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Fri, 3 May 2002 12:28:41 -0400

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Matt,

See my previous post for volume loss estimates.  They're ultimately less
important than the condition of the patient in front of you.

Management includes airway, breathing, control of hemorrhage to the extent
you're able (splinting), and making haste for an appropriate hospital (that
is, one with skilled orthopedists and, if it's not too much trouble,
interventional radiology).  Multiple proximal long bone fractures or pelvic
fracture should trigger air transfer, if you're four hours out by ground.

I think it's fair to say that splinting of the pelvis is a matter of
controversy.  There are many who suggest that this is the last defensible
application for PASG's, others who'd recommend a snugly-tied sheet.  In
either case, your mission is to prevent secondary injury more than to reduce
intraperitoneal or retroperitoneal volume.  

Fluid resuscitation (note the term: there is no indication for fluid
replacement in the absence of hypoperfusion) is a whole other can of worms.
At the very least it should be undertaken with attention to restoring
perfusion, not maximizing blood pressure; and care should be taken that
transport is delayed as little as possible, if at all.

Good luck to you.  Your corner of Australia sounds a bit like my corner of
the States.

Pret

-----Original Message-----
From: Camille and Matt [mailto:camillematt@bigpond.com]
Sent: Thursday, May 02, 2002 6:52 AM
To: trauma-list@trauma.org
Subject: Blood loss related to closed fractures

Hi All,
Does anyone have details of estimated/possible blood loss related to closed
fractures of long bones and pelvis. Articles that are able to be referenced
much appreciated. Any ideas on non-operative management of the above in a
remote area (>4hrs from Hospital).
Cheers Matt Mason RN
Amata Clinic 
Central Australia

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<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002>Matt,</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=630560216-03052002>See my 
previous post for volume loss estimates.&nbsp; They're ultimately less important 
than the condition of the patient in front of you.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002>Management includes airway, breathing, control of 
hemorrhage to the extent you're able (splinting), and making haste for an 
appropriate hospital (that is, one with skilled orthopedists and, if it's not 
too much trouble, interventional radiology).&nbsp; Multiple proximal long bone 
fractures or pelvic fracture should trigger air transfer, if you're four hours 
out by ground.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=630560216-03052002>I 
think it's fair to say that splinting of the pelvis is a matter of 
controversy.&nbsp; There are many who suggest that this is the last defensible 
application for PASG's, others who'd recommend a snugly-tied sheet.&nbsp; In 
either case, your mission is to prevent secondary injury more than to reduce 
intraperitoneal or retroperitoneal volume.&nbsp; </SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002></SPAN></FONT><FONT color=#800000 face=Arial 
size=2><SPAN class=630560216-03052002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=630560216-03052002>Fluid 
resuscitation (note the term: there is no indication for fluid <EM>replacement 
</EM>in the absence of hypoperfusion) is a whole other can of worms.&nbsp; At 
the very least it should be undertaken with attention to restoring perfusion, 
not maximizing blood pressure; and care should be taken that transport is 
delayed as little as possible, if at all.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN class=630560216-03052002>Good 
luck to you.&nbsp; Your corner of Australia sounds a bit like my corner of the 
States.</SPAN></FONT></DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002></SPAN></FONT>&nbsp;</DIV>
<DIV><FONT color=#800000 face=Arial size=2><SPAN 
class=630560216-03052002>Pret</SPAN></FONT></DIV>
<BLOCKQUOTE style="MARGIN-RIGHT: 0px">
  <DIV align=left class=OutlookMessageHeader dir=ltr><FONT face=Tahoma 
  size=2>-----Original Message-----<BR><B>From:</B> Camille and Matt 
  [mailto:camillematt@bigpond.com]<BR><B>Sent:</B> Thursday, May 02, 2002 6:52 
  AM<BR><B>To:</B> trauma-list@trauma.org<BR><B>Subject:</B> Blood loss related 
  to closed fractures<BR><BR></DIV></FONT>
  <DIV><FONT face=Arial size=2>Hi All,</FONT></DIV>
  <DIV><FONT face=Arial size=2>Does anyone have details of estimated/possible 
  blood loss related to closed fractures of long bones and pelvis. Articles that 
  are able to be referenced much appreciated. Any ideas on non-operative 
  management of the above in a remote area (&gt;4hrs from 
Hospital).</FONT></DIV>
  <DIV><FONT face=Arial size=2>Cheers Matt Mason RN</FONT></DIV>
  <DIV><FONT face=Arial size=2>Amata Clinic </FONT></DIV>
  <DIV><FONT face=Arial size=2>Central 
Australia</FONT></DIV></BLOCKQUOTE></BODY></HTML>

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