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Mon Nov 15 22:41:53 GMT 2004

Errington...
You are right, but do you have any "hard" data proving that one or the other 
method (prehospital) is effective? Any randomised trials?

Rgs
Jarek Gucwa MD
Krakow
Poland

----- Original Message ----- 
From: "E C Thompson" <ecthompson at msn.com>
To: <trauma-list at trauma.org>
Sent: Monday, November 15, 2004 11:37 PM
Subject: RE: Pelvic Fx Management (WAS RE: drug screens in trauma)

Actually, many surgeons consider splinting the pelvis as a resuscitation
maneuver.

E

Errington C. Thompson, MD, FACS, FCCM
Trauma/Surgical Critical Care
Trinity Mother Frances
Tyler, Tx
ecthompson at msn.com
Don't think you are
Know you are
                  - Morpheus (The Matrix)

>From: "Bjorn, Pret" <pbjorn at emh.org>
>Reply-To: Trauma & Critical Care mailing list <trauma-list at trauma.org>
>To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
>Subject: Pelvic Fx Management (WAS RE: drug screens in trauma)
>Date: Mon, 15 Nov 2004 14:03:36 -0500
>
>PLEASE, folks: if for whatever reason you decide to completely switch
>topics
>in mid-thread, CHANGE THE FREAKING SUBJECT LINE.
>
>Splinting the pelvis isn't a resuscitation technique.  It's just good
>fracture management, thereby producing a patient variously less needful of
>resuscitation.
>
>The sometimes surprising fact is that unstable pelvic fracture patterns
>(Young and Burgess A&B Type II+'s and all vertical shear patterns) tend to
>bleed to death from causes unrelated to simple malalignment.  Pelvic
>arterial injuries are uncommon, and pelvic venous injuries are
>low-pressure--usually self-limiting if the retroperitoneum is undisturbed.
>In either case, if a vascular injury is the primary culprit in your
>patient's ongoing exsanguination, you're probably past the point where
>fixation alone--of any kind--is going to make a critical difference.  Make
>haste to angiography and leave a note for the orthopod telling her where to
>find you.
>
>So.  Where the true pelvis is concerned, we're left with the last
>significant bleeding source being the bones themselves--which bleed plenty,
>and like any fractures, bleed more when they're crunching around
>unrestricted.  The earlier we attend to keeping them still, the less
>resuscitation we'll all have to endure.  Splinting is a means of reducing
>secondary (often nosocomial) injury; nothing less, nothing more.  Don't
>make
>it difficult.
>
>Several years ago, Harborview published an interesting paper suggesting
>that
>a snugly-tied bed sheet makes a respectable external fixator.  Many
>hospitals still use percutaneous external erector sets; some a big C-clamp;
>we like an expensive but intuitive commercial girdle gizmo with lots of
>Velcro.  Whatever method you select, the idea is that you're trying to keep
>bone mobility to a minimum, in a manner conspicuous enough that others can
>immediately appreciate and embrace your objectives.
>
>It helps if your chosen technique allows maximal access to the patient
>beneath; at the very least, carefully examine everything you're covering
>up,
>'cause the more the splint gets taken down and redone, the less good it's
>doing.
>
>Gavin suggests avoiding PASG's unless they're "totally indicated."  Given
>pretty much any other means of pelvic splinting (including duct tape and
>premixed concrete), there's NO INDICATION FOR PASG's FOR ANYTHING ANYMORE.
>Destroy them, before anyone else gets hurt.
>
>Finally, remember that a major cause of death in victims of pelvic trauma
>is
>extrapelvic injury.  Busted pelvises are rarely diagnosed in isolation.
>Another reason to keep things simple: the faster you immobilize (and maybe
>embolize), the faster you can move on to that pesky liver injury.
>
>Hope this is helpful.
>
>Pret Bjorn, RN, etc.
>EMMC Trauma Program
>489 State St
>Bangor, ME 04401
>
>
>-----Original Message-----
>From: GAVIN SUTTON [mailto:Gsutton at pgwc.gov.za]
>Sent: Monday, November 15, 2004 8:40 AM
>To: trauma-list at trauma.org
>Subject: RE: drug screens in trauma
>
>
>Shane
>
>My name is Gavin and I'm head of Training & Development for EMS in Cape
>Town, South Africa.
>
>We are making use of a device called the pelvi-grip for ? pelvic
>fractures. It was designed by one of our trauma personnel and has proved
>to be very valuable. MAST/PASG are still in circulation here, but are
>seldom used due to the difficulties in removing them from patients once
>applied.
>
>In areas where hospital transport times are long or delayed, there is
>always the potential for causing crush-like injuries when applying any
>"splinting" of potential pelvic fractures. This is especially in
>circumstances where the wrap is applied too tightly and extends to the
>distal area of the buttocks. It is for this reason that we try avoid
>using the MAST/PASG unless it is totally indicated. In certain
>situations, the Kendricks Extrication Device may also prove valuable in
>splinting pelvic fractures although it was not really designed for this
>purpose. It is in my experience that the frank complications of applying
>pre-hospital pelvic splinting do not exceed the pros and I would
>therefore not hesitate to make use of it if required.
>
>Regards
>Gavin
>
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