The Trendelenburg Debate

[SwissEMT]

Fellow providers,

I bring up this rather controversial topic to light as I'd like to hear some opinions, help gather information and hell, even learn something.

The Trendelenburg and Modified Trendelenburg position are used by a HUGE percentage of pre-hospital providers during hypotensive emergencies across the US. The main reasons for using it when asked have primarily been "I've seen it work" or "It increases their BP and cardiac output" yet studies time after time show it to have negligible benefit and even some negative effects on patients. Studies published unfortunately do not present unified results. Some studies have states an 8% increase in arterial BP in 15% of cases lasting 7 minutes while some state that the position causes respiratory compromise.

Do you believe in the Trendelenburg Position, if so, why? How long have you been using it for? Are there cases where it made a difference in patient condition? Share some stories.

I'll say my piece: I think it's completely useless.

Discuss...

 

[Ridryder911]

I have posted many articles and debates about the "myth" of Trendelenburg as well the "myth" of the Golden Hour, and many other legendary wives tale.

R/r 911

 

[firecoins]

I have posted many articles and debates about the "myth" of Trendelenburg as well the "myth" of the Golden Hour, and many other legendary wives tale.

R/r 911

You may have disproven the Golden Hour but the myth of the Golden Girls will never be disproven!!!!<_<

 

[Ridryder911]

You may have disproven the Golden Hour but the myth of the Golden Girls will never be disproven!!!!<_<

Whew!.. I first thought, you wrote Golden Showers!...


R/r 911

 

[Epi-do]

Early on, I had used Trendelenburg before, but not in the last several years. Personally, I have never seen it be effective, and I have yet to see a medic that I work with ever use it. Yet, it remains in our local protocols...maybe after medic class I will have the time to do the research so I can propose its removal.

 

[natrab]

Hm, I haven't heard of this. We use shock position all the time out here. I've seen noted improvement in pts who present with orthostatic hypotension. Most of the time just laying them back and kicking their feet up will make the dizziness and nausea subside. If not, the next step is O2 which usually takes care of the problem. I haven't seen a medic or EMT here *not* use shock position in cases of hypovolemia. Can someone explain the reasoning here? Granted, we don't position the head and torso down, we just lay the pt supine and elevate the feet.

 

[SwissEMT]

I have posted many articles and debates about the "myth" of Trendelenburg as well the "myth" of the Golden Hour, and many other legendary wives tale.

R/r 911

I did a search for posts covering it and didn't find any, my search fu must be weak. Do you have any idea which threads that info might be in?

 

[SC Bird]

I too would be interested in reading some of the writings on this site about it....guess I haven't been around long enough to have seen 'em while cruising the site.

-Matt

 

[bstone]

I am a much bigger fan of Husband's Tales than Wives Tales, actually.

 

[Ridryder911]

Lerner, EB; Moscati (2001). "The Golden Hour: Scientific Fact or Medical "Urban Legend?"". Academic Emergency Medicine 8 (7): 758-760.

Bledsoe, Bryan E (2002). "The Golden Hour: Fact or Fiction". Emergency Medical Services 6 (31): 105.

www.emsresponder.com/print/Emergency--Medical-Services/EMS-Myth-4--Lights-and-sirens-save-a-significant-amount-of-travel-time-and-lives/1$2027

http://dev.emsresponder.com/publica...teus.cygnus.value.Publication@13491ce&id=2029

I will attempt to find more information later. I have to go to work for now.

R/r 911

 

[rgnoon]

I'm especially interested in the studies regarding trendelenburg's position. If you can locate them I'd love to read them.

 

[natrab]

As far as helicopters go, they are crucial to areas that don't have trauma centers. I worked in a large county with a couple urban areas that had no definitive care for trauma. Every trauma was flown out, and if not, they truthfully were screwed. I've had to transport patients from our local hospitals while they still had internal bleeding because the hospital couldn't handle it. How would you like to do a 1 hour code 3 transport with a patient who's bleeding out in front of you? I had one code mid-transport.

In an area with trauma centers, where I work now, helicopters are only needed in the rural areas or on mcis. No reason to fly them when you can drive them (especially if you delay transport time for the helicopter).

 

[SC Bird]

Lerner, EB; Moscati (2001). "The Golden Hour: Scientific Fact or Medical "Urban Legend?"". Academic Emergency Medicine 8 (7): 758-760.

Bledsoe, Bryan E (2002). "The Golden Hour: Fact or Fiction". Emergency Medical Services 6 (31): 105.

www.emsresponder.com/print/Emergency--Medical-Services/EMS-Myth-4--Lights-and-sirens-save-a-significant-amount-of-travel-time-and-lives/1$2027

http://dev.emsresponder.com/publica...teus.cygnus.value.Publication@13491ce&id=2029

I will attempt to find more information later. I have to go to work for now.

R/r 911

Thanks...

-Matt