[Medical, ethical and economical limitations in the treatment of multitrauma patients].

In the early post-traumatic period severe traumatic brain injuries and massive bleeding from disrupted parenchymal organs, large vessels or crush injuries of the pelvis may present as morphological damage that renders survival impossible, although aggressive fluid and blood replacement therapy in conjunction with immediately stopping blood loss surgically may result in survival in selected cases. In contrast, late mortality from multiple organ failure - which in the past limited survival in 10 to 30% of patients in that condition - has in recent years reduced this as the cause of death to less than 5%. Part of the responsibility of the surgeon caring for the severely injured into consider the ethical limitations to avoid futile use of the sophisticated life-support measures in the intensive care setting. A threat to optimal care of the severely injured patient may arise from the economical restraints imposed on health-care providers. When one considers the enormous political and socioeconomical importance of rehabilitating the predominantly young trauma patients and reintegrating them into the work world, an appeal has to be made to all those responsible to secure optimal care for severely injured patients in the future.