Re: Trendelenburg position

[Guest guest]

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at page

169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at page

169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Thank you, Mr. Gandy!

________________________________

To: texasems-l

Sent: Thursday, May 17, 2012 2:14 AM

Subject: Re: Trendelenburg position

 

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at page

169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Thank you, Mr. Gandy!

________________________________

To: texasems-l

Sent: Thursday, May 17, 2012 2:14 AM

Subject: Re: Trendelenburg position

 

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at page

169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Thanks Gene, I almost always learn things from your posts. Barry

Barry Sharp, MSHP, MCHES

Tobacco Prevention & Control Program Coordinator

Substance Abuse Services Unit

Mental Health and Substance Abuse Division

From: texasems-l [mailto:texasems-l ] On Behalf

Of Wegandy

Sent: Thursday, May 17, 2012 2:15 AM

To: texasems-l

Subject: Re: Trendelenburg position

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at page

169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Does this apply as well to diver rescue, such as encountering a diver that may

possibly be bent? The " theory " behind it was to keep the nitrogen bubbles that

came out of solution, in the blood stream, away from the heart. While breathing

compressed surface air, which contains 78% Nitrogen, 20% O2, and 2% " other "

(give or take) and adding pressure, brings a law in play that says : a gas, in

contact with liquid and placed under pressure, goes into " Solution " . When the

pressure is relieved, the gas will come out of solution and return to it's

previous state. A diver coming up too quickly, who has Nitrogen in solution in

their blood stream, will cause the Nitrogen to come out of solution, causing

" air " bubbles through out the entire vascular system. Trendelenburg has always

been taught as a positioning for this type rescue, to keep the bubbles towards

the feet, and not " choke " the pump till you could get them to a decompression

chamber.

I have always thought this was a crock, because we have an enclosed system

working under pressure, and the bubbles would make the entire " rounds " , even if

you were hung by your toe nails. So my question........is Trendelenberg (e or

u)  ousted as a treatment for ALL medical situations?

I'll keep my Guns, my Freedom and my MONEY,

You can keep the " CHANGE. "

Subject: Re: Trendelenburg position

To: texasems-l

Date: Thursday, May 17, 2012, 2:14 AM

 

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at

page 169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Does this apply as well to diver rescue, such as encountering a diver that may

possibly be bent? The " theory " behind it was to keep the nitrogen bubbles that

came out of solution, in the blood stream, away from the heart. While breathing

compressed surface air, which contains 78% Nitrogen, 20% O2, and 2% " other "

(give or take) and adding pressure, brings a law in play that says : a gas, in

contact with liquid and placed under pressure, goes into " Solution " . When the

pressure is relieved, the gas will come out of solution and return to it's

previous state. A diver coming up too quickly, who has Nitrogen in solution in

their blood stream, will cause the Nitrogen to come out of solution, causing

" air " bubbles through out the entire vascular system. Trendelenburg has always

been taught as a positioning for this type rescue, to keep the bubbles towards

the feet, and not " choke " the pump till you could get them to a decompression

chamber.

I have always thought this was a crock, because we have an enclosed system

working under pressure, and the bubbles would make the entire " rounds " , even if

you were hung by your toe nails. So my question........is Trendelenberg (e or

u)  ousted as a treatment for ALL medical situations?

I'll keep my Guns, my Freedom and my MONEY,

You can keep the " CHANGE. "

Subject: Re: Trendelenburg position

To: texasems-l

Date: Thursday, May 17, 2012, 2:14 AM

 

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at

page 169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Or........as Jeraldo may pronounce it on national television.....trenda

lend burg. hahhahaha,....no seriously, he actually DID that.

I'll keep my Guns, my Freedom and my MONEY,

You can keep the " CHANGE. "

Subject: Re: Trendelenburg position

To: texasems-l

Date: Thursday, May 17, 2012, 2:14 AM

 

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at

page 169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

Or........as Jeraldo may pronounce it on national television.....trenda

lend burg. hahhahaha,....no seriously, he actually DID that.

