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Prehospital pelvic compression

Marc Matthews - MedPro MMC X Marc_Matthews at medprodoctors.com
Thu Mar 12 17:53:31 GMT 2009


Thank you, Scott. Will read it tonight.
 
MRM

________________________________

From: trauma-list-bounces at trauma.org on behalf of Sherry, Scott :LPH Trauma
Sent: Thu 3/12/2009 10:46 AM
To: Trauma & Critical Care mailing list
Subject: RE: Prehospital pelvic compression



1.	Ho AM, Fung KY, Joynt GM, Karmakar MK, Peng Z. Rigid cervical collar and intracranial pressure of patients with severe head injury. Journal of Trauma-Injury Infection & Critical Care 2002;53(6):1185-8. 

I havent read it. may be a good start...
one of our stratigies is to make sure the collar is placed loosly on a paitent with refractory elevated icps. 
suppine positioning also can increase icps as well. we try to get reverse trendelenberg 30 dg. and tl clearance asap. not sure what difference no collar would have prehosp if you are still keeping pt flat...just needs to be loose enough to allow venous drainage. 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Patzalek, Wayne
Sent: Thu 3/12/2009 5:58 AM
To: Trauma & Critical Care mailing list
Subject: RE: Prehospital pelvic compression



I would be interested in references to CID devices increasing ICP.

Respectfully,

Wayne Patzalek
Instructional Coordinator, Paramedicine
School of Health Sciences
College of the North Atlantic
1 Prince Philip Dr
St. John's, NL A1C 5P7

ph 709.758.7682
fax 709.758.7634
-----Original Message-----
From: Dr Timothy Hardcastle [mailto:dr.tchardcastle at absamail.co.za]
Sent: March 11, 2009 3:01 PM
To: Trauma & 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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>>
>>
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