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Fri Mar 9 12:59:57 GMT 2007

Thank you. 

Sanjay 

--- "Hardcastle, Tim, Dr <tch at sun.ac.za>"
<tch at sun.ac.za> wrote:

> 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
> Intern program Coordinator: Surgery
> M.Med (Emergency Medicine) Executive Committee
> member
> Clinical Head (Director): Diana Princess of Wales
> Trauma Unit
> Division of Surgery (General) Room 4064
> Department of Surgical Sciences
> Tygerberg Hospital / University of Stellenbosch
> PO Box 19063
> Tygerberg 7505
> Western Cape
> South Africa
> e-mail: tch at sun.ac.za
> Cell: +27824681615
> Office: +27219389281 or 4911 pager 0302
> 
> 
> 
> -----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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Sanjay Gupta MD
Tel: 412 335 6304

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