Nombre de militaires l'ont adopté car elle protège du soleil, du vent du sable. Tout ceci est connu de longue date notamment des sahariens.
Mais une chèche c'est aussi ET SURTOUT ce qui permet de réaliser une stabilisation pelvienne, un garrot de fortune,un packing de plaie, une immobilisation de fortune, .....
La chèche un équipement important dans le cadre du sauvetage au combat.
Pour vous en convaincre lisez ce document
The effectiveness of a newly developed reduction method of anterior shoulder dislocations; Sool's method
Park MS et Al. Am J Emerg Med. 2016 Apr 9. pii: S0735-6757(16)30036-5. doi: 10.1016/j.ajem.2016.04.01
Nearly a dozen reduction methods for the treatment of anterior shoulder dislocation have been reported, but the majority are painful and require patients to be in the supine or prone position.
This retrospective cohort study was conducted in a university-affiliated emergency department (ED). Sool's method and traditional shoulder reduction methods (TSRMs) were performed for the patient with anterior shoulder dislocation. Fifty-nine eligible patients were recruited; 35 were treated with TSRMs, wherease 24 were treated with Sool's method.
The rate of successful reduction was 80% (26/35) in the TSRM group and 75% (18/24) in the Sool's method group (P=.75). The length of stay in the ED was 72.3minutes in the Sool's method group and 98.4minutes in the TSRM group (P=.037). No significant difference was observed between the neurovascular deficit before and after reduction in either group. The procedural time of successfully reduced cases in patients treated by Sool's method was shorter than that of the failed cases (P=.015).
Sool's method was as successful as other methods at reducing shoulder dislocation and has demonstrated encouraging results, including significant reduction in length of stay in the ED and unnecessary use of sedation. Sool's method is technically easy and requires only a place to sit and a single operator.
Safety of the lateral trauma position in cervical spine injuries: a cadaver model study
Cervical spine injuries in civilian victims of explosions: Should cervical collars be used?
Klein Y et Al. J Trauma Acute Care Surg. 2016 Mar 18. [Epub ahead of print]
En contexte de terrorisme civil, la pose d'un collier cervical apparaît plutôt inutile et source de perte de temps.
Semi-rigid cervical collars (SRCC) are routinely applied to victims of explosions as part of the pre-hospital trauma protocols. Previous studies have shown that the use of SRCC in penetrating injuries is not justified due to the scarcity of unstable cervical spine injuries and the risk of obscuring other neck injuries. Explosion can inflict injuries by fragments penetration, blast injury, blunt force and burns. The study purpose was to determine the occurrence of cervical spine instability without irreversible neurological deficit and other potentially life threatening non-skeletal neck injuries among victims of explosions. The potential benefits and risks of SRCC application in explosion related injuries (ERI) was Evaluated.
a retrospective cohort study of all explosions civilian victims admitted to Israeli hospitals during the years 1998-2010. Data collection was based on the Israeli national trauma registry and the hospital records, and included demographic, clinical and radiological details of all patients with documented cervical spine injuries.
the cohort included 2,267 patients. All of them were secondary to terrorist attacks. SRCC was applied to all the patients at the scene. Nineteen patients (0.83%) had cervical spine fractures. Nine patients (0.088%) had unstable cervical spine injury. All but one had irreversible neurological deficit on admission. 151 patients (6.6%) had potentially life threatening penetrating non-skeletal neck injuries.
Unstable cervical spine injuries secondary to explosion are extremely rare. The majority of unstable cervical spine fractures were secondary to penetrating injuries, with irreversible neurological deficits on admission. The application of SRCC did not seem to be of any benefit in these patients and might pose a risk of obscuring other neck injuries. We recommend that SRCC will not be used in the pre-hospital management of victims of explosions.
LEVEL OF EVIDENCE:
Retrospective observational study, level III.
Simple self-reduction method for anterior shoulder dislocation
C'est la plus fréquente des luxations. La diversité des méthodes de réduction illustre bien la difficulté qu'il peut y avoir à la réduire sans avoir recours à une anesthésie/sédation. C'est encore plus vrai en cas d'isolement extrême. Une méthode à connaître.
