The Effectiveness of Pelvic Circumferential Compression Devices - Term Paper Example

The Effectiveness of Pelvic Circumferential Compression Devices I. Introduction a. Presentation of the Issue Pelvic circumferential compression devices (PCCDs) are included in the methods to treat pelvic fractures due to high-energy trauma. For that matter, the application of PCCDs is for the management of the pelvic fracture to be able to resolve the massive hemorrhage. The method of pelvic circumferential compression is utilized as an emergency technique prior to hospitalization phase specifically during the early non-invasive hemodynamical stabilization through the compression of the structures around the pelvis (Knops et al. 101). b. Background Information and Definition of Important Terms There are various terms that are considered important in the study of the effectiveness of PCCDs on EMS cases of pelvic traumas. Pelvic fractures can be considered as one of the most common injuries that can result from the different forms of accidents and traumas that can lead to high amount of hemorrhage from any of the following injuries namely, the venous plexus lesion, arterial injury, and localized bleeding of the specific fracture sites (Knops et al. 101). The said condition has high incidence of mortality and recorded as the third leading cause of death in vehicular accident cases specifically motor vehicles (Wayne 39). Pelvic circumferential compression device is defined as an apparatus commonly in the form of a belt with a mechanism for tightening that is put around the pelvis that had been fractured. It works by constricting and preventing any form of movement, thus, it stabilizes the fractured pelvis. The Pelvic Binder, T-POD and the SAM Sling are the most common types of PCCDs (Knops et al. 101; Spanjersberg et al. 1031). c. Relevance of the Procedure to EMS Due to the need for immediate method to manage pelvic fracture or trauma, studies on the application of the pelvic circumferential compression devices are prevalent while studies that are focused on the effectiveness of the said devices are scarce. This can be attributed to the fact that applications of new development in PCCDs are immediate due to the need e.g. in emergency cases or emergency medical services (EMS). This can be observed in the data presented in references and guidelines in cases of pelvic injuries. One example is the Advanced Trauma Life Support wherein PCCDs are indicated to be the main method to manage unstable pelvic fracture (Spanjersberg et al. 1031). The role of the PCCDs in managing pelvic fracture specifically in EMS can be considered essential on the basis of the need of such cases for immediate care. If the pressure on the skin exceeding 9.3 kPa continuously affects a person for 2 to 3 hours, the safety of the patient is affected and the effectiveness of the procedure is affected (Knops et al. 101). The objective of the paper is to present the effectiveness of PCCDs and the application of the said devices in specifically in EMS. Included in the topics to be discussed are the history and development of PCCDs and the review of related literature regarding the uses and functions of the said devices. The functions and advantages as well as the limitations and disadvantages of the use of PCCDs are also included. The importance and relevance to EMS is also included in the research conducted. II. Review of Literature a. Development of Pelvic Circumferential Compression Devices The prevalence of different types of pelvic traumas and fractures required the development of methods and techniques for the management of the resultant blessing. To be able to resolve and lessen the danger of pelvic fractures due to bleeding, trauma surgeons in around the world recognized and noted the need of pelvic fractures stabilization specifically in emergency cases. In the study conducted by Wayne in 2006, it was indicated that the application of PCCDs is a recent method. Prior to the declaration that made the use of PCCD a standard first aid protocol, other forms of binders are utilized but the need for such a device continued due to the limitations in functions of the said binders. Any binding device or technique then failed to target the position or shape that can achieve the exact circumferential compressive force needed to support the pelvic fracture or trauma (p. 39). There are different non-invasive methods and tools that had been developed prior to the PCCDs. In 1974, the Medical Anti-Shock Trouser (MAST) and the Pneumatic Anti-Shock Garment (PASG) had been developed and applied. The use of the said devices though resulted