Pelvic fracture

Question 1

pelvic trauma man with shock ( SBP 70 , hr 110 , GCS 15 , )) after a fall from 10 meter on his back
xray shows vertical shear #
What is the MX priorities for this patient ?

Answer 1

1- looking for other source of bleeding
2-spinal precautions ( c spine collar )
3-analgesia : fentanyl titrated to effect , starting with 50mcg IV bolus , reassess .
4- two large access IV cannula + activation of MTP
5- urgent orthopedic /IR/ trauma alert

Question 2

Describes 4 essential elements of a massive transfusion protocol ?

Answer 2

1- indications of starting a massive transfusion
2- indications for cessation a massive transfusion
3- Clinical and biochemical indicators to stopping a massive transfusion.
4-having a defined transfusion strategy ratio 1:1:1
5- Involvement of other stakeholders ( hematology , blood bank, critical care groups )

Question 3

patient with APC type 3 ( x ray : disrupted pubic symphysis , disrupted right SI joint ,) what are the potential complications, assessment findings ( hx , exam , ix ) and the definitive mx ?

Answer 3

1-pelvic haemorrhage : positive e fast / blush on CT , mx : IR / OT
2- urethral injury :blood at meatus , mx : urology OT
3- bladder injury : leak of contrast on CT , mx : urology OT
4- bowel injury : PR bleeding , mx ( surgical OT )