Sunday, October 2, 2011

Pelvic Fractures in Remote Areas

   For those who enjoy extreme sports such as rock climbing, mountain biking, abseiling, parachuting, paragliding and mountaineering the rewards far outweigh the risks. Still the risks for major injuries are ever present.
   This week we are going to focus on injuries to the pelvis.

   Pelvic fractures are often caused by rapid deceleration in extreme sports. To be fair, the risk for a pelvic fracture is higher during the drive to your event than it is for the event itself. These injuries are 3% of all skeletal fractures in the United States (Mechem, 2010). Pubic fractures are by far the most common and cause an "open book" pelvic fracture.

   The signs and symptoms of a pelvic fracture:
      Elevated Pulse Rate
      Elevated Breathing Rate
      Point tenderness in the pelvic region
      Rectal bleeding

      DO NOT SPRING THE PELVIS! It was common practise to push on the pelvis to see if there was pain or crepitus. Recent developments in the current wars in the Middle East has shown that moving the broken pelvis causes excessive internal bleeding.

       Bind the pelvis
      Administer whole blood if available
      Administer fluids if blood is not available. Titrate to a radial pulse for the first hour and then to a normal blood pressure after that.  Hypotensive resuscitation has shown to be a life saver for pelvic fractures.

   Pelvic fractures can bleed up to three litres into the pelvic cavity. Aggressive treatment is required especially in remote areas. Bind the pelvis before the casualty is moved or rolled.

Binding the Pelvis

   This is the first and best treatment for any suspected pelvic fractures. Most pelvic fractures are an open book type of break and can be splinted using a pelvic binder.
   There are commercial options for pelvic binders but to be honest, Remote Medics have enough gear to carry already. Having another bit of kit that only treats one type of injury is not something that is worth carrying.

   These are thee options for binding a pelvis: First is an improvised binder using a triangular dressing. Second and third are commercial options.
   Improvised Pelvic Binders should be a well learned skill for any Remote Medic. Here is a video showing how to use a SAM splint as a pelvic binder.

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