Originally posted on The Collective:
During the writing of part three of this series on pelvic fractures and particularly after reading Julian Cooper’s comments (thank you Julian) I realised that the observational data around pelvic binders does not entirely fit with the theories. Let’s start with the theory and I might directly borrow Julian’s comments from Part 2 as he says it better than I could:
“In any type of pelvic injury. the bleeding will be either:
- Venous or bone ends: in which case keeping things still with a binder is likely to allow clot formation (low pressure bleeding, low or high flow).
- “Slow” arterial (the sort of thing seen as a blush on contrast CT) which will probably trickle on…
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Originally posted on FOAMcast:
The Free Open Access Medical Education (FOAM)
Dogma persists that ketamine may increase intracranial pressure, which would be bad in traumatic brain injury (TBI) given the fixed space in the cranial vault. These are largely from Yet, these patients often need sedation, for agitation or intubation, and drops in blood pressure are also deleterious (see EMCrit on neuroprotective intubation).
PRO (Le Cong): The literature doesn’t show clinically significant deleterious outcomes from ketamine use in the head injured patient. Review in Annals on ketamine and ICP. Deleterious effects of apnea may result from other sedative agents.
CON (Zammit): Studies showing that ketamine does not increase ICP confounded by the presence of other sedatives on board. As…
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