#SimBlog: When Santa Fell off a Chimney
““Approx. 60 y/o fallen from a roof. Insisting he has to get back to work as he is very busy.””
Observations
A – Patent, C-spine Immobilised
B – Bilat air ent, Sats 95% (15l)
C – HR 123 Bp 75/40
D – GCS e3 v4 m6 (13)
Clinical findings
Complaining of pain in lower abdo and hips.
Why we simulated?
With the introduction of Major Trauma Centres (MTCs), trauma units like ours see significantly less trauma than we used to. As a result our staff are less familiar with dealing with major trauma patients who slip through the net or come to us for clinical reasons. As a unit that cannot necessarily provide definitive care for patients with major trauma we need to resuscitate effectively then ensure we transfer to the MTC in a timely manner. This is not always easy.
Pelvic Fractures are a high energy injury, however in the elderly or frail less force may be required. It can cause disruption of blood vessels leading to major haemorrhage with a risk of death. Identifying these patients and treating the injury can be life saving. By applying a pelvic binder if you have suspicion you may be able to stabilise your patient.
Learning outcomes
Pelvic binder should be centred over the greater trochanters – it is a common mistake to site them too high.
Think about the best way to apply the binder to the patient e.g. using the scoop/trauma mattress and placing a binder on the trolley before patient arrival.
Our Resus stack contains a splinting drawer in which you can find a TPOD pelvic binder, Kendric splint and equipment to aid in Thomas splint application.
Positive feedback
Good preparation prior to arrival – clear roles for all team members and plan of priorities for first 5 minutes.
All team members verbalised key information clearly within the scenario, promoting situational awareness.
Constructive discussion regarding further resuscitation & investigation vs early transfer to MTC.
Position for application of (Tpod) Pelvic Binder
Location of Pelvic Binders in Resus
