Upload
curtis-hancock
View
217
Download
0
Tags:
Embed Size (px)
Citation preview
ESTABILISHED STANDARD PREHOSPITAL TRANSPORT PROTOCOL AND EMERGENCY
DEPARTMENT MANAGEMENT ALGORITHMS
11% PREALGORITHM7% POST ALGORITHM
1-MOTORCYCLE COLLISION
2-CAR VS PEDESTRIAN3-FALL OVER 4.6 M
4-LATERAL IMPACT 5-MVC WITH VEHICLE INCOMPATIBILITY
HIGH ENERGY TRAUMA
MEN > WOMEN
33YEARS
SUSPICION OF PELVIC FRACTURE 1-MECHANISM OF FRACTURE
EMERGENCY MEDICAL PROFESSTIONAL INFORMATION
2-PATIONT PRESENTATION 3-PHYSICAL EXAM
1 -SHORTENING OF LOWER LIMBVERTICAL SHEAR
2-LATERAL ROTATION ROTATIONAL INSTABILITY
3-PRINEAL ECHYMOSIS AND FLANK SCROTAL,LABIAL
4-RECTAL BLEEDING 5-VAGINAL BLEEDING
URETHRAL BLEEDING -6
PHYSICAL EXAM 1-LATERAL COMPRETION (ILIAC WING)2-ANTEROPOSTERIOR COMPRETION
MAKE PAIN OR GROSS INSTABILITY 3-GAP OR PUBIS SYMPHYSIS
SEPARATION 4-VAGINAL AND RECTAL EXAM
HIGH POSISION PROSTAT=URETRA TEARRECTAL EXAM IN CHILD ONLY WHEN
HEMORAGE
5-NEROLOGIC EXAMSCIATIC NERVE AND
LUMBOSACRAL BRANCHS IS NEAR Fx
BULBOCAVVERNUS REFLEX MOTOR FUNCTION
IMAGINGIMAGING1-STANDARD AP
COLINEAR PUBIS SYMPHYSIS AND SACRAL SPINOUS PROCESS
1-DISPLASMENT OF SACRUM OR SI JOINT
2-L5 SPINOUS PROCESS FRACTURE3-PUBIS SYMPHYSIS DIASTASIS OR
RAMI Fx WITH DISPLACEd
PELVIC INLET PROJECTION45 DEGREE CODAL
1-LATERAL ROTATION OF HEMIPELVIC2-OPEN SI JOINT 3-IMPACT SACRAL ALA 4 -AP DISPLACEMENT OF HEMIPELVIC
PELVIC OUTLET PROJECTION
45 DEGREE CEPHALAD1 -SACRUM 2-SI JOINT 3-VERTCAL DISPLACEMENT4 -UNSTABLE HEMIPELVIS
FLEXION EXTENTION DEFORMITYIS SEEN IN 3 XRAY BUT IS BETTER
OUT LET VIEW( ROTATION POINTIS TYPICALY AT POSTERIOR RING)
CT SCAN2-3 mm AXIAL SECTION IS GOOD
FOR MAJORITY OF SIGNIFICANT INJURIES
GOOD FOR THREE DIMENTIONAL RECONSTRACTIONS
CT IS INDICATED DOUBT ABOUT THE DIAGNOSIS
IN PLAIN RADIOGHRAPH OPERATIVE INTERVENTION IS
PLANNED
CT SCANNING CHANGED INJUREY CLASSIFICATION IN
15% MANAGEMENT IN 3% OF
PATIENTS
CT AIDS DECISION FOR OPERATION
AND CONSERVATIVE IMPROVE OPERATION
APPROACH SELECTION
MANY TRAUMA CENTERSOPTAIN CT ROUTINLY FOR ABDOMEN AND
PELVIC VISCERAL INJURY
MRI OFFERS SIMILAR BENEFITESOF CT ,WITH THE ADVANTAGES OVER CT IN DELINEATING SOFT
TISSUE INJURIES,ABSENCE OF IONIZING RADIATION,FRACTURESOF CARTILAGINOUS STRACTURES
RADIOISOTOPE BONE SCANIS RARELY USEFUL FOR THE DIGNOSIS
OF NONDISPLACED PELVIC FRACTURESAND IN THE IDENTIFICATION OF ACUTE
INJURIES IN CHILDREN ADULTS WITH HEAD INJURIES OR MULTIPLE SYSTEM
INJURIES
Unstable pelvic fractures
1-2.5 cm pubis symphysis disruption2-sacro spinous lig rapture 3-lateral sacral avulsion fx 4 -ischial spine fx 5-sachral fx with gap(vertical
Instability )
6-L5 TRANSVERS PROCESS FX (VERTICAL INSTABILITY ) 7-VERTICAL DISPLACEMENT OF
HEMIPELVIS 1CM (VERTICAL) 8-STRES TESTING FOR INSTABILITY
ONLY ONE TIME HEMODINAMIC INSTABILITY AND ZONE 2,3 SACRUM
DUE TO NERVE INJURY
STABLE Fx 1 -intact posterior ligament 2-impact fx of anterior sacrum
In LC fractures ))