Rapid Trauma assessment- pelvis

[PheUsh]

Hello Everyone. I'm in school to become a Basic, and we're on assessments. We were taught to compress the pelvis downward and inward to check for stability. Apparently this is called rocking the pelvis. From reading these forums, I have gathered that sometimes what you learn in EMT school is not always correct. Is there anything wrong with what I've been taught here or perhaps a nuance that I should know about?

 

[teedubbyaw]

No.

 

[Akulahawk]

Hello Everyone. I'm in school to become a Basic, and we're on assessments. We were taught to compress the pelvis downward and inward to check for stability. Apparently this is called rocking the pelvis. From reading these forums, I have gathered that sometimes what you learn in EMT school is not always correct. Is there anything wrong with what I've been taught here or perhaps a nuance that I should know about?

You aren't being taught wrong, just not being taught beyond what you need at this point. Compressing the pelvis straight down and later inward basically checks some of the bony integrity of the pelvis. The thing is that you don't have to shove. Often just a little push is all that's necessary to feel crepitus.

I wouldn't suggest learning other tests until you have a good understanding of the structure of the pelvis. Yes, there are a couple more, but at your level, they're not going to be all that useful.

 

[Brandon O]

Also called "springing" the pelvis and some other things.

Bear in mind that a pelvis unstable in this way is the sort of pelvis you don't want moving, which is why some folks advise caution or avoidance of this technique. Scott Weingart recommends compressing once, and if there's mobility, do NOT let go until a sheetwrap (you guys probably talked about this in class) or a commercial stabilizing device is in place to keep things where they are. Don't fiddle, don't bring everyone in to come squeeze the cool wobbly pelvis... this is not a teaching moment.

 

[mycrofft]

Try this: point tenderness to gentle but directed palpation including the public symphisis and a suspect mech of injury (like seatbelt and collision, versus playing football) means immobilize. The receiving hospital will nod and smile and remove all your work to xray the patient anyway, catheterize for blood, etc etc.

If a pelvis seems to need immob in the field, do it. You and the pt will do better in the long game.

For examinations, do what the book says.

 

[Brandon O]

Try this: point tenderness to gentle but directed palpation including the public symphisis and a suspect mech of injury (like seatbelt and collision, versus playing football) means immobilize. The receiving hospital will nod and smile and remove all your work to xray the patient anyway, catheterize for blood, etc etc.

If a pelvis seems to need immob in the field, do it. You and the pt will do better in the long game.

Seems a bit obnoxious, given that (if it's unstable) they should NOT be messing with it until surgery, and if it's not they're going to need the area exposed...

 

[mycrofft]

We are told generically to expose the patient for assessment. Is this always advisable? Or always rational? If the time and pt discomfort (if conscious) involved in a full EMT level pelvic workup (an oxymoron since you will not be able to do bimanual palpation intra vaginally or rectally) is taken in the field, what course of immediate action does it influence? Your field exam will influence how the receivers tilt THEIR head-to-toe exam maybe, but they will in the final draft use their exam and X-rays etc to dictate treatment and diagnosis.

Bringing in a pt with point tenderness of the pubic symphisis (or other positive tests) and pelvic immobilization will do as much for the pt, be faster, and (in the case of actually testing for CREPITUS) without increased chance for iatrogenic injury such as a lacerated bladder, increase comminution of the fracture ends/zones, and shock. (Crepitus as a test endpoint is for unconscious patients, right? Since conscious one going to go through the roof or pass out from the pain).

 

[Brandon O]

I suppose I take your point, but a truly unstable pelvis is probably rare enough that prophylactically bundling up everyone whose hips hurt ("the backboard principle") is, I'm guessing, going to cause far more headaches for everyone than it's worth. Particularly if they have other injuries that need to be visualized and managed, not covered in sheets.

 

[Mariemt]

I don't usually actually expose the pelvis in the field, a quick look if they have sweat pants or loose clothing for deformity will do unless i see blood seepage but for testing, say you are. Snip snip away.

Usually a fist between the knees and the pt not being able to squeeze your fist is a pretty good indicator of a pelvis fracture. However, when in doubt, I add support and wrap it. There is potential for a lot of blood loss in the pelvis, hip and femur areas.

For class and testing, chest for crepitus, stability, expose and wrap.

 

[Mariemt]

I suppose I take your point, but a truly unstable pelvis is probably rare enough that prophylactically bundling up everyone whose hips hurt ("the backboard principle") is, I'm guessing, going to cause far more headaches for everyone than it's worth. Particularly if they have other injuries that need to be visualized and managed, not covered in sheets.

I've seen my share of horrid pelvis fx

 

[mycrofft]

I suppose I take your point, but a truly unstable pelvis is probably rare enough that prophylactically bundling up everyone whose hips hurt ("the backboard principle") is, I'm guessing, going to cause far more headaches for everyone than it's worth. Particularly if they have other injuries that need to be visualized and managed, not covered in sheets.

Good point taken, especially since "hip pain" is usually femoral head or neck pain, especially bursitis.

Pelvises (pelvi?) are only part of the exam. If anything else needs tx more urgently, then it gets precedent.

I saw very few pelvix fractures, and a couple didn't survive the attendant trauma (one fell 16 stories onto his feet, the other was on a moped and run over after cracking his skull like an egg on the side of the truck).