Pelvic fracture - operative findings

• Previous message: Pelvic fracture - operative findings
• Next message: Pelvic fracture - operative findings
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

What Saaboor experienced in this case is just what we have seen repeatedly
over these 13 years we have used the technique. We have been around the
world to spread this very efficient and lifesaving procedure and I can tell
you it's astonishing to see how difficult it is to change practise among us
surgeons.

Even more important, this is a technique for rural hospitals or hospital
taking part in a  chain of care that doesn't have the angio services. We in
Norway have therefore trained people in these hospitals by several trauma
programs (BEST, war surgery courses, courses for lifesaving procedures). We
also have been travelling around specifically for training this procedure
among smaller hospitals. This practise improves the care and save lives. 

Olav

Olav Røise
Chairman, MD, Ph.D

Division of Neuroscience and Muscoloskeletal Medicine, Ullevaal University
Hospital

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 Saboor Khan
Sent: 28. oktober 2007 16:52
To: Trauma &amp, Critical Care mailing list
Subject: Pelvic fracture - operative findings

Thanks to those who replied: Just to mention a few points:

1. I agree, with such an injury a urethrogram should have been performed.
2. Cannot comment on whether the crystalloid resuscitation was excessive.
3. The CT scan did not show a blush, however my (experienced) orthopaedic
colleague, who has an interest in pelvic trauma, was concerned because of
his hypotension - and wondered about packing - I hadn't performed one
before!). I did not think that there was substantive evidence of a bleed.
4. A rigid sigmoidoscopy was performed, pre-op and he had blood in the
rectum.
5. Just curious, what is a 'VOMIT' as described by k?

Intra-op findings (antibiotics administered );

Gen Surg - low midline laparotomy - pristine abdominal cavity, some bruising
at peritoneal reflection, paused.

Orthopaedic: complete diastasis as soon as the support was released, the
pelvis 'sprung' open, instantly held together by orthopaedic 'tongs'. Brisk
venous ooze, welling up, retro-peritoneum either side of bladder - tightly
packed - haemsotatic plugs and gauze, exactly as described by Olav and
yes, 'surprisingly easy' and very effective, even for a novice. Site of
subcutaneous emphysema identified - copious lavage.

Gen Surg-  Sigmoid loop mobilised and brought to the surface, Abdomen
closed. lithotomy position, stoma matured, distal sigmoid copious washout
with bladder catheter (balloon inflated). Rigid sigmoidoscopy repeated -
small 'rent' in anterior rectum, haemostatic plugs just about visible! No
further attempt at repair.

Day 2, patient awake, stable, plan to revisit / review and remove pack
tomorrow.

Criticism: Would an end stoma, mucous fistula be a better option  (complete
defunctioning)?

Finally, impressed with the practicality and ease of packing, a worthy
damage limitation technique.

Best Wishes,
Saboor Khan
Coventry
UK
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

• Previous message: Pelvic fracture - operative findings
• Next message: Pelvic fracture - operative findings
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]