XXXX control in @entity174 --a survey of surgical capabilities.

@entity1 @entity174 @entity548
BACKGROUND: In the emergency management of @entity1 with @entity174 , there is ongoing debate about the roles of angiography and open pelvic packing. It is agreed that some form of @entity548 control is required for @entity1 who are haemo-dynamically unstable despite resuscitation. We set out to determine whether on-call general and orthopaedic surgeons would feel able to perform emergency surgical procedures for these @entity1 and whether vascular radiology was available to them. METHODS: Surveys were sent to all 221 general and orthopaedic surgeons in Wales. Questions included: sub-speciality interest, geographical region, whether there is a pelvic binder in their hospital, availability of interventional radiology, and whether surgeons would perform a range of procedures to control @entity548 in the emergency setting. RESULTS: There were 141 responses to the survey, giving a 64% response rate. Only 18% reported that their unit had a formal rota for interventional radiology out of hours. 16% did not know. 96% of orthopaedic surgeons would perform external fixation, although only 49% would use a C-clamp. 90% of general surgeons would be able to pack the pelvis from within the abdominal compartment and 84% would be prepared to cross-clamp the aorta if the situation required. Despite being widely recommended in the literature as a method of @entity548 control, our survey revealed only 45% would perform extra(pre)-peritoneal packing of the pelvis (58% of general surgeons; 34% of orthopaedic surgeons) and only 12% had received formal training in this procedure. CONCLUSIONS: With appropriately targeted training it is likely that the care of @entity1 with @entity174 can be significantly improved.
