RTA Pelvic Fracture

Question 1

A 29-year- old motorcyclist has fractured his femur and tibia along with ecchymosis in the flanks, tenderness and pain in the lower abdomen with blood at the urethral meatus. The patient is pale ,hypotensive and tachycardic

Q1: What’re the other injuries would you suspect in this patient and how would you approach this patient?

Answer 1

Pelvic #/ Uretheral tear / Renal tear/ Vascular injuries of renal vessels/ Bladder injury

Question 2

Q2: What’s your first priority in managing a multi trauma patient?

Answer 2

ATLS
Airway and C spine
Breathing

Question 3

Q3: If the patient’s airway is secure and breathing and ventilation are fine, what is your next step?

Answer 3

Circulation/ Assessing Bp/HR/ CRT / 2 canulas / take blood sample for Labs/ Cross matching and grouping / start IV fluids and order blood
FAST / Monitor UOP / Good stabilization of Pelvis.

Question 4

Q4: Given X-ray what can you see ?

Answer 4

Pubic distaisis, it’s serious and cause injury to posterior blood vessels of pelvis.

Question 5

Q5: What’re the types of pelvic fractures?

Answer 5

AP compression / Lat compression / Vertical share / Complex type

Question 6

Q6: What’s the type of shock you would expect in a patient with both femur and pelvis fractures? Which class? How would you expect the pulse pressure to be in this case?

Answer 6

Hypovolemic Hgic shock. / Could be Class 4 / narrow pulse pressure as systolic P will be very low and D will be compensated a little by incr. in PVR.

Question 7

Q7: How would you manage this patient’s shock?

Answer 7

Grouping and Cross matching / Order 6 units of blood and Start IV fluid like 1 l in the first 30 mins while monitoring the response of the pt

Question 8

Q8: How can you tell that patient’s improving?

Answer 8

Monitoring Vital signs/ Mental Status / UOP / CRT

Question 9

Q9: If you find blood at the urethral meatus, would you still insert a folye’s catheter? Why?

Answer 9

No, as this pt likely to have a tear in the memb urethra and a cather will compromise it and aggrevate it.

Question 10

Q10: How would you confirm your suspicion?

Answer 10

Antegrade cystourethrogram or CT scan

Question 11

Q11: What’s the other pelvic organ that is commonly injured in open pelvic fractures?

Answer 11

Urethra , UB , Ureters

Question 12

Q12: When to avoid inserting a Folye’s catheter?

Answer 12

Confimed pelvic # / Blood in meatus / Perineal Hemtoma / Pre-existing infection on Glans penis / High arising prostate ( prostate higher than its normal level)

Question 13

Q13: What would you do if a Foley’s catheter is contraindicated?

Answer 13

Suprapubic catheter by the help of a urologist.

Question 14

Q14: Do you know other types of catheters? Mention 6.

Answer 14

• Condom catheter.
• Straight catheter.
• Coudé tip catheter.
• Silicon catheter
• 3-way catheter for continuous bladder irrigation.
• Suprapubic catheter.
• Nélaton’s catheter for irrigation of clots

Question 15

Q15: How would you manage a pelvic fracture?

Answer 15

Pelvic Binder to stop bleeding / Volume replacement / Blood transfusion / Activation of massive hgic protocol / tranxmic acid / Coiling of bleeding by interv. Radio or pelvic packing / Ext. Fixation of pelvis /