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- W2023600558 abstract "We write in response to Udy and colleagues' interesting case reports of activated Factor VII in the setting of pelvic trauma [1]. While recognising the difficulty of managing this type of case, and concurring with their use of activated Factor VII, we would like to make a number of observations. Firstly, we would contend that both patients could have been managed with a low volume resuscitation strategy, at least initially [2]. There is increasing evidence that fluid resuscitation before control of haemorrhage is not a benign intervention [3]. Patient 1 had an initial blood pressure that was acceptable, and patient 2, although hypotensive, did not have a head injury and had a GCS of 15/15, usually taken to imply adequate cerebral perfusion. By limiting initial volume expansion, the initial early thrombus that has started to form at the site of injury can be protected from disruption. It is our contention that early and aggressive attention to control of haemorrhage must take precedence over volume resuscitation. Procedures such as skeletal traction (case 2) should not be deferred until stability is achieved; rather such interventions are the most reliable method of achieving such stability. The authors do not mention the management of compound femoral fracture in the first patient; we assume (and would advocate) that early traction splinting and compression were performed to control bleeding. Physical examination of the pelvis is unreliable at detecting significant injury [4], and may provoke life threatening blood loss. Given the rapid availability of radiography in UK practice we do not believe palpation to demonstrate instability (‘springing’) is justified. Our practice is to immobilise the pelvis with circumferential splint on suspicion of pelvic injury [5, 6]. In addition to speed and safety of application, this technique has the advantage of reducing a greater range of injury patterns than standard pelvic external fixation." @default.
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- W2023600558 date "2005-12-01" @default.
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- W2023600558 title "Recombinant Factor VIIa in blunt pelvic trauma" @default.
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- W2023600558 doi "https://doi.org/10.1111/j.1365-2044.2005.04449.x" @default.
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