I'll keep my Guns, my Freedom and my MONEY,

You can keep the " CHANGE. "

Subject: Re: Trendelenburg position

To: texasems-l

Date: Thursday, May 17, 2012, 2:14 AM

 

Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at

page 169 of the 7th edition: " The Trendelenburg position does not improve

cardiopulmonary performance compared with the supine position. It may worsen

pulmonary gas change and predispose to aspiration. "

Instead, " passive leg raising above the level of the heart with the patient

supine can be effective.

Trendelenburg forces the abdominal contents up against the diaphragm, limiting

diaphragmatic excursion and increasing the work of breathing. Further, there is

no medical evidence proving that it improves cardiac output.

Several studies, easily found if you Google " Trendelenburg in hypovolemic

shock, " have examined the literature and concluded that use of Trendelenburg

position in hypovolemic shock is based on tradition rather than science.

It was originally developed for use during abdominal surgery to make the organs

more accessible to the surgeon, not for use in shock treatment.

It is simply another medical myth that refuses to die.

Gene Gandy, LP, NREMT-P

EMS Educator

Tucson, AZ

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***

[Guest guest]

According to medscape it shouldnt be used

" Do not put patient into Trendelenburg position. Placing the patient in a

head-down posture used to be considered a standard treatment of diving

injuries to prevent cerebral gas embolization. This practice should be

abandoned. The process actually increases intracranial pressure and

exacerbates injury to the blood-brain barrier.[52]

http://emedicine.medscape.com/article/769902-treatment>It

also wastes time and complicates movement of the patient. "

Source: http://emedicine.medscape.com/article/769902-overview which cites:

https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZ\

S5jb20vbWVkbGluZS9hYnN0cmFjdC84MjExMDgy&ac=401

> **

>

>

> Does this apply as well to diver rescue, such as encountering a diver that

> may possibly be bent? The " theory " behind it was to keep the nitrogen

> bubbles that came out of solution, in the blood stream, away from the

> heart. While breathing compressed surface air, which contains 78% Nitrogen,

> 20% O2, and 2% " other " (give or take) and adding pressure, brings a law in

> play that says : a gas, in contact with liquid and placed under pressure,

> goes into " Solution " . When the pressure is relieved, the gas will come out

> of solution and return to it's previous state. A diver coming up too

> quickly, who has Nitrogen in solution in their blood stream, will cause the

> Nitrogen to come out of solution, causing " air " bubbles through out the

> entire vascular system. Trendelenburg has always been taught as a

> positioning for this type rescue, to keep the bubbles towards the feet, and

> not " choke " the pump till you could get them to a decompression chamber.

>

> I have always thought this was a crock, because we have an enclosed system

> working under pressure, and the bubbles would make the entire " rounds " ,

> even if you were hung by your toe nails. So my question........is

> Trendelenberg (e or u) ousted as a treatment for ALL medical situations?

>

>

> I'll keep my Guns, my Freedom and my MONEY,

> You can keep the " CHANGE. "

>

>

>

>

> Subject: Re: Trendelenburg position

> To: texasems-l

> Date: Thursday, May 17, 2012, 2:14 AM

>

>

>

> Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at

> page 169 of the 7th edition: " The Trendelenburg position does not improve

> cardiopulmonary performance compared with the supine position. It may

> worsen pulmonary gas change and predispose to aspiration. "

>

> Instead, " passive leg raising above the level of the heart with the

> patient supine can be effective.

>

> Trendelenburg forces the abdominal contents up against the diaphragm,

> limiting diaphragmatic excursion and increasing the work of breathing.

> Further, there is no medical evidence proving that it improves cardiac

> output.

>

> Several studies, easily found if you Google " Trendelenburg in hypovolemic

> shock, " have examined the literature and concluded that use of

> Trendelenburg position in hypovolemic shock is based on tradition rather

> than science.

>

> It was originally developed for use during abdominal surgery to make the

> organs more accessible to the surgeon, not for use in shock treatment.

>

> It is simply another medical myth that refuses to die.

