List Archives

Sat Nov 1 20:21:51 GMT 2008

I am familiar with the statement below.   It is not a consensus  of the way 
to treat pelvic fractures in unstable patients in the  USA.   It is my view 
that the aggressive treatment actually  contributes to the mortality -  
IATROGENIA.      I  have NEVER been convienced that the MAST, the pelvic wrap devices, 
or the  external fixators did anything but made the patient's access more  
difficult.    I also have not been convienced that the  embolization of arterial 
vessels did anything to venous bleeding except got the  patient away from the 
aggressive fluid resuscitators for a few  hours.    We need a better way.    I 
am watching  the pelvic packing data and it looks interesting, but too few 
cases so  far.     The issue is selection of the few unstable patients  that 
need it.   For the majority of patients with pelvic fracture,  they need for the 
emergency ohysicians, trauma surgeons and orthopedic surgeons  to keep their 
hands off for a while.  

k

In a message dated 10/31/2008 1:16:59 P.M. Central Daylight Time,  
michaelwparra at yahoo.com writes:

The
current management of pelvic fracture patients who  are
hemodynamically unstable in the United States consists of  aggressive
resuscitation, mechanical stabilization, and angioembolization.  Despite
this multidisciplinary approach, recent analysis confirms  an
alarming 40% mortality in these high-risk patients(7). The statement  by
Duchesne "we can not control for patient pelvic volume and degree  of
exsanguination in the presence of a closed or open  retro-peritoneum..."
is not an absolute.The implemetation of Pre-Peritoneal  Pelvic Packing
(PPP) is a rapid method for controlling pelvic  fracture-related
hemorrhage that can supplant the need for emergent  angiography. There
is a significant reduction in blood product transfusion  after PPP, and
this approach appears to reduce mortality in this select  high-risk
group of patients(7). We have used this technique with great  success
and low morbidity at our institution.  

**************Plan your next getaway with AOL Travel.  Check out Today's Hot 
5 Travel Deals! 
(http://pr.atwola.com/promoclk/100000075x1212416248x1200771803/aol?redir=http://travel.aol.com/discount-travel?ncid=emlcntustrav00000001)

List Archives

For your convenience, find the Trauma List Archive Below

pelvic fractures (michael parra)