Pelvic pressure changes after a fracture: A pilot cadaveric study assessing the effect of pelvic binders and limb bandaging
Morris R et Al. Injury http://dx.doi.org/10.1016/j.injury.2015.12.009
Stabiliser un bassin pour lequel il existe une suspicion de fracture est une des composantes majeures du sauvetage au combat. Ceci vise à réduire la mortalité par hémorragie non garrotable ou non comprimable. Il existe des ceintures spécifiques pour cela. Ce travail est intéressant car il illustre la complémentarité des ceintures pelviennes ET de l'immobilisation des genoux. Cette dernière permet à elle seule d'augmenter la pression intra-abdominale et partant probablement de réduire le saignement. Donc n'oublier pas d'immobiliser les genoux. Que vous disposez ou pas de ceinture pelvienne, cela sert.
Objectives: Pelvic binders are a life-saving intervention for hypovolaemic shock following displaced pelvic fractures, thought to act through increasing intra-pelvic pressure to reduce venous bleeding. This cadaveric study assesses changes in intra-pelvic pressure with different binders augmented by bandaging the thighs to recruit the femora as levers to close the pelvis. Access to femoral vessels via an in situ binder was also assessed.
Methods: Two embalmed cadavers were used with unstable pelvic injuries (OA/OTA 61-C1) created through disrupting the pelvic ring anteriorly and posteriorly. To measure intravesical pressure, which reflects intra-pelvic pressure, a supra-pubic catheter was inserted and connected to a water manometer whilst a spigot was placed in a urethral catheter to reduce leakage of fluid. The common and superficial femoral arteries were dissected in the left groin for each specimen prior to any intervention to allow inspection following binder application. A SAM pelvic sling II, Trauma Pelvic Orthotic Device (T-POD), Prometheus pelvic splint and an improvised pelvic binder were used on each cadaver, with each applied following lower limb bandaging with the knees slightly flexed. The groins were then inspected to assess if the femoral vessels were visible. Statistical analysis was performed in SPSS using a paired samples t test to determine if any difference existed between initial pelvic pressure in specimens compared to pressures with bandaging on and binders applied.
Results: Bandaging the lower limbs alone produced a significant increase in both peak and steady mean intra-pelvic pressure, 15.69 cmH2O and 12.38 cmH2O, respectively, compared to the baseline pressure, 8.73 cmH2O (p = 0.002 and p = 0.001, respectively). Applying the pelvic binder with the bandaging in place increased intra-pelvic pressure compared to the baseline (peak pressure of 25.38 cmH2O (p < 0.001) and steady pressure of 15.13 cmH2O (p = 0.003)). Steady mean pressures between bandaging alone and bandaging with the binder applied were not significantly different (p = 0.09), whilst the peak pressures were significantly greater when the binder was applied (p = 0.005). The improvised binder and T-POD both required cutting to access the femoral vessels which resulted in decreasing efficacy.
Conclusions: Intra-pelvic pressure was significantly increased through bandaging the lower limbs alone, and this represents a simple measure to increase intra-pelvic pressure and therefore efficacy of the binder. Access to the femoral vessels varied with binder type and represents an important consideration in polytrauma patients.
The incidence of pelvic fractures with traumatic lower limb amputation in modern warfare due to improvised explosive devices
Excepté l'extraction d'urgence de blessés sous le feu, la prise en charge den cas d'amputation traumatique doit inclure la forte probabilité de traumatisme du bassin. Une utilisation large des immobilisations pelviennes doit donc être à l'esprit. On rappelle simplement la gravité et la difficulté de prise en charge des hémorragies liées aux fractures de bassin.
A frequently-seen injury pattern in current military experience is traumatic lower limb amputation as a result of improvised explosive devices (IEDs). This injury can coexist with fractures involving the pelvic ring. This study aims to assess the frequency of concomitant pelvic fracture in IED-related lower limb amputation.
A retrospective analysis of the trauma charts, medical notes, and digital imaging was undertaken for all patients arriving at the Emergency Department at the UK military field hospital in Camp Bastion, Afghanistan, with a traumatic lower limb amputation in the six months between September 2009 and April 2010, in order to determine the incidence of associated pelvic ring fractures.
