Tim Pohlemann1, Ulf Culemann, Joerg H Holstein. 1. Department of Trauma, Hand, and Reconstructive Surgery, University of Saarland, Homburg, Germany. tim.pohlemann@uks.eu
Abstract
BACKGROUND: Because the average exposure of surgeons to pelvic injuries with life-threatening hemorrhage is decreasing, training opportunities are necessary to prepare surgeons for the rare but highly demanding emergency situations. We have developed a novel pelvic emergency simulator to train surgeons in controlling blood loss. QUESTIONS/PURPOSES: We (1) described the design and use of the simulator; and (2) determined whether the simulator correctly identified proper and improper mechanical stabilization and bleeding control. METHODS: The device contained two tube systems. The tubes of the first system were passed through the disrupted sacroiliac joint and the symphysis. By reduction (manual traction on the leg) and compression (application of the C-clamp) of the disrupted pelvis, the tubes were pinched by the synthetic bones leading to a stop of simulated blood flow through the tubes of the first system. The tubes of the second system ended in a foam representing the presacral and paravesical venous plexus. By correct preperitoneal packing, the flow into the foam was stopped. Simulated bleeding was monitored by quantifying flow out of a fluid reservoir and flow into fluid samplers. RESULTS: The pelvic emergency simulator has been used for eight training sessions since 2002. Bleeding control by packing was achieved after 6 ± 3 minutes. Total simulated blood loss during the training session was 1296 ± 892 mL. CONCLUSIONS: Our data suggest the simulator can be used as a tool to train surgeons to reduce blood loss in severe pelvic ring injuries.
BACKGROUND: Because the average exposure of surgeons to pelvic injuries with life-threatening hemorrhage is decreasing, training opportunities are necessary to prepare surgeons for the rare but highly demanding emergency situations. We have developed a novel pelvic emergency simulator to train surgeons in controlling blood loss. QUESTIONS/PURPOSES: We (1) described the design and use of the simulator; and (2) determined whether the simulator correctly identified proper and improper mechanical stabilization and bleeding control. METHODS: The device contained two tube systems. The tubes of the first system were passed through the disrupted sacroiliac joint and the symphysis. By reduction (manual traction on the leg) and compression (application of the C-clamp) of the disrupted pelvis, the tubes were pinched by the synthetic bones leading to a stop of simulated blood flow through the tubes of the first system. The tubes of the second system ended in a foam representing the presacral and paravesical venous plexus. By correct preperitoneal packing, the flow into the foam was stopped. Simulated bleeding was monitored by quantifying flow out of a fluid reservoir and flow into fluid samplers. RESULTS: The pelvic emergency simulator has been used for eight training sessions since 2002. Bleeding control by packing was achieved after 6 ± 3 minutes. Total simulated blood loss during the training session was 1296 ± 892 mL. CONCLUSIONS: Our data suggest the simulator can be used as a tool to train surgeons to reduce blood loss in severe pelvic ring injuries.
Authors: G Tosounidis; J H Holstein; U Culemann; F Holmenschlager; F Stuby; T Pohlemann Journal: Acta Chir Orthop Traumatol Cech Date: 2010 Impact factor: 0.531