List Archives

Fri Oct 31 13:50:51 GMT 2008

Does anyone use the DeRoyal collar at your hospital? We currently use the Aspen and may be switched to DeRoyal. Wondering if you find the product effective, or any bits of wisdom you can give me regarding these!

Thanks so much

Cathy Dain
APN trauma
KGH
Kingston, ON 

-----

--- On Thu, 10/30/08, trauma-list-request at trauma.org <trauma-list-request at trauma.org> wrote:
From: trauma-list-request at trauma.org <trauma-list-request at trauma.org>
Subject: trauma-list Digest, Vol 64, Issue 31
To: trauma-list at trauma.org
Date: Thursday, October 30, 2008, 8:00 AM

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Today's Topics:

   1. RE: Fwd: Pelvic fractures (William Bromberg)
   2. RE: Fwd: Pelvic fractures (McSwain, Norman E Jr.)
   3. Re: Fwd: Pelvic fractures (jduchesne1)
   4.
 RE: Fwd: Pelvic fractures (Brandon Rollins) <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

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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The key factor is that although you can control for all home made or manufacture devices for patients  with OBPF..........we can not control for patient pelvic volume and degree of exsanguination in the presence of a closed or open retro-peritoneum..........no matter what device is in place........patient anatomy and physiology are different.
My 2 cents
Duchesne
CharityOne,NO
Sent via BlackBerry by AT&T

-----Original Message-----
From: "McSwain, Norman E Jr." <nmcswai at tulane.edu>

Date: Wed, 29 Oct 2008 13:44:56
To: Trauma &amp; Critical Care mailing
 list<trauma-list at trauma.org>
Subject: RE: Fwd: Pelvic fractures

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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--
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http://www.trauma.org/index.php?/community/Our policy is a simple flat sheet wrapped around the
 trocanters.

--- 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, 12:19 PM

One more thought: why should they spend money on studies when no one
cares. Folks buy them and USE them without any
 supporting data. Research
is a waste of their money that they can pocket.

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 McSwain, Norman E
Jr.
Sent: Wednesday, October 29, 2008 12:09 PM
To: trauma-list at trauma.org
Subject: Re: Fwd: Pelvic
 fractures

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

----- 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 Oct 29 11:55:50 2008
Subject: RE: Fwd: Pelvic fractures

Dr McSwain,

Which technique/tool do you employ and why?

We still use the sheet method and early ext fix.

David A. Summers RN, CFRN, EMT-P
Pediatric Trauma Nurse Coordinator
St. Mary's Trauma Center
901 45th Street
West Palm Beach, FL 33407
561-882-6429 -
 Office
561-881-0945 - Secured Fax
david.summers at tenethealth.com  

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Jr.
Sent: Wednesday, October 29, 2008 12:43 PM
To: Trauma &amp; Critical Care mailing list
Subject: RE: Fwd: Pelvic fractures

Does anyone  have any data that this alters outcome? Last time I asked
the suppliers al they
 came up with was antidotal papers. NONE with
comparisons. "Yes look at my wonderful device. See how it works. There
is no need to compare because I say it works"

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 Dr Timothy
Hardcastle
Sent:
 Wednesday, October 29, 2008 11:01 AM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Fwd: Pelvic fractures

Skin traction for shear or a hospital sheet folded 30cm wide around the
trocanters. If you have fancy stuff - pelvigrip device is probably
easiest
to use

Keep it simple
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
>
>
>>>> "Dan Burgess" <dburgess at mhg.com> 10/29/2008
8:30 AM >>>
> What device to you use to stabilize  unstable pelvic fractures for
> transfer to another facility?
>
> Dan P Burgess RN MS CEN
> Trauma Program Coordinator
> Memorial Hospital at Gulfport
> 228-575-2079
>
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