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Re: Pelvic binder in fracture pelvis
Milton L. Routt 18 Апрель 2009, 12:55
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It’s important to not be led astray by algorithms...they are appropriate as conceptual guides, but each individual patient is unique and likewise has a unique injury pattern and primary organ system injuries and response to their traumatic event...the treating team must be efficient, communicative, aware, skilled, dynamic, cooperative, and adaptable.
Simple techniques that gather together an unstable pelvic ring while allowing the resuscitation efforts to proceed without negatively impacting further definitive procedures are optimal.... accurate reduction and stable internal fixation rule the eventual clinical result.
It’s not that we haven’t tried to push the edge, but if you keep working long enough at some point the clinical realities and individual diversities become apparent.
Wrap, warm, fill, (squirt and/or divert if necessary), reduce, and fix expeditiously.
chip
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Re: Pelvic binder in fracture pelvis
Adam J. Starr, M.D. 18 Апрель 2009, 12:57
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I think what Chip said is right on the money.
Although it's hard to prove statistically, most of us believe that stabilizing the pelvis provisionally - with sheet, binder, etc. - helps the patient.
You can find people who argue - strenuously - that provisional pelvic stabilization does nothing at all to help. However, given the fact that you can apply a binder quickly, with very little risk, I have a hard time seeing why you wouldn't want to do it.
Different centers will make different choices on how to provisionally stabilize the pelvis. At our place we use binders. Others are happy with sheets.
I think speed counts, so a method that is simple to teach and simple to apply is best. The people on the front lines of care are the ones who should be taking early steps to help the pelvic fracture patient.
We have tendencies at Parkland, and have outlined them in a flowchart to help guide our thinking, or to remind us of things when people get excited. But we also stray from the chart if the situation demands it.
Good luck,
Adam
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