>

> Gene Gandy, LP, NREMT-P

>

> EMS Educator

>

> Tucson, AZ

>

> Trendelenburg position

>

> I was recently told they are not teaching the trendelenburg position for

> shock to the EMT class. I would like some insight as to why so that I can

> keep up with some of the changes. Thanks in advance

>

> ***you can e-mail me off-list if you would like***

>

>

[Guest guest]

According to medscape it shouldnt be used

" Do not put patient into Trendelenburg position. Placing the patient in a

head-down posture used to be considered a standard treatment of diving

injuries to prevent cerebral gas embolization. This practice should be

abandoned. The process actually increases intracranial pressure and

exacerbates injury to the blood-brain barrier.[52]

http://emedicine.medscape.com/article/769902-treatment>It

also wastes time and complicates movement of the patient. "

Source: http://emedicine.medscape.com/article/769902-overview which cites:

https://login.medscape.com/login/sso/getlogin?urlCache=aHR0cDovL3d3dy5tZWRzY2FwZ\

S5jb20vbWVkbGluZS9hYnN0cmFjdC84MjExMDgy&ac=401

> **

>

>

> Does this apply as well to diver rescue, such as encountering a diver that

> may possibly be bent? The " theory " behind it was to keep the nitrogen

> bubbles that came out of solution, in the blood stream, away from the

> heart. While breathing compressed surface air, which contains 78% Nitrogen,

> 20% O2, and 2% " other " (give or take) and adding pressure, brings a law in

> play that says : a gas, in contact with liquid and placed under pressure,

> goes into " Solution " . When the pressure is relieved, the gas will come out

> of solution and return to it's previous state. A diver coming up too

> quickly, who has Nitrogen in solution in their blood stream, will cause the

> Nitrogen to come out of solution, causing " air " bubbles through out the

> entire vascular system. Trendelenburg has always been taught as a

> positioning for this type rescue, to keep the bubbles towards the feet, and

> not " choke " the pump till you could get them to a decompression chamber.

>

> I have always thought this was a crock, because we have an enclosed system

> working under pressure, and the bubbles would make the entire " rounds " ,

> even if you were hung by your toe nails. So my question........is

> Trendelenberg (e or u) ousted as a treatment for ALL medical situations?

>

>

> I'll keep my Guns, my Freedom and my MONEY,

> You can keep the " CHANGE. "

>

>

>

>

> Subject: Re: Trendelenburg position

> To: texasems-l

> Date: Thursday, May 17, 2012, 2:14 AM

>

>

>

> Here's what Tintinalli's Emergency Medicine says about Trendelenburg, at

> page 169 of the 7th edition: " The Trendelenburg position does not improve

> cardiopulmonary performance compared with the supine position. It may

> worsen pulmonary gas change and predispose to aspiration. "

>

> Instead, " passive leg raising above the level of the heart with the

> patient supine can be effective.

>

> Trendelenburg forces the abdominal contents up against the diaphragm,

> limiting diaphragmatic excursion and increasing the work of breathing.

> Further, there is no medical evidence proving that it improves cardiac

> output.

>

> Several studies, easily found if you Google " Trendelenburg in hypovolemic

> shock, " have examined the literature and concluded that use of

> Trendelenburg position in hypovolemic shock is based on tradition rather

> than science.

>

> It was originally developed for use during abdominal surgery to make the

> organs more accessible to the surgeon, not for use in shock treatment.

>

> It is simply another medical myth that refuses to die.

>

> Gene Gandy, LP, NREMT-P

>

> EMS Educator

>

> Tucson, AZ

>

> Trendelenburg position

>

> I was recently told they are not teaching the trendelenburg position for

> shock to the EMT class. I would like some insight as to why so that I can

> keep up with some of the changes. Thanks in advance

>

> ***you can e-mail me off-list if you would like***

>

>

[Guest guest]

The US Navy Diving Manual, 2008 edition, says to keep the patient lying flat.

GG

Trendelenburg position

I was recently told they are not teaching the trendelenburg position for shock

to the EMT class. I would like some insight as to why so that I can keep up with

some of the changes. Thanks in advance

***you can e-mail me off-list if you would like***