Complications in severe trauma
Spinal and pelvic injuries are frequently accompanied by extensive tissue damage, creating a high risk of complications. They are generally divided into two main categories:
- Local complications. These are associated with infection setting in directly at the injury site. Extensive hematomas, as well as areas of necrotic or poorly viable tissue with compromised microcirculation, become an ideal breeding ground for pathogenic microflora. Open soft tissue wounds are particularly dangerous as they serve as wide "entry portals" for microbes.
- General complications. Against the background of severe trauma and the patient's forced immobility, systemic pathologies such as pneumonia or generalized wound infection (sepsis) may develop.
Pre-hospital infection prevention
Only primary surgical debridement (PSD) can fully protect the wound, but it is not performed before arrival at the hospital. Therefore, the following measures are applied at the scene:
- Applying aseptic dressings. The main goal is to close the wound and prevent the entry of new microorganisms during patient evacuation. It is extremely important to avoid unnecessary dressings: the dressing should only be adjusted or re-bandaged in case of absolute necessity.
- Early antibiotic therapy. In the presence of open wounds (especially open fractures), broad-spectrum antibiotics should be administered within the very first hours. If transportation is delayed, medications are administered even before reaching the hospital.
- Specific prophylaxis. Measures to prevent tetanus and anaerobic infection must be carried out according to established medical protocols.
Indications for hospitalization
Patients with spinal or pelvic injuries unquestionably require hospitalization. A casualty can be left for outpatient treatment (at an outpatient trauma clinic) only in cases of minor injuries with no threat to life, an absolutely clear diagnosis, and full capabilities for proper home rehabilitation.
In addition to pelvic and spinal injuries, absolute indications for referral to a specialized hospital include:
- Open fractures and deep soft tissue wounds.
- Injuries to major joints (both open and closed).
- Fractures of long tubular bones accompanied by displacement, as well as fracture-dislocations.
- Any conditions requiring surgical intervention.
Note: Admission to the hospital does not always mean the patient will stay there for long. After clarifying the diagnosis and providing emergency care, the person may be discharged to continue treatment on an outpatient basis.
Rules for gentle transportation
Evacuating patients with severe injuries presents a difficult dilemma: any movement and repositioning exacerbates the casualty's condition, yet delivery to the hospital is essential for care. The primary task is to make transportation as gentle as possible.
To achieve this, work is structured in four directions:
- Preparation. Before movement begins, adequate analgesia must be performed and reliable immobilization of the injured segments ensured.
- In-transit therapy. Medical accompaniment with ongoing anti-shock measures is mandatory. Modern resuscitation teams can transport patients even on mechanical ventilators under therapeutic sedation.
- Choice of transport. This is guided by the principle of expediency, weighing the risks of the journey against the benefits of hospital arrival. In megalopolises and hard-to-reach areas, air ambulance services (low-noise helicopters with helipads built directly at clinics) become the optimal solution.
- Routing. The evacuation route is calculated to minimize time and distance.
Briefly: answers to topical questions
In what position should a patient with a pelvic bone fracture be transported?
A patient with a pelvic bone fracture must transported in the supine position. Transportation is carried out strictly on a rigid surface (spinal board) following appropriate immobilization. A bolster is placed under the patient's knee areas. A specially formed structure made of tied and bent ladder splints can be used for reliable fixation of this position and the bolster itself.
How is transport immobilization performed for cervical spine trauma?
Transport immobilization for cervical spine trauma is performed using special orthoses or improvised means.
The following devices are used:
- Standard cervical collars — special rigid fastened collars, which are the modern standard.
- Schanz collar — a cotton-gauze or cardboard-cotton-gauze bandage that rests against the occipital protuberance and mastoid processes at the top, and against the chest at the bottom.
- Cotton-gauze ring — placed under the head so that the occiput rests within the opening.
The most effective tactic is a combination of a rigid neck brace, a rigid spinal board, and securing the patient with straps.
What means are used for pelvic immobilization at the scene?
Rigid surfaces and vacuum devices are used for pelvic immobilization at the scene.
The following products are applied:
- Spinal board — provides a rigid surface for casualty evacuation.
- Transport splints — used for pelvic fixation prior to transportation.
- Vacuum mattresses — airtight covers that provide rigid fixation after air is evacuated.
- Vacuum immobilization stretchers — preferred for full immobilization as they allow rigid fixation of the patient.
In what position is a patient with a thoracic spine fracture transported on soft stretchers?
If soft stretchers must be used, a patient with a thoracic spine fracture is transported in the prone position. This is an alternative evacuation method in the absence of a rigid spinal board. A wide bolster must be placed under the chest and head for immobilization and to maintain proper alignment.
Class and exam questions
Can pelvic or spinal injuries be treated on an outpatient basis?
No, these types of injuries are an absolute indication for referring the casualty to a specialized hospital.
Should one attempt to clean and surgically debride the wound before the arrival of the ambulance?
Primary surgical debridement is not performed at the pre-hospital stage. It is sufficient to apply an aseptic dressing to prevent further contamination and try not to change it without urgent necessity.
What to do if patient transportation is delayed?
In case of delayed delivery to the hospital, it is necessary to ensure reliable immobilization, analgesia, and begin the administration of broad-spectrum antibiotics directly at the pre-hospital stage.
What else to study on this topic
- Criteria for discharging patients to outpatient care for minor injuries
- Organization of outpatient trauma clinic workflows and medical triage rules
- Specifics of anti-shock measures during transportation
- Use of air ambulances in modern megacities
- Prophylaxis protocols for tetanus and anaerobic infection in open injuries
Master the entire topic in the "Traumatology" course
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Other topics in the section "General Questions of Traumatology and Orthopedics"
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