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Tue Nov 4 08:16:40 GMT 2008

With respect, you undoubtedly know that using an every other day  
strategy is not randomization.

Rob Smith
On Nov 3, 2008, at 6:58 AM, McSwain, Norman E Jr. wrote:

> You seem to have a great chance to study this problem. If you  
> impressions are real and correct.
>
> Randomize one day use and one one no use, as Ken did with the PASG  
> and IV fluids.
>
> Unfortunately 'impressions' without data are not very good support.  
> STUDY IT !
>
> Norman
>
> Norman McSwain MD
> Trauma Director, Charity Hospital
> Professor of Surgery, Tulane University
> New Orleans LA
> 504 988 5111
> norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu>
>
> ________________________________
>
> From: trauma-list-bounces at trauma.org on behalf of Sarah CAllier
> Sent: Mon 11/3/2008 12:37 AM
> To: Trauma & Critical Care mailing list
> Subject: RE: Fwd: Pelvic fractures
>
>
>
> In the EMS service that I work for we stabilize the Pt's hips with a  
> Vinal band and pillows between the legs. They range in size from 3-6  
> inches wide, and varrie in length. They are placed in the Pt's leg  
> with a pillow between the legs. The fracture straps (vinal bands)  
> are then placed two around both femurs and one below the knees.
> I have noticed an inprovement in patients once they have been  
> stabilized by this method and a reduction in pain. I have had  
> patients who stated that their pain was at a 10 on a 1-10 pain scale.
> I have seen the PASG utilized and have seen better results with the  
> fracture straps,
>
> ~Sarah
>
> --- On Wed, 10/29/08, McSwain, Norman E Jr. <nmcswai at tulane.edu>  
> wrote:
>
> From: McSwain, Norman E Jr. <nmcswai at tulane.edu>
> Subject: RE: Fwd: Pelvic fractures
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Date: Wednesday, October 29, 2008, 1:44 PM
>
> I guess I did not state the  question properly. I wanted to see some  
> type of
> data that the sling type device does anything to benefit the  
> patient: reduce
> blood loss, reduce pain, reduce length of stay, reduce mortality vs  
> doing
> nothing at all. The only device that I have seen data to support in  
> the PASG in
> a study done by Flint several years ago. There are other studies  
> using PASG for
> hemorrhage control that demonstrate effectiveness. Burgess sent out  
> the
> comparative study on unstable patients by Croce shows a reduction of  
> transfusion
> requirements when compared to external fixation and a reduced  
> hospitalization.
> The effectiveness was similar to the PASG
>
> My concern is that there are no studies that demonstrate ANY altered  
> outcome on
> the patients who arrive in the ED with a simple pelvic fracture.  
> Would they not
> be just as well off if nothing was applied? If someone has data on  
> these
> patients, please identify them to me.
>
> Norman
>
> Norman McSwain Jr, MD FACS
> Trauma Director Charity Hospital
> Professor of Surgery
> Tulane University School of Medicine
> 504 988 5111
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org 
> ] On
> Behalf Of William Bromberg
> Sent: Wednesday, October 29, 2008 12:50 PM
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: Fwd: Pelvic fractures
>
> <snip>I don't use any of them. If they don't work, why waste the
> patients
> money. If they work, then the manufactures should be willing to study
> them. I have asked all of them if they plan good comparative studies.
> Uniform answer "No"
> Typed by the thumbs of
> Norman on his BlackBerry
>
> Norman McSwain, MD
> Tulane Univ Surgery
> 504 988-5111 </snip>
>
>
> Dr McSwain, what do you want them to compare to? Compared to each  
> other
> - they do the same thing, pick the one that's cheapest/easiest to use.
> Compared to a bed sheet --They do the same thing - but they are SO
> much easier (and less likely to loosen up) that many people think it's
> worth it. As to comparing them to emergent ex. fix. I don't think
> funding is the difficult part of that study, it's getting the  
> orthopods
> to come in (and the problems with emergent consent).
>
> Is it that you don't believe that the concept (closing the pelvic
> volume) is sound  at all or do you go right to ex. fix?
>
> Bill Bromberg
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