On Mon, 23 Apr 2001, Dunn Matthew Dr. ACCIDENT & EMERGENCY - SwarkHosp-TR wrote:
... Midface fractures are a problem if you
> lay the patient supine. Airway obstructs, patient thrashes around as they
> feel (correctly) that you are trying to suffocate them. In first world war,
> patients with big midface injuries were carried face down on the stretcher.
> Alternative is letting the patient sit upright- risks to the spine, but
> depends on how likely you feel the spine to be injured and whether you feel
> the risks are outweighed by those of respitory compromise with at best
> avoidable; and at worst failed intubation. BVM and airways just don't work
> in these cases. A judgement call (medicolegally safer to keep the patient on
> their bak nad go for intubation, though)
>
> Matt Dunn
>
Dear Matt,
Emerging pre-hosp practice is to transport these patients in a RED/KED
- one of the few indications for this piece of kit in the rapid
extrication/PHTLS era, though takes some effort to secure them en route
to prevent them falling off the stretcher (!). Probably the other
indication would be severe chest trauma with spontaneous respiration
where the act of lying the patient supine compromises their respiration -
certainly the helis have had problems with a couple of these patients.
Just as well most RED/KEDs have now been removed ...
Anton van Dellen
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