London Splint
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Vermeulen B, Peter R, Hoffmeyer P, Unger PF, 'Prehospital stabilization of pelvic dislocations: a new strap belt to provide temporary hemodynamic stabilization.' Swiss Surgery. 5(2):43-6, 1999.
Abstract: High energy pelvic fractures or dislocations are associated with a high rate of early complications, due to the associated intrapelvic organs. The high rate of early mortality is mostly due to the intrapelvic, retroperitoneal bleeding caused by the laceration of vascular structures located in the presacral area. External compression of the pelvic ring, using such devices as PASG or external fixators may prevent the intrapelvic collection of large hematomas by providing indirect tamponade.
Unfortunately, these devices are either unavailable on the accident site, or the complexity of their handling is discouraging for the primary care-taker. A simple system of external pelvic compression which could be applied on the scene of trauma consisting of a pelvic strap-belt was therefore developed. The application of the device is easy, quick (30 seconds) and straightforward. Its use does not induce any known complications and requires minimal training. The cost and transportability of the system are further advantages. The system has already been used in 19 patients equipped on accident scene. Our first experiences using this device are reviewed.
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Kendrick Extrication Device (KED)
Trauma-List mailing list thread:
An alternative to using Pneumatic Antishock Garment (PASG) for an unstable pelvis is to use a Kendrick Extrication Device (KED). Slide the KED under the patient with the head support toward the feet. Secure the straps around the waist and legs. Scoop the pt to a LS board.
SFC Bill Fults, NREMT-P, 75th Ranger Regiment
Pneumatic Antishock Garment (PASG)
Connolly B; Gerlinger T; Pitcher JD
'Complete masking of a severe open-book pelvic fracture by a pneumatic
antishock garment.' J Trauma 1999 46(2):340-2
Department of General Surgery, Madigan Army Medical Center,
Tacoma, Washington, USA.
Flint LM Jr; Brown A; Richardson JD; Polk HC 'Definitive control of bleeding from severe pelvic fractures.' Ann Surg 1979 189(6):709-16
'Failure of patients to respond promptly to the G-suit strongly suggests arterial bleeding amenable to selective catheterization and embolic occlusion.'
Abstract: Forty patients with severe pelvic fracture and extraperitoneal hemorrhage were reviewed. Eighteen patients seen prior to 1975 (group I) were clinically similar to 22 patients seen subsequently (group II). Major pelvic fracture hemorrhage was defined as bleeding in excess of 2,000 ml over and above initial resuscitation volumes. Ten of 22 group II patients met the criteria for continued extraperitioneal bleeding and were immobilized in an inflatable G-suit after surgically remediable lesions had been excluded. Ventilator support and hemodynamic monitoring were instituted and clinical response recorded. Prompt cessation of bleeding was observed in nine of ten patients. One patient required selective catheterization of a bleeding artery with subsequent embolic occlusion. Significant reductions in overall mortality and the frequency of shock related death were observed in group II patients. Sepsis was the leading cause of late death in survivors. Immobilization of pelvic fracture patients in the G-suit is recommended as a means of controlling continuing retroperitoneal hemorrhage when surgically correctable bleeding points have been dealt with. Failure of patients to respond promptly to the G-suit strongly suggests arterial bleeding amenable to selective catheterization and embolic occlusion.