Of 77 consecutive patients with traumatic lower limb amputations, 17 (22%) had an associated pelvic fracture (eleven with displaced pelvic ring fractures, five undisplaced fractures and one acetabular fracture). Unilateral amputees (n = 31) had a 10% incidence of associated pelvic fracture, whilst 30 % of bilateral amputees (n = 46) had a concurrent pelvic fracture. However, in bilateral, trans-femoral amputations (n = 28) the incidence of pelvic fracture was 39%.
The study demonstrates a high incidence of pelvic fractures in patients with traumatic lower limb amputations, supporting the routine pre-hospital application of pelvic binders in this patient group
Cervical spine injury in dismounted improvised explosive device trauma
La mise en place d'un collier cervical est une mesure classique en traumaotlogie routière. Elle n'est cependant pas recommandée en cas de traumatisme d'origine ballistique. La probabilité de lésions instables du rachis semble faible surtout si il s'agit de blessures survenues lors de combat à pied et sans atteinte crânienne associée. L'étude présentée conforte cette position.
The injury pattern from improvised explosive device (IED) trauma is different if the target is in a vehicle (mounted) or on foot (dismounted). Combat and civilian first response protocols require the placement of a cervical collar on all victims of a blast injury.
We searched the Joint Theatre Trauma Registry (JTTR) and the Role 3 Hospital, Kandahar Airfield (KAF) database from Mar. 1, 2008, to May 31, 2011. We collected data on cervical fracture; head injury; traumatic amputation; initial blood pressure, pulse, injury severity score (ISS), Glasgow Coma Scale (GCS) score and base excess; and patient demographic information.
The concordance rate between JTTR and KAF databases was 98%. Of the 15 693 admissions in JTTR, 326 patients with dismounted IED injuries were located. The rate of cervical collar prehospital placement was 7.6%. Cervical fractures were found in 19 (5.8%) dismounted IED victims, but only 4 (1.2%) were considered radiographically unstable. None of these 19 patients had prehospital placement of a collar. Patients with cervical spine fractures were more severely injured than those without (ISS 18.2 v. 13.4; GCS 10.1 v. 12.5). Patients with head injuries had significantly higher risk of cervical spine injury than those with no head injury recorded (13.6% v. 3.9%). No differences in frequency of cervical spine injury were found between patients who had associated traumatic amputations and those who did not (5.4% v. 6.0%).
Dismounted IED is a mechanism of injury associated with a low risk for cervical spine trauma. A selective protocol for cervical collar placement on victims of dismounted IED blasts is possible and may be more amenable to combat situations.
Improvised traction splints: a wilderness medicine tool or hindrance?
Immobiliser un membre le plus tôt possible et ce de manière efficace est un des enjeux de la mise en condition d'évacuation. Il s'agit là de prévenir le mieux possible toute complication secondaire, de réduire le saignement et la douleur. Pour cela existe de nombreux équipements proposés par l'industrie. Miass sont ils vraiment utiles ? Pas si évident si l'on en croit le document proposé. Il pourrait exister à l'évidence des moyens simples et efficaces surtout moins coûteux d'atteindre ces objectifs.
To investigate whether a traction splint made from improvised materials is as efficacious as commercially available devices in terms of traction provided and perceived comfort and stability.
This was a prospective randomized crossover study utilizing 10 healthy, uninjured volunteers. The subjects were randomized to be placed in 4 different traction devices, in differing order, each for 30 minutes. Three of the traction splints are commercially available: The HARE, Sager, and Faretech CT-EMS. The fourth traction device was an improvised splint made as described in Medicine for the Backcountry: A Practical Guide to Wilderness First Aid. At the end of 30 minutes the pounds of force created by each device was measured. The volunteers were also asked at that time to subjectively report the comfort and stability of the splint separately on a scale from 1 to 10.
All traction splints performed similarly with regard to the primary outcome measure of mean pounds of traction created at the end of 30 minutes of application with results ranging from 10.4 to 13.3 pounds. There was little difference reported by participants in regard to stability or comfort between the 4 traction devices.
In this small pilot study, an improvised traction splint was not inferior to commercially available devices. Further research in needed in this area.
