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Fri Mar 9 05:02:38 GMT 2007

Hang on Matthew

Sanjay painted the picture of a STABLE patient. This situation is different to the unstable scenario you suggest and the protocol for care to be used in that situationwhich you provided quite correctly.

Sanjay - most likely this situation will remain stable. Unless your patient was a transient responder (unlikely given he scenario you sketched), which indeed may require angio-embolisation, this should be a stable situation with a low chance of a rebleed unless someone goes and over-enthusiastically examines the pelvis (which should not be done at this stage) Iliac wing fractures often bleed initially, seldom late. Rami fractures are mostly stable (and are best treated conservatively unless compound). Bed-rest and 2-hourly pressure care log-rolling should be all that is needed. Obviously long-distance transfers should be avoided, but if your institution is providing the definitive care there should not be a problem.

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
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-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of Wilson, Matthew,
M.D.
Sent: Thursday, March 08, 2007 10:08 PM
To: 'Trauma &amp'; 'Trauma &amp, Critical Care mailing list'
Subject: RE: Pelvic fractures

The bleeding can be quite extensive requiring a massive transfusion
protocol.  If worried get angio. For hemodynamic instability transfuse until
stable.  PRBC and FFP and Platelets must be warmed.  Wrap pelvis with a
sheet to reduce volumw of the pelvic ring.  Check Xray to confirm reduction.
Mortality high if bleeding not controllesd.  Good luck

 -----Original Message-----
From: 	Sanjay Gupta MD [mailto:sanjaygupta99_91 at yahoo.com]
Sent:	Thursday, March 08, 2007 11:12 AM Pacific Standard Time
To:	Trauma &amp, Critical Care mailing list
Subject:	Pelvic fractures

Pelvic fracture - lateral compression with superior
and inferior pubic rami fractures on right and
fracture of the iliac wing on the right very close to
the SI joint.  No other injuries.  Patient
hemodynamically stable.  Any specific precautions in
transporting these patients until their pelvis gets
fixed (which is usually 2-3 days in our center).  Can
such fractures bleed massively later in the hospital?

Any insight / comments appreciated.

Sanjay

--- Coats Tim - Professor of Emergency Medicine
<Tim.Coats at uhl-tr.nhs.uk> wrote:

> No. Absolutely and definitely no log roll. 
> 
> He could well have a fracture pelvis. These unstable
> patients can die if
> you log roll them (movement of pelvic bones disrupts
> clot, increases
> bleeding, patient arrests). Have learnt this through
> observation the
> hard way (thought I guess harder for my patients
> than for me!).
> 
> I always practice and teach minimum patient handling
> to preserve clot.
> Log roll in the type of patient you describe is
> usually of little
> benefit and carries a high risk - so don't.
> 
> Tim. Coats.
> Professor of Emergency Medicine.
> Leicester University.
> 
> -----Original Message-----
> From: Jacob Scholtz [mailto:jacob.scholz at gmail.com] 
> Sent: 07 March 2007 18:13
> To: trauma-list at trauma.org
> Subject: Log-roll in the trauma bay
> 
> A patient is brought into your trauma-bay after a
> from a building. He
> has a neck-collar, but the rest of his spine has not
> been immobilised.
> He is in respiratory distress. The airway is clear.
> Breath-sounds are
> present bilaterally. Saturation 99% with 10 L O2.
> Blood pressure 65/-.
> His abdomen is tender. He has no obvious open
> injuries to the thorax,
> abdomen or extremities. Fluids are given, but the
> blood pressure does
> not improve significantly. The surgeon wants the
> patient brought to the
> OR for a laparotomy. The patient is complaining of
> pain from the lower
> back, the abdomen and his legs bilaterally. Would
> you log-roll the
> patient before bringing him to the OR?
> 
> Jacob
> 
> 
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Sanjay Gupta MD
Tel: 412 335 6304

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