to different complications aside from the failure to present any survival benefit. Abdominal compartment syndrome and pressure sores are included in the negative effects in the use of the said devices. In addition, surgical access was also hindered by the said devices specifically in areas such as abdomen, groin and upper legs (Spanjersberg et al. 1032). The PCCD being used presently had been developed by the Biometrics Laboratory of the Legacy Health Systems in Portland, Oregon. The said device which is referred to as a pelvic sling had been developed and studied through the use of cadavers. It was then succeeded by the application in clinical trials. The research had been conducted and funded by the U.S. Office of Naval Research and the U.S. Department of Defense. Based on the objectives of the said research, first PCCD that was developed then has five (5) main purposes. First is the manner of application to be able to achieve optimum reduction and stabilization of the pelvis. Another is the presentation of the place where the device should be applied. The determination of the amount if force needed to be applied to the pelvis to be able to achieve the needed effect is also included in the guiding objectives of the study. The effectiveness and safety in using the developed PCCD are also covered by the study of the group. Results of the empirical studies conducted by the institution led to positive effects towards the patient specifically reduction of open book pelvic injuries and prevention of lateral injuries associated with such cases. In addition to the development of the first type of PCCD, the clinical study resulted to 50% decrease in the rate of mortality which indicated the effectiveness of the device (Wayne 39-40). b. Current Literature There are different studies presented in recent years on the effectiveness of the utilization of different types of PCCDs. The early researches and assessment studies on the application of PCCDs had been presented in the review by Spanjersberg et al in 2009. In the study, it had been concluded that based on the articles reviewed, PCCDs were proven to be effective in terms of stabilizing the unstable pelvic fractures thus preventing and lowering mortalities due to hemorrhage and massive bleeding. The data supporting specific percentage of decrease in mortality though were not available. In addition, certain disadvantages were also observed such as pressure sores (Spanjersberg et al. 1031-35). In the recent 2010 study by Knops et al, the focus is the mechanism of action of PCCDs which can be related to effectiveness. Measurement of exerted pressure by PCCDs was studied for the 3 different PCCDs namely Pelvic Binder, SAM-Sling and T-POD at four (4) different locations in the anatomy of the patient, namely the right, left, posterior and anterior areas. Based on the gathered results, the pressure sores observed from other studies can be explained because the pressure given by the different devices on the parts of the body all exceeded the required pressure. For that matter, prolonged use cannot be facilitated (Knops et al. 101-105). One of the most recent studies on PCCDs is undertaken by Tan, van Stigt and van Vugt on the effect of the new pelvic stabilizer T-POD in cases of unstable pelvic fractures for pelvic volume reduction and hemodynamic stability. Based on the research, T-POD is effective in providing compressive effect that supports pelvic fractures, thus, this is included in the PCCDs that can support and stabilize the pelvic ring in cases of pelvic traumas and fractures (Tan, van Stigt and van Vugt 1-5). The said studies presented both the advantages and limitations of the different types of PCCDs. The said data are essential in the determination of the effectiveness of the said devices in the management and stabilization of pelvic fractures. III. Discussion of the Issue a. Functions and Advantages of the PCCDs The development of the different types of PCCDs is due to the need for tools and management techniques to be able to resolve cases of pelvic fractures that is known to cause significant numbers of death. In such cases hemorrhage can be considered as the primary cause of death. The PCCDs, based on the gathered data are presently the main device used for managing pelvic fractures based on the protocol. Although there are limitations on the use of the said devices, there are essential functions which serve as the main reasons for the utilization of PCCDs. There are various advantages of PCCDs which primary includes promotion and protection of clot formation in the pelvic area that can prevent the hemorrhage through the