Trauma Guideline Manual - SUNY Upstate Medical University

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94____________ Trauma Guideline ManualUpstate Medial University Trauma Centerb. If anterior ring injury and pubic diastatsis >2cm, consider performing retrogradeurethrogram prior to passing Foley catheter.7. If patient is hemodynamically unstable (may interrupt this guideline if patient becomeshemodynamically normal):a. Continue vigorous fluid resuscitation. (Activate MTP as these patients have significantblood loss)b. Use T-Pod to temporarily stabilize pelvis (see protocol below). If not available, thenwrap a sheet tightly around pelvis (do not twist the sheet). Avoid unnecessarymovement.c. If remains hemodynamically unstable FAST/CT negative for intraperitoneal blood thenemergently activate IR/Vascular for angio-emobilization plus Ortho for possible externalfixation..d. If still hemodynamically unstable despite adequate fluid resuscitation and aboveconsider salvage exploration and packing. (Note: prognosis gave at this point.)8. If urethrogram shows urethral disruption, consult urology. Do not attempt Foleycatheterization.9. If patient has major perineal laceration involving the rectum or extending deeply, go to OR.a. Control bleeding.b. If there is significant injury of rectum, anus, or perianal skin, consider divertingcolostomy.c. Distal segment should be washed outt.d. Debride and pack wound. Closure may be possible on a delayed basis.10. If patient is stable, obtain inlet and outlet views of pelvis. Consider CT scan with thin cuts ofthe pelvis at discretion of orthopedic consult.
Trauma Guideline Manual______________Upstate Medical University Trauma Center95PRACTICE GUIDELINES: PLACEMENT OF T-POD ON UNSTABLE PELVIC FRACTURESOBJECTIVES:1. Definethe appropriate indications for the use of a temporary pelvic stabilizer2. Define the appropriate use of the T-POD pelvic temporary stabilizing device.GUIDELINES:1. Follow ATLS guidelines while pelvis x-rays are being performed.2. Consider the T-POD temporary pelvis stabilizing device in the following situations:a. Pelvis fractures with unstable vital signs. Consider permanent pelvic fixator orangiography while T-POD is being appliedb. Open book pelvis fracturesc. Lateral shear pelvis fracturesd. All pelvic fractures in which a CT scan show significant pelvic hematoma.3. Follow the directions below. When the T-pod is being placed, make sure that the breathingis not compromised and that an NG tube has been placed to avoid aspiration.4. Remove only after more permanent stabilizing procedures have been considered orplanned.STEP 1STEP 2
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Trauma Guideline Manual - SUNY Upstate Medical University

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