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Sun Oct 28 11:37:22 GMT 2007

Doesn't work for me either even if I cut and paste. 

How does one technically do this? Do you worry about violating expanding
hematoma?

Rob Smith

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Richard Wigle MD FACS
Sent: Saturday, October 27, 2007 10:19 PM
To: Trauma &amp, Critical Care mailing list
Subject: RE: Pelvic fracture

Having had the opportunity to hear Dr Moore speak on this
topic I would very much like to have access to this
presentation. This link- and the previous link- are,
however not working for me despite my trying all the usual
tricks to milk reticent data from web sites. Any other
suggestions?

R Wigle
--- Stephen Luk <Sluk at harthosp.org> wrote:

> A presentation by Dr. Moore from the Panamerican Trauma
> Society meeting
> on Pelvic Packing.  
> 
>
http://www.panamtrauma.org/Lectures/Pelvic%20Retroperitoneal%20Packing%20Rel
ated%20to%20Hemorrhage%20by%20Fractures/player.html
> 
> 
> 
> 
> Stephen S. Luk, MD, FACS, FCCP
> Assistant Professor of Surgery
> Associate Director of Trauma
> Medical Director, ATOM Course
> Hartford Hospital
> EMS/Trauma Program
> 80 Seymour Street
> Hartford, CT 06102-5037
> (860) 545-3766
> sluk at harthosp.org 
> 
> 
> >>> Olav Røise <olav.roise at medisin.uio.no> 10/27/2007
> 10:26 AM >>>
> I agree with Ken Mattox. I introduced extrapelvic packing
> in Oslo in
> 1994
> and it has been part of our pelvic bleeding protocol ever
> since.
> 
> So as the patient is haemodynamically unstable this would
> be the option
> in
> this case.  First the fracture should be stabilized with
> the binder or
> sheet
> around the trochanter region and kept in place during the
> surgical
> procedure
> of damage control. 
> 
> For the urethral injury I would not have put the catheter
> in before
> the
> urethra was cleared by an urethra-graphy.  It is known
> that catheter
> can put
> a partial rupture into a total disruption. I would not
> focus on the
> urethra
> before the pelvic bleed is under controll. 
> 
> With regard to the possible rectal injury we are doing a
> rectal/sigmoidoscopy to exclude injury. We have seen
> false negative
> contrast
> exam. of the rectum. This has of low priority and should
> not be done
> before
> control of the bleed. Eventually a sigmoidotomy shoul be
> done - keeping
> in
> mind the later reconstruction of the pelvis - and talk to
> the pelvic
> surgeon
> to avoid incision conflict for later reconstruction of
> the pelvis 
> 
> 
> 
> With kind regards,
> 
> Olav
> 
> Olav Røise
> 
> Division of Neuroscience and Muscoloskeletal Medicine,
> Ullevaal
> University
> Hospital, Oslo
> 
> Cellular phone;+4790895062
> E-mail;olro at uus.no or; olav.roise at medisin.uio.no 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] 
> On Behalf Of KMATTOX at aol.com 
> Sent: 27. oktober 2007 15:44
> To: trauma-list at trauma.org 
> Cc: ccm-l at ccm-l.org 
> Subject: Re: Pelvic fracture
> 
>  
> In a message dated 10/27/2007 5:39:42 A.M. Central
> Daylight Time,  
> hpb.surgery at gmail.com writes:
> 
> 1.  Pelvic fracture + suspected ongoing retro peritoneal
> venous bleed, 
> what
> surgical strategy would you employ?
> 2. If a rectal tear is  suspected, without any perioneal
> trauma, how
> would
> you
> de-function, loop  colostomy? Or end colostomy and mucous
> fistula?
> Would you
> try and establish  the site of perforation - on-table
> flexible
> sigmoidoscopy
> etc.?
> 
> 
> 
> I agree with Bjorn regarding the excessive fluid
> administration.  
>  
> The patient appears to be hemodynamically stable.    If 
> unstable, then
> one 
> of several tactics to impede ongoing blood loss is 
> indicated.   I
> have
> never 
> been totally satisfied with arterial  embolization for
> control of
> venous 
> bleeding.    I also have not  been satisfied with
> external fixation to
> reduce blood 
> loss.   The  orthopedic community is mixed in its support
> of external 
> 
> fixation.    The new extra peritoneal packing as reported
> from  Europe
> and
> from a 
> couple of centers in the United States bears  watching.  
>  I might have
> 
> considered such a procedure in this  patient.   It is a
> temporizing
> ("damage
> control") 
> tactic.  
>  
> With the case as you describe, I would consider going to
> OR for an  
> examination under anesthesia, looking mainly at the
> rectum.     For
> this one
> does not 
> need to do a flexible sigmoidoscopy, as it is only the 
> rectum which is
> of 
> concern.     This can be done with a  straight short
> scope.     Even a
> full 
> thickness injury might  be missed, but your CT
> description is
> suggestive of
> a rectal 
>  injury.     I would strongly consider a LOOP colostomy,
> but  to be
> sure
> that 
> the distal stoma is totally defunctionalized, unless the
> patient  is
> obese 
> and the mesentery is foreshortened and to do a loop would
> create 
> vascular 
> compromise to the exteriorized
>  segment.       If the patient's pelvis
> was 
> operatively repaired, and he did not become  febrile, I
> would study
> the
> distal rectum 
> via the loop colostomy and if NO LEAK,  I would consider
> closing this
> colostomy 
> at the first  hospitalization.   
>  
> k
> 
> 
> 
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