Evaluation of commercially available traction splints for battlefield use
L'immobilisation d'une fracture de fémur nécessite idéalement une traction. Les attelles de type thomas-lardenois ne sont pas utilisables en préhospitalier. La classique attelle de Donway n'est pas idéale dès lors que l'on est en combat à pied. Bien que l'intérêt de telles attelles reste discuté (1) , nous disposons à la nomenclature de l'atelle Faretec CT6. Le document présenté vante de manière très surprenante les qualités de l'attelle de slishman. Certes cette dernière semble plus rapide à poser mais avec un taux d'échec beaucoup plus important. La CT6 reste donc un excellent choix, c'est d'ailleurs ce qui est également dit dans ce document qui parait quelque peu orienté dans ces conclusions.
Background: Femoral fracture is a common battlefield injury with grave complications if not properly treated. Traction splinting has been proved to decrease morbidity and mortality in battlefield femur fractures. However, little standardization of equipment and training exists within the United States Armed Forces. Currently, four traction splints that have been awarded NATO Stock Numbers are in use: the CT-6 Leg Splint, the Kendrick Traction Device (KTD), the REEL Splint (RS), and the Slishman Traction Splint (STS).
Objective: The purpose of this study was to determine the differences between the four commercially available traction devices sold to the U.S. Government.
Methods: After standardized instruction, subjects were timed and evaluated in the application of each of the four listed splints. Participant confidence and preferences were assessed by using Likertscaled surveys. Free response remarks were collected before and after timed application.
Results: Subjects had significantly different application times on the four devices tested (analysis of variance [ANOVA], p < .01). Application time for the STS was faster than that for both the CT-6 (t-test, p < .0028) and the RS (p < .0001). Subjects also rated the STS highest in all post-testing subjective survey categories and reported significantly higher confidence that the STS would best treat a femoral fracture (p < .00229).
Conclusions: The STS had the best objective performance during testing and the highest subjective evaluation by participants. Along with its ability to be used in the setting of associated lower extremity amputation or trauma, this splint is the most suitable for battlefield use of the three devices tested
Reduction of Acute Shoulder Dislocations in a Remote Environment: A Prospective Multicenter Observational Study
Acute dislocations of the glenohumeral joint are common in wilderness activities. Emergent reduction should take place at the site of trauma to reduce the patient's pain and the risk of vascular and neurological complications. A limited number of reduction methods are applicable in remote areas. The aim of this study is to present our method of reduction of anterior shoulder luxation that is easily applicable in remote areas without medication, adjuncts, and assistants and is well tolerated by patients.
A prospective observational study was conducted during a 5-year period. The patients included underwent closed manual reduction with our technique. After each reduction, the physician who performed the reduction completed a standardized detailed history, and reexamined the patient (for acute complications). The patients were contacted 6 months after the trauma to investigate long-term postreduction complications.
Diagram depicting the steps of our reduction procedure. The practitioner holds the patient’s wrist with the left hand (in the case of a left shoulder dislocation) and the patient’s elbow with the right hand.
(B) With the elbow in 90° of flexion, the glenohumeral joint is flexed forward to 90°. (C) While still in flexion, the glenohumeral joint is adducted until the elbow reaches the midline of the body; it is important to continue this movement until this landmark is completely reached. (D) Then, internal rotation of the shoulder is performed. During this step, the patient’s elbow must stay at the landmark described above. At 25° to 30° of rotation, a mild resistance is usually encountered. (E) The last step of the maneuver consists of applying a constant internal rotation pressure to overcome this mild resistance without pain. Reduction is usually achieved at approximately 30° of internal rotation.
Reduction was achieved with our method in 39 (100.0%) of 39 patients. The mean pain felt during our reduction procedure was rated 1.7 ± 1.4 (on a scale of 10) using the visual analog scale scoring system. No complications were noted before or after the reduction attempts. We did not find any long-term complications.
The reduction method presented in the present study is an effective method for the reduction of acute shoulder luxations in remote places. Our data suggest that this method could be applied for safe and effective reduction of shoulder dislocation.
Recommandation 1 (grade:1C) :
Neutral alignment should be restored and maintained with light or moderate manual cervical traction during extrication, unless such a maneuver is met with resistance, increased pain, or new or worsening neurologic deficit.
Recommandation 2 (grade:1C):
Patients requiring extrication, when the cervical spine cannot be cleared before extrication, should be placed in a cervical collar and allowed to exit the situation under their own volition if alert and reliable. Otherwise extrication should be performed with a KED (or similar device) plusc ervical collar,and the immobilized patient moved in a sitting position onto a long spine board, vacuum mattress, orsimilar device.
