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Wed Nov 5 04:16:37 GMT 2008

Rob

Maybe not randomisation, but still better than nothing and the ability to
predict what you get is still less!

Remember too: evidence based medicine is about aplying best available
evidence, even if it is not always Level 1!

Tim

Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
> 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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