prevention of movement. Another advantage is the reduction of pelvic volume through circumferential compression that can result to the prevention and significant decrease of venous bleeding. Another contribution of the device for pelvic splinting is the reduction of the need for narcotics since PCCDs can contribute comfort. The added feature which is an auto-stop buckle with two stainless steel precision springs can control pressure thus preventing the device to exceed the safe pressure which enables optimization of the advantages and functions of the PCCD (Wayne 40). One of the most important advantages of PCCDs is the ease in utilization since these devices can be considered as a simple tool yet it can significantly contribute to the welfare of the patient (Spanjersberg et al. 1032). The benefits of the PCCD then can be applied to various types of injuries in the pelvic area such as internal rotation which has the risk for internal collapse. Also, the PCCDs can enable faster action in EMS and easier transportation of patients to the hospital for proper medical care and attention (Wayne 41). b. Disadvantages of PCCDs There are disadvantages and limitations that can hinder the optimum utilization of PCCDs but these are considered minimal compared to the functions and advantages that can be achieved in the use of these devices. One of the limitations of PCCD is the risk that it can cause pressure-induced necrosis of skin underlying the device. Higher risk had been observed in the case study involving soft tissue injuries in addition to the pelvic fracture (Krieg et al. 468). c. Importance and Relevance to EMS The importance of the use of PCCDs is basically related to EMS cases since these cases are in need of simple methods and tools that can save the patients. Stability specifically in patients with high risk of hemorrhage is important. For that matter the use of PCCDs is greatly relevant to EMS. Another reason is that PCCDs coincide with the objectives of emergency care with is the safely achieved in the quickest possible time. PCCDs provide reproducible, controlled and time-efficient actions, thus, these devices are greatly relevant to EMS (Krieg et al. 468). IV. Summary Based on the data gathered through the research undertaken, the role of PCCDs specifically in EMS is essential since these devices are easy to use, efficient and can achieve the stability which is important in the target cases of pelvic fractures. Compared to previous technologies and devices for stability through pelvic compression, PCCDs were able to do the job in minimal risks. The only recorded risk is possible necrosis of skin under the device which can only be achieved in prolonged use. For that matter, in EMS this risk can be considered irrelevant. The study undertaken had been able to present the effectiveness of PCCDs through the presentation of related literature and comparative analysis of the advantages versus the disadvantages. In conclusion then, based on the data gathered, an understanding of the reasons why PCCDs are promoted and applied by trauma medical professionals had been achieved. V. Works Cited Knops, Simon P., Esther M.M. Van Lieshout, W. Richard Spanjersberg, Peter Patkaa and Inger B. Schipper. “Randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers.” Injury 210 Oct. Knops, Simon P., van Riel, Marcel P.J.M., Goossens, Richard H.M., van Leishour, Esther M.M. and Schipper, Inger B. “Measurements of the Exerted Pressure by Pelvic Circumferential Compression Devices.” Open Orthopedic Journal 4 (2010): 101-106. Krieg, James C., Marcus Mohr, Amer J. Mirza and Michael Bottlang. “Pelvic Circumferential Compression in the Presence of Soft Tissue Injuries: A Case Study.” Journal of Trauma Injury, Infection, and Critical Care 59 (2005): 468-470. Spanjersberg, Willem R., Simon P. Knops, Niels W.L. Schep, Esther M.M. van Lieshout, Peter Patka and Inger B. Schipper. “Effectiveness and Complications of Pelvic Circumferential Compression Devices in Patients with Unstable Pelvic Fractures: A Systematic Review of Literature.” Injury, Int. J. Care Injured 40 (2009): 1031-1035. Tan, Edward C.T.H., Sander F.L. van Stigt and Arie B. van Vugt. “Effects of a New Pelvic Stabilizer (T-POD®) on reduction of Pelvic Volume and Haemodynamic Stability in Unstable Pelvic Fractures.” Injury, Int. J. Care Injured 4239 (2010): 1-5. Wayne, Marvin A. “New Concepts in the Prehospital and ED Management of Pelvic Fractures.” Israeli Journal of Emergency Medicine 6.1 (2006): 39-42. Wiesel, Samuel W. Operative Techniques in Orthopaedic Surgery: An Illustrative Approach. Lippincott Williams & Wilkins, 2010. Read More