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Wed Mar 11 17:58:37 GMT 2009

I have not seen the data demonstrating that C-collars increase ICP. Where is it printed?

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 Dr Timothy Hardcastle
Sent: Wednesday, March 11, 2009 12:31 PM
To: Trauma &amp; Critical Care mailing list
Subject: Re: Prehospital pelvic compression

Karim

Agree with your sentiments. As for collars, we know they increase ICP. I
am aware of Ambulance services and trauma systems that no longer use them
- replaced with headblocks and spidder harness

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Lecturer University of KwaZulu-Natal Dept Surgery
Deputy Director - IALCH Trauma Service
Durban - South Africa
> Let's be clear what we're talking about here.  Are we talking about
> pelvic belts in general or the T-POD binder?
>
> Pelvic belts are an ideal prehospital device.  They provide fracture
> splintage during the phases where there is the most movement (and
> potential clot disruption). They should be placed to protect &
> stabilize a suspected pelvic injury, just like any splint - and as a
> protective device just like the C-collar.  Like any splint they will
> reduce bleeding from bone ends and some venous bleeding.  (They will
> never control significant arterial bleeding).   (Tim - following your
> logic about exposure then cervical spine collars should not be placed
> pre-hospital).
>
> The belts are there to stablize - not to "close-down" a pelvis.  As
> such they can be placed on any pelvic fracture (before the fracture
> pattern is known). They should not be applied by two gorillas leaning
> on the pelvis, but just snugly over the greater trochanters.
>
> I personally don't see any reason for placing them over clothes.
> These should be cut off and then the belt placed.  BUT if they are on
> over clothes then take it off, cut the clothes off and then put it
> back on!!
>
> I've never liked the T-POD.  It's too big, too over-engineered, too
> inflexible and doesn't allow easy access for laparotomy/angio.  Like
> Tim says a simple belt like the Pelvigrip or SAM sling is ideal.
>
> As for no data - it's true there is little specific data related to
> the belts (but about as much as there is for any type of splintage).
> BUT there is data recently from protocolised care of bleeding pelvic
> fractures that includes using the pelvic belt as part of the
> management algorithm.
>
> Karim
>
> 2009/3/10 Dr Timothy Hardcastle <dr.tchardcastle at absamail.co.za>:
>> Johan
>>
>> Good reason to change practice - they should NOT be used pre-hospital:
>> The
>> pelvic binder is only useful for open-book fractures (AP compression
>> type), more for patient support than anything else (I agree with
>> Norman's
>> comments).
>>
>> Good practice of ATLS is to do an EXPOSURE with ENVIRONMENTAL control -
>> neither is possible with the binder. If they want to use something, the
>> Pelvigrip type device, with velcro straps for easy removal/adjustment is
>> a
>> better option. Also re-usable (made of neoprene)
>>
>> How fast do you get your trauma-CT. If less than 30 minutes - fine,
>> otherwise get the pelvic mobile film in the ER.
>>
>> Regards
>> Tim
>>
>> Dr T C Hardcastle
>> M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
>> Principal Specialist Trauma Surgeon /
>> Honorary Lecturer University of KwaZulu-Natal Dept Surgery
>> Deputy Director - IALCH Trauma Service
>> Durban - South Africa
>>>
>>> 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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