[A Fatal Case of Fulminant Necrotising Fasciitis in a 47-Year-Old Male]. / Foudroyante nekrotisierende Fasziitis bei einem 47-jährigen Mann.

Necrotising fasciitis (NF) is a rare soft tissue infection characterized by rapid progressive necrosis. Initially patients usually present with nonspecific symptoms like fever, severe pain and skin lesions that progress rapidly. It requires prompt recognition and early treatment with extensive surgical debridement and intravenous antibiotics. Mortality despite adequate therapy is high, ranging between 15 and 46%. NF has previously been reported in literature. Some assumed premorbid conditions associated with NF are diabetes mellitus, chronic kidney injury, adiposity, peripheral artery occlusive disease, arterial hypertension, intravenous drug abuse and immunocompromised state. Here we present a fatal case of NF in a 47-year-old male patient without any comorbidity after minor trauma with a fulminant septic course.

Survival benefit of helicopter emergency medical services compared to ground emergency medical services in traumatized patients.

INTRODUCTION: Physician-staffed helicopter emergency medical services (HEMS) are a well-established component of prehospital trauma care in Germany. Reduced rescue times and increased catchment area represent presumable specific advantages of HEMS. In contrast, the availability of HEMS is connected to a high financial burden and depends on the weather, day time and controlled visual flight rules. To date, clear evidence regarding the beneficial effects of HEMS in terms of improved clinical outcome has remained elusive. METHODS: Traumatized patients (Injury Severity Score; ISS≥9) primarily treated by HEMS or ground emergency medical services (GEMS) between 2007 and 2009 were analyzed using the TraumaRegister DGU® of the German Society for Trauma Surgery. Only patients treated in German level I and II trauma centers with complete data referring to the transportation mode were included. Complications during hospital treatment included sepsis and organ failure according to the criteria of the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus conference committee and the Sequential Organ Failure Assessment (SOFA) score. RESULTS: A total of 13,220 patients with traumatic injuries were included in the present study. Of these, 62.3% (n=8,231) were transported by GEMS and 37.7% (n=4,989) by HEMS. Patients treated by HEMS were more seriously injured compared to GEMS (ISS 26.0 vs. 23.7, P<0.001) with more severe chest and abdominal injuries. The extent of medical treatment on-scene, which involved intubation, chest and treatment with vasopressors, was more extensive in HEMS (P<0.001) resulting in prolonged on-scene time (39.5 vs. 28.9 minutes, P<0.001). During their clinical course, HEMS patients more frequently developed multiple organ dysfunction syndrome (MODS) (HEMS: 33.4% vs. GEMS: 25.0%; P<0.001) and sepsis (HEMS: 8.9% vs. GEMS: 6.6%, P<0.001) resulting in an increased length of ICU treatment and in-hospital time (P<0.001). Multivariate logistic regression analysis found that after adjustment by 11 other variables the odds ratio for mortality in HEMS was 0.75 (95% CI: 0.636 to 862). CONCLUSIONS: Although HEMS patients were more seriously injured and had a significantly higher incidence of MODS and sepsis, these patients demonstrated a survival benefit compared to GEMS.