Twitter discussion today about how to stabilise a pelvic fracture with a concurrent femoral shaft fracture. How do you do it? SAM, T-Pod or sheet for pelvis? Donway, CT6, or Kendrick for femur? Can you do both? Or should you just tie the legs together, use a simple splint, or put them in a vac-mat? Do prehospital femoral traction devices destabilise pelvic fractures? Do you leave pre-hospital femoral traction devices on in ED? How long can you leave them on for? Or should you convert ASAP to skin traction? Lots of questions!
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- Awesome comments everyone.
Tim: I eagerly await your parcel in the post. And yes, alternative devices will be in the next ETM Course, in skills station, as well as pelvic injury lecture. Will update manual as well regarding this issue.
Dave: I agree with all of your points. Aim for a clinical end-point and don't just apply a device because the patient has a certain injury.
Minh: There's some things that might just be too hard to create good evidence for! This is a pretty rare injury combination. Could do a cadaver study? Eminence based medicine opinion from a trauma centre colleague I sought today was "if you know the pelvis is unstable, don't put any device on the leg except skin traction". Will ask around a bit more and get back to you all. Another complication none of you mentioned, I hear it can be also be hard to shut the back door of the ambulance if the patient is very tall and has CT6 applied! True?Jul 23, 2014
- yes it can be difficult to close the door if the pt is tall. Just requires some pretty planing to move them a touch further up the bed.
The Slishman splint looks like it may be a better device for that particular issue.Jul 23, 2014
- Andy, I feel that when real iatrogenic harm is possible, it behoves us to seek best practice..that means research and trying to get closer to the truth.
okay I agree not all things can be controlled and studied to the nth degree but to take a page from the Chrimes book of logic...
that is a separate issue.Jul 23, 2014
- Re: splint length. My experience with CT6 (cf clinical experience with Hare and training with Donway and Kendrick) is that CT 6 is no worse and potentially better than other splints. Ankle strap must be shortened prior to tractioning then once fitted elongate groin strap while maintaining traction to allow splint to slide up leg for optimal length.Jul 26, 2014
- I'll also say that often the CT6 pelvic sheet combo is contraindicated due to a non traction able limb injury.
The CT6 is the easiest of the Hare or CT6 to get into the ambulance they are all I've played with.
Only time I had real difficulties was with a 200cm tall pt and he barely fit on the stretcherJul 26, 2014
- UK protocol here on pelvic # management with some eminent authors
Recommends use of SAM w kendrick when appropriate (and by implication, similar devices like CT6, Slishman I suppose)
Also full of other pearls which may be obvious to prehospital bods, but can remain unfamiliar to those who go thro the ATLS-EMST machine
"Splint to skin"
"No place for log roll in blunt trauma"
I am going to use this when teaching EMST pelvic # skills stations in future as a handout!Jul 29, 2014
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