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Wed Nov 5 08:57:37 GMT 2008

My concern is that someone gathers some real data to answer the question. We, at Charity, do not have the patient population as we are 65-75% penetrating since "the Storm". Those with more blunt should be able to get an answer rather than WAG

Typed by the thumbs of
Norman on his BlackBerry 

Norman McSwain, MD
Tulane Univ Surgery
504 988-5111

----- Original Message -----
From: trauma-list-bounces at trauma.org <trauma-list-bounces at trauma.org>
To: Trauma &amp; Critical Care mailing list <trauma-list at trauma.org>
Sent: Wed Nov 05 02:39:38 2008
Subject: Re: Pelvic fractures

Tim and Norm,

I understand what you're saying. I think on the list we try to point  
out some things so that others may not get incorrect impressions. Of  
course I know how Dr. Mattox divided the treat vs. not treat patients  
in his famous paper. This was not necessarily a strength of the paper  
but as Tim correctly says, sometimes one has to be willing to bend in  
order to advance our knowledge.

Rob
On Nov 4, 2008, at 3:54 PM, McSwain, Norman E Jr. wrote:

> One day on and one off is exactly what Dr Mattox did when he studies  
> the
> local standard of care with IV fluids and PASG. He produced a landmark
> study using those rules
>
> Norman
>
> Norman McSwain MD
> Professor, Tulane School of Medicine
> Trauma Director, Charity Hospital Trauma Center
> norman.mcswain at tulane.edu
> 504 988 5111
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org] On Behalf Of Robert Smith
> Sent: Tuesday, November 04, 2008 2:17 AM
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: Pelvic fractures
>
> 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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