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Wed Mar 11 00:37:20 GMT 2009

By far the majority of pelvic fractures need NOTHING done in the ambulance  
nor in the emergency room.     Make the diagnosis and then  do what is 
necessary.   I have lived through several generations of  expensive gadgets sold to 
EMS and EM, but with NO data to support their use in  the majority of patients 
with pelvis fracture:    MAST,   Pelvic Binder,  C Clamp, External Fixators, 
etc. etc.  etc.         

That is not to say that persons with severe pelvic fractures do not bleed  to 
death.  They do, but the gadgets do not reduce the rate of  bleeding.   I am 
not even convinced that pelvic artery embolization  reduces the rate of death 
or bleeding in these horrible and extensive pelvic  fractures.    Our problem 
is that we have no way of  recognizing these severe fractures in the EMS or 
Emergency  Department.     

We do know that excessive crystalloid resuscitation DOES increase the  venous 
pressure and that 70%+ of patients with bleeding from pelvic fractures do  so 
from VENOUS bleeding.    Therefore keeping the venous and  arterial pressure 
lowish should be an objective, both in the ambulance,  emergency room and ICU. 

k

In a message dated 3/10/2009 4:36:58 P.M. Central Daylight Time,  
rajesh84 at asianetindia.com writes:

My  impression was that they allow one to prevent the pelvis opening  
up(increasing the volume as it is proportional to the diameter) and help  
control the volume of space available for blood to flow into, thus leading  
to a tamponade effect.It is not to actively control bleeding per  se.

K.R.Rajesh FRCS,FRCS(Orth)
Staff Specialist  (Ortho)
Bega
NSW
----- Original Message ----- 
From: "McSwain,  Norman E Jr." <nmcswai at tulane.edu>
To:  <trauma-list at trauma.org>
Sent: Wednesday, March 11, 2009 4:24  AM
Subject: Re: Prehospital pelvic compression

> First  understand the data
> These devices close the pelvic fracture, however  there is NO data that 
> shows that they control hemorrhage. The answer  to your question is based 
> on your need.
> Why were they  applied?
> Is  that outcome needed and
> beneficial for the  patient
> Does the data support it's use?
>
> 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-list at trauma.org  <trauma-list at trauma.org>
> Sent: Tue Mar 10 12:03:18 2009
>  Subject: Prehospital pelvic compression
>
>
> Hello!
>  I have a question to all of you regarding the use of prehospital pelvic  
> binders. I work at a small hospital where we dont have access to  x-ray of 
> the pelvis in the traumaroom. Currently the prehospital  personel applies 
> the TPOD (pelvic binder) in the prehospital setting  whenever they suspects 
> a pelvic fracture. The TPOD is often placed  before removing the patients 
> cloths. This approach interferes the  examination of the patient in the 
> traumaroom because when the pelvic  divice is applied prehospital every one 
> is afraid of removing it with  the fear of bleeding. Since we dont have 
> acces to plain x-ray in the  traumaroom we often leave the TPOD until the 
> trauma-ct is done and we  have  pictures. The tpod also makes it difficult 
> to remove the  patients clothes and sometimes makes it impossible to make a 
> good  examination of the lower back, perineum/rectum. How would yo approach 
>  this matter?
>
> Johan
>
>
>
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Pelvic Fractures - Some Urban Legends