Recommandation 3 (grade:1C):
The lift and slide transfer with trap squeeze is preferred to the log roll when transferring patients to and from a backboard
Recommandation 4 (grade:2C):
Spinal immobilization should be considered in patients with evidence of spinal injury, including those with neurologic injury, and those patients who have experienced severe trauma and are unconscious or exhibit altered mental status.
Recommandation 5 (grade:2B):
The cervical collar (or improvised equivalent) should beconsidered one ofs everal tools available to aid in immobilization of the cervical spine. It should not be considered adequate immobilization in and of itself, nor should it beconsidered necessary if adequate immobilization can be accomplished by other means, or if the presence of the collar in itself compromises emergent patient care.
Recommandation 6 (grade:1B):
Use of the cervical collar is contraindicated in ankylosing spondylitis. Patients with suspected injury should hav etheir neck supported in a position of comfort
Recommandation 6 (grade:1C):
Vacuum mattress provides superior immobilization, with or without a standard cervical collar, and improved patient comfort (with corresponding decreased risk of pressure sores) and is preferred over a backboard for immobilization of either the entire spine or specific segments of concern.
Recommandation 6 (grade:1A):
Appropriately trained personnel, using either the NEXUS criteria or the Canadian C- spine rule, can safely and effectively make decisions in the prehospital setting about whether or not ac ervical spine should be immobilized.
Spinal immobilization should not be performed in the presence of penetrating trauma
Les attelles de type Sam Splint sont INCONTOURNABLES en médecine militaire comme on peut le voir dans une brochure spécifique. Certains proposent de l'utiliser comme base d'une stabilisation pelvienne.
Comparison of circumferential pelvic sheeting versus the T-POD on unstable pelvic injuries: A cadaveric study of stability
Prasarn ML et All. Injury. 2013 Jun 27. pii: S0020-1383(13)00256-8
Objectives: Commercially available binder devices are commonly used in the acute treatment of pelvic fractures, while many advocate simply placing a circumferential sheet for initial stabilization of such injuries. We sought to determine whether or not the T-POD would provide more stability to an unstable pelvic injury as compared to circumferential pelvic sheeting.
Methods: Unstable pelvic injuries (OTA type 61-C-1) were surgically created in five fresh, lightly embalmed whole human cadavers. Electromagnetic sensors were placed on each hemi-pelvis. The amount of angular motion during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). Either a T-POD or circumferential sheet was applied in random order for testing. The measurements recorded in this investigation included maximum displacements for sagittal, coronal, and axial rotation during application of the device, bed transfer, log-rolling, and head of bed elevation.
Results: There were no differences in motion of the injured hemi-pelvis during application of either the T-POD or circumferential sheet. During the bed transfer, log-rolling, and head of bed elevation, there were no significant differences in displacements observed when the pelvis was immobilized with either a sheet or pelvic binder (T-POD).
Conclusions: A circumferential pelvic sheet is more readily available, costs less, is more versatile, and is equally as efficacious at immobilizing the unstable pelvis as compared to the T-POD. We advocate the use of circumferential sheeting for temporary stabilization of unstable pelvic injuries.
The use of pelvic binders in the emergent management of potential pelvic trauma
Chesser TJS et all. Injury, Int. J. Care Injured 43 (2012) 667–669
Prehospital Spine Immobilization for Penetrating Trauma—Review
and Recommendations From the Prehospital Trauma Life Support
- There are no data to support routine spine immobilization in patients with penetrating trauma to the neck or torso.
- There are no data to support routine spine immobilization in patients with isolated penetrating trauma to the cranium.
- Spine immobilization should never be done at the expense of accurate physical examination or identiﬁcation and correction of life-threatening conditions in patients with penetrating trauma.
- Spinal immobilization may be performed after penetrating injury when a focal neurologic deﬁcit is noted on physical examination although there is little evidence of beneﬁt even in these cases.
Le PHTLS, qui correspond à un ensemble de procédures destinée à être mises en oeuvre par des techniciens d'urgence, ne reflète pas du tout la pratique française.
Ce document est à mettre en lien avec l'impotrance d'un positionnement correct de ces dispositifs. Il s'agit seulement d'une fois sur 2 d'un positionnement au niveau des grands trochanter. Dans près de 40% des cas le positionnement était trop haut.