Log Roll Pelvic injuried with face downward for transportation

[shangkay99]

Dear There,

my case : Patient with car accident trap under the car, the position is face downward, suspected pelvic injury, severe shock,conscius
After removed from the car to safe area using scoop strecther, we sould reffered him to hospital.
Is it possible/allowed to log roll to supine position to applied KED for transportation to hospital ? or we should sent him with face downward position ?

Need your help please..
any reference are welcome...

 

[DesertMedic66]

What would be some issues with transporting a patient in the prone position?

 

[mycrofft]

Severe shock and conscious?

One negative issue about prone position: positional asphyxia for the obese.
Negative issues about supine: positional asphyxia, airway embarrassment, additional manipulation (in this case).

KED is for extrication, then left on to avoid additional manipulation before hospital. If pt is in "safe place", then extrication is done. So, why use KED? (I might, but not if it means rolling supine).

 

[shangkay99]

Dear mycrofft and Firefite,

Thanks for your repply...

"KED is for extrication, then left on to avoid additional manipulation before hospital. If pt is in "safe place", then extrication is done. So, why use KED? (I might, but not if it means rolling supine)" .

i'm agreed with you no doubt, but if we want refer him in to hospital using ambulance, is the patient still in prone position ?

Thanks

 

[Handsome Robb]

Why are you set on keeping him prone? I would log roll him and use a scoop and collar. If its appropriate you could apply a pelvic binder before logrolling him but if he truly Is in "severe shock" after a traumatic injury he's on his way out and needs bright lights and cold steel not a paramedic or EMT. With that said stabilizing a true open book pelvic ring fracture may potentially help slow the internal hemorrhage.

 

[mycrofft]

Okay.

 

[ffemt8978]

How are you going to monitor and check for things like airway, pupils, tracheal deviation, and pardoxical chest wall movement if you leave the patient prone?

I just don't see how you can do a complete assesment leaving the patient prone.

 

[mycrofft]

Okay.
Add that in trauma cases the majority of signifcant events occur anteriorly.

It's just a shame that a breathing extricated and secured patient can't be left that way, when I've seen time and again that going supine means the pt crashes iatrogenically. Just need to be scrupulous about stabilization, and have airwayand suction ready for when the pt needs it.

PS: Can't auscultate resps or apical pulse dorsally? Take a BP ? Apply dressings? Done that, went well, then we rolled one and things went to hell. We need to question all premises once in a while, and one is flipping patients over to supine without considering the risks. We're taught everything anteriorly except maybe chiropractic (just kidding), so we do tend to feel out of bounds when the presentation is lateral or posterior.

 

[Handsome Robb]

This issue I have with leaving this guy prone is the hamper it puts on your assessment as ffemt pointed out as well as treatment. Also what happens when you are jumping down the road with this guy and he crumps? Now you've got to deal with turning him over before you can gain access to his airway, you could technically decompress a tension pneumo using this mid/anterior auxiliary 5th intercostal space but you are still making the management of this patient much more difficult on yourself.

Another point is this guy is going too get log rolled to supine as soon as he hits the trauma table unless there's a really good reason to keep him prone (read: impaled object posteriorly).

Another thought to consider, pt comfort. Have you ever ridden in an ambulance on the cot? It isn't a smooth ride. Add in a patient with potentially severely painful injuries, "suspected pelvic fracture", and you laying this patient on his face and bumping down the road rather than rolling him over, stabilizing any injuries that you can and providing proper analgesia is a disservice to this patient. Just my opinion.

 

[bigbaldguy]

Also what happens when you are jumping down the road with this guy and he crumps?

This would be my major problem with it. Maintaining an airway is going to be tricky unless you pull the auto mechanic trick and slide up under the patient.

 

[mycrofft]

OK. Points taken.

 

[shangkay99]

Thank you for al of you..
yes it's clear for me right now..

 

[mycrofft]

You are welcome. Where on earth are you right now?

You are on earth, right?