It’s #traumatuesday!
This series we are providing #coderedtips on how to optimise casualty management.
Last week we covered the importance of space creation and gaining 360 access around your casualty (where possible) to allow for optimal assessment and treatment. Today’s topic is improving pelvic binder application – an area of practice that particularly bothers Steph!
But first, a recap on indications:
Pelvic immobilisation should NOT be applied as a precaution purely on mechanism. Patients should only have pelvic immobilisation applied if a major pelvic fracture is suspected.
I.E.
Where mechanism of injury is suggestive of a pelvic fracture AND is accompanied by ANY of the following: • Haemodynamic instability/signs of shock • Deformity on examination • Suspected open pelvic fracture due to bleeding PU, PV, PR (or scrotal haematoma).
A pelvic binder is an INTERVENTION to prevent ongoing internal haemorrhage, NOT a packaging device. It should therefore be applied early, on SKIN, to provide stability and promote clot formation.
For a suspected pelvic injury, moving and rolling should be kept to an absolute minimum to avoid clot disruption – remember the first clot is the best one.
Code Red Tips: 1. Do NOT ‘scissor’ (slide and effectively wiggle) a pelvic binder under the knees or the small of the back of a casualty and move (scissor) in line with the greater trochanters. This works on plastic manikins…not on real, haemodynamically shocked people. ‘Scissoring’ always results in unnecessary movements of the pelvis.
2. Instead, use the ‘L FOLD TECHNIQUE’ (see in photo below), ideally at the same time a scoop stretcher is applied – concurrent activity and minimal movement achieved!
3. The pelvic binder should be applied to bare skin unless exceptional circumstances exist (hostile environment or patient refusal). Cut the underwear, but then place a strip of fabric over the casualty’s genitals for dignity (and protection from the t-pod pulley system).
4. KEEP YOUR CASUALTY WARM. Get them off the ground and wrap a blizzard blanket around the bottom of the scoop for optimised temperature management. Cold bleeding casualty = poor clotting = worse outcomes.
5. Don’t forget to tie the casualty’s legs together (ideally prior to pelvic binder application) unless the casualty has associated fractured femur(s). We are trying to bring the pelvis back into anatomical alignment – leaving the legs apart may exacerbate internal bleeding.
Our mission is to make a difference by #empoweringothers to have the knowledge, skills and confidence to alleviate suffering and save lives. Access further free CPD and learn more about our trauma courses at www.coderedtraining.co.uk