estabilished standard prehospital transport protocol and emergency department management algorithms...

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 ))