Question on pelvic wraps / splinting

[iMac]

Youve broken your hip twice?

...Or you've taken care of two patients with broken hips?

does that answer your question? :wink:

[fiznat]

:shock: Oh my...

Yours is high up in the Illium though. I wonder which kind of fx is more common (Femoral Head or Illium), and if the position of comfort differs between them. Looks like you broke yours in about the same place on both sides - you say both times it helped to have your knees elevated?

[iMac]

Absolutely. Takes the pressure and weight off the pelvis. I don't think I was able to straighten my legs for weeks without significant pain. A pillow under each knee is the way to go.

[Arizonaffcep]

Today I had a typical call to the nursing home for a fall. Pt fell onto their R hip. My pt has 10/10 pn shooting down their leg from the R hip, external rotation and tenderness to palp over the hip/proximal femur and inability to make gross movement of the R leg, including lifting the R leg off the ground. The pt had fractured the R hip before, requiring surgery. My pt's pelvis is stable. This was a typical hip fracture based on my exam and confirmed with radiological exam upon arrival in the ER.

My question is: would you apply a pelvic wrap or commercial pelvic girdle/splint to this patient? Particularity the SAM pelvic sling? It was my impression that pelvic splinting is for pelvic instability and may actually harm a broken or dislocated hip. I cannot find any literature or contraindications to pelvic splinting with a through search on Google. I ask because the FD was about to put this device on my pt before I said something, and, needless to say I was more concerned with pain management. FD was not mistaken about the hip either, they knew it was a hip issue and were going to apply the device anyway. So I thought maybe I was missing something....

Typically, these pelvic binders are used to immobilize unstable pelvic fx's, where there is at LEAST the potential for significant bleeding (if it's not evident already). Reason-one of best ways to slow or stop bleeding due to fx is to splint and immobilize.

[Doczilla]

Those aren't hip fractures in the xrays. Those are pelvic fractures.

Isolated hip fractures should not get a compression wrap. That would cause lots of pain.

'zilla

[firedoc5]

does that answer your question? :wink:

OUCH!!!

As being stated, keep pt. in position of comfort. I've never broken my hip and/ or pelvis, but I have had sciaticas numerous times and that cushioning between the knees makes a world of difference. My mother did too.

Now I personally, usually, if used the scoop stretcher, removed it once pt. was placed on the cot. Now I know how some will leave the scoop under them. I've heard so many arguments to leave it or remove it. How about y'all?

[rock_shoes]

OUCH!!!

As being stated, keep pt. in position of comfort. I've never broken my hip and/ or pelvis, but I have had sciaticas numerous times and that cushioning between the knees makes a world of difference. My mother did too.

Now I personally, usually, if used the scoop stretcher, removed it once pt. was placed on the cot. Now I know how some will leave the scoop under them. I've heard so many arguments to leave it or remove it. How about y'all?

I'll leave the scoop if the transport time is short because it's going to reduce painful patient movement as it will be needed again to move the patient onto the hospital bed. If it's a long transport I'll remove it for patient comfort.

[Arctickat]

Thanks Doc, I knew something didn't look quite right with those x-rays, but I couldn't quite put a finger on it. A little slow this morning.

[Chief1C]

Scoop your patient onto a backboard with your pelvic stabilizing device already laying on it. I had purchased a set of SAM Slings for our service, as a donation, after a member of the services was in a wreck and had several pelvic fractures. They had no idea how to stabilize it, because their sheet method wasn't working. That's the only way they were taught, in fact, that's the only way I was taught.

However, they were reluctant to accept them, and now they're on a shelf in my closet. The SAM Sling is an accepted device, the state even has a con-ed program with them. However, I guess they like a home-made device (a sheet with two straps sewn on) as an easy to use alternative. Maybe I should have just gave them the cash to build more.. :?

[rock_shoes]

For an unstable pelvis we use "zap straps". At least that's what we call them. They're wide elasticized straps that keep even pressure across the pelvis.