that a state of shock develops on a life-threatening scale.

Symptoms

The time until the first symptoms appear varies greatly from person to person. They can appear after a few minutes, but usually after 20 minutes of free hanging at the latest. Typical are paleness, sweating, shortness of breath, visual disturbances, dizziness, nausea, drop in blood pressure and numbness of the drooping legs.

therapy

As a preventive measure, a suitable belt system should be used that does not impair breathing or constricts the extremities when hanging freely. In addition, rope loops are recommended as emergency equipment. The casualty can put his feet in this and then support himself with his legs in order to stimulate the function of the muscle pump. These measures can also be used therapeutically in the initial phase. However, it is crucial to rescue the patient from the suspended position as quickly as possible.

Since the hanging trauma is a shock event, it is an emergency medical clinical picture (→ shock ). The previous recommendation to initially position the patient upright in order to avoid a rescue death has been replaced by the recommendation of an initial flat position with the unchanged cABCDE algorithm due to more recent findings.

General meaning

Artist's impression of a crucifixion. ( Hieronymus Bosch ) around 1497

The hanging trauma is a rare occurrence; its importance is assessed differently. Employers' liability insurance associations see the need to be particularly active in prevention (occupational safety) . Around 20 documented cases in which the sole cause of death is suspected to be hanging trauma date from the 1960s and 1970s. Lee et al. therefore asked whether the suspension trauma when using modern belt systems is to be assessed specifically or merely as a “theoretical risk” and call for further research projects. Even on construction sites that are considered to be safe, accidents have been reported in individual cases in which a suspension trauma is an obvious (near) cause of death. In (sport) climbing , hanging trauma is considered a very rare complication, but according to the German Alpine Club there are no exact statistics on accidents in this area.

Sports and occupational medicine

Nowadays, hanging trauma mainly plays a role in accidents beyond the emergency medical aspects. Appropriate prevention and therapy can basically save lives in many cases. The hanging trauma therefore plays a role in both sports and occupational medicine .

Executions

A crucifixion victim would be in exactly the right position and situation to suffer excessive venous pooling and orthostatic shock: upright with no movement of the legs. (Quote by)

The crucifixion was in the past, a common form of execution. The victims were fixed hanging freely in an upright body position. In theology , the hanging trauma is discussed as the cause of Jesus' death on the cross.

Definition of terms

The causes of death when hanging are the compression of the cervical soft tissues with possible restriction of the cerebral blood flow, irritation of the carotid sinus or suffocation and, rarely, the " Hanged man's fracture " (arched fracture of the axis with spondylolisthesis and possible compression of the medulla oblongata ).

Initial description

The French doctor and cave explorer Maurice Amphoux is considered to be the first person to describe hanging trauma. In the 1970s, he had noticed unexplained deaths among speleologists who had died after an initially harmless-looking crash. Even though there had been first attempts with hanging people as early as the late 1960s, it was he who was the first to propose the thesis that the cause of the sometimes fatal outcome of hanging trauma are cardiovascular problems ("circulatory shock").

See also

Individual evidence

  1. ↑ a b c Harald Dippe: Development of a training concept for rope-assisted rescue in mining . GRIN Verlag, 2007, ISBN 3-638-82129-3 , p. 8, books.google.de
  2. ^ Great Britain: HM Fire Service Inspectorate: Fire and Rescue Service Manual . The Stationery Office, 2006, pp. 9ff., ISBN 0-11-341312-2 , books.google.com
  3. ↑ Ch. Hick et al .: Intensive Physiology Course . Urban & FischerVerlag, 2006, ISBN 3-437-41892-0 , pp. 89ff., Books.google.de
  4. ↑ a b c d e Emergency situation: hanging trauma . (PDF) "First Aid" committee of the German Social Accident Insurance; Retrieved February 1, 2009
  5. ↑ a b c Suspension Trauma / Orthostatic Intolerance . ( Memento of May 11, 2008 on the Internet Archive ) US Department of Labor Safety and Health Information Bulletins; Retrieved February 2, 2009
  6. ↑ a b c d e f g h P. Seddon: Harness suspension: review and evaluation of existing information . (PDF) In: Health and Safety Executive - Contract Research Report 451/2002.
  7. ↑ H. von Hintzenstern et al .: Emergency Doctor Guide . Urban & FischerVerlag, 2004, ISBN 3-437-22461-1 , p. 116, books.google.de
  8. ↑ Raimund Lechner, Enrico Staps, Hermann Brugger, Simon Rauch: Rescue service strategy for hanging trauma in rescue! - Edition 05 - Volume 8 - November 2019. Georg Thieme Verlag KG Stuttgart, p. 113ff, [1]
  9. ↑ a b c W. Dieker: Apparently saved - The hanging trauma, a deadly danger that is too little known . Professional Association for Food and Restaurants; Retrieved February 2, 2009
  10. ↑ Working with a full body harness . ( Memento of October 28, 2007 in the Internet Archive ) (PDF) In: Unfall-stop , Berufsgenossenschaft Handel- und Warendistribution, 2 / March 2006, pp. 8–9.
  11. ↑ Fall protection - arrogance comes before the fall . ( Memento from September 14, 2008 in the Internet Archive ) ARD - Ratgeber Technik, September 8, 2007
  12. ^ C Lee et al .: Suspension trauma. In: Emerg Med J. 2007 Apr, 24 (4), pp. 237-238, PMID 17384373 .
  13. ^ R Clemens: Learning from bitter experience - The construction site accident in Grevenbroich-Neurath . ( Memento of May 30, 2009 in the Internet Archive ) (PDF) In: gute Arbeit , 12/2007, pp. 29–30; Retrieved February 6, 2009
  14. ^ V. Schöffl: The fight on the wall . In: medicalsports network, 4/08, succidia Verlag, pp. 44-46, ZDB -ID 2417844-5
  15. ↑ M. Schieferecke: climbers after falling in mortal danger . Stuttgarter Zeitung-Online from July 25, 2008, stuttgarter-zeitung.de ( Memento from March 9, 2009 in the Internet Archive ); Retrieved February 7, 2009
  16. ↑ P. Bishop: An Alternative Mechanism For Death by Crucifixion . In: Linacre Quarterly , Catholic Medical Association, August 2006, pp. 282-289, ISSN  0024-3639 , pdf
  17. ↑ Hamid Abdolvahab-Emminger: Exaplan . Urban & FischerVerlag, 2007, p. 2348, ISBN 3-437-42462-9 , books.google.de
This version was added to the list of articles worth reading on February 23, 2009 .