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Wed Mar 11 22:04:23 GMT 2009

Thank you all for all your comments! I guess each of you have more trauma experience than the total experience of our team together, so I really appreciate your comments, they will be helpful for us. The question(s) I asked you: How should we handle the patient with a suspected pelvic injury, that have got a pelvic device applied over the clothes by the prehospital personnel and then brought to the ER where we don't have the possibility to do a plain X-ray of the pelvis.

The use of the pelvic binder has increased over the last years in our region. The EMS now tends to over use it, just in case, of pelvic fracture and not on clear indications. Question: How would you state the criterions for the use of a pelvic device prehospital. My own suggestion would be 1. No question, what so ever, that the patient have an clinically instable pelvic fracture. OR 2. Trauma to the pelvic region in combination with hemodynamic instability. Please comment.

Norman and Tim: If I understand you correct you say, don't use a pelvic binder prehospital unless it is an obvious open book fracture. If stabilization is indicated then don't use the TPOD there are devices that allow exposure with environmental control in a better way. We have access to CT in aprox 15min sometimes shorter.

Karim: We are talking about pelvic belts in general and I understand that you agree with Tim and suggest us to stop using the TPOD and try samsling or pelvigrip because the TPOD in your opinion is too big, too over-engineered, too
inflexible and doesn't allow easy access for laparotomy/angio. The clothes should be cut prehospital before applying the pelvic belt and if not remove the belt at the ER remove the clothes and put it back on. In the patient with a severe open book fracture where the TPOD is placed over the clothes would you still remove it and risk bleeding in the ER?

Tina: You agree with Karim, remove the clothes and put it back on. The question above goes to you as well.

Zsolt: We have aprox. 1 1/2h transport to a traumacenter. I totally agree, and I guess all of you does, we need an X-ray installed in our traumaroom. Thanks for sharing how you handle the TPOD in the OR.

Ken: The pelvic binders don't reduce the rate of bleeding and probably don't have an impact on patient outcome, better keep blood pressure fairly low and reduce the administration of crystalloids. Did I get it correct?

Thank you all!

Johan

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Prehospital pelvic compression