Originally posted on The Collective:
This is part 2 in Dr Alan Garner’s series on pelvic fractures and the approach to binders. You can find part 1 here.
In part one we had a look at the evidence for benefit from pelvic binders. In short there is no study yet published showing a significant improvement in mortality. Not even a cohort study.
Of course, it still might be OK to use them if they possibly help as long as there is no evidence of harm either (and they don’t cost too much). The probability of good has to outweigh the probability of evil. It is the potential for evil that I want to examine now so we can see where the balance lies.
Before we can do that though we need to have a quick look at the types of pelvic ring fractures (no one is suggesting that non-pelvic ring fractures of the pelvis…
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Thanks to @nutmeig on Twitter for alerting me to this brilliant article and photography of Northern PHARM!
Originally posted on The Collective:
This post by Dr Alan Garner is the first of a trio on the topic of pelvic fractures and the evidence for what to do. Alan is an emergency physician at Nepean Hospital in Sydney and the Medical Director of CareFlight, having started in prehospital medicine in 1996. He has a bunch of other interests but there’s not enough space for that here.
Unfortunately I am old enough to remember when MAST suits were considered standard of care. In many states of the US it was law that ambulances had to carry them – that is how convinced everyone was that the things were doing good, not evil. We were all misled by measuring surrogates of outcome such as blood pressure rather than the outcomes that really matter, morbidity and mortality. Of course when good studies evaluating mortality were eventually done we discovered the evil side of the device and…
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Originally posted on AmboFOAM:
There has been a fair bit about mechanical CPR devices floating around the FOAMasphere lately, so I thought I should probably do a post.
These devices are not exactly new (check out the Thumper, in use in Victoria in the 70s) However, there seems to be a surge in interest in these devices, and I must say there seems to me to have been a largely positive buzz about them in spite of the evidence for their effectiveness being somewhat lacking to say the least.
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Originally posted on Auckland HEMS:
Pretty much summarizes the severe traumas that define the essence of our trade.
And sometimes, the answer to critical bleeding is to give blood.
We are grateful to our colleagues at Sydney HEMS, who advise: “blood is provided to transfuse patients with life-threatening bleeding after meticulous attention to hemorrhage control.”
Auckland HEMS is poised to begin providing prehospital blood as part of our bundle of critical clinical interventions. We are fortunate to collaborate with the New Zealand Blood Service and with our local District Health Board to provide this service. http://www.nzblood.co.nz
Herein, please find our training video. We welcome your feedback.
Our draft Blood SOP is undergoing usability testing with our clinical teams. Once finalized, we will share this for FOAM.
This is an unsystematic review of the current literature. A few themes are emerging:
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Originally posted on FOAMcast:
The Free Open Access Medical Education (FOAM)
We review Dr. Scott Weingart’s episode 133 on pre-hospital REBOA (resuscitative endovascular balloon occlusion of the aorta). Weingart interviews Dr. Gareth Davies about the encounter, underscoring the increasing use of REBOA.
For a quick REBOA refresher, check out Episode 121.
REBOA (Review of REBOA) – First described in 1954 in the Korean War, this is a form of hemorrhage control below the level of the chest without having to do a thoracotomy with aortic cross clamping, which has sparse mortality benefit and can be dangerous to providers. Most of the REBOA literature is from swine models and case-series, although there are currently larger trials underway.
- Outline of procedure – Obtain arterial access through the common femoral artery, pass a vascular sheath, float a balloon catheter to the appropriate section of the aorta, and inflate the…
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