RTA / pelvis #

Question 1

24 y.o. man brought to A+E department following motorbike accident

tachycardic, hypotensive (PR 120, BP 80/40)

clinical exam shows bruising over left side of pelvis and tenderness on pelvic compression test

there is blood at the external urethral meatus

you suspect a fractured pelvis

(a) other than a #, name 2 other associated injuries which could cause hypotension in this case

Answer 1

1. bleeding e.g. haemothorax or splenic rupture
2. neurological - head injury / c-spine injury (loss of sympathetic supply)

Question 2

(b) what is the significance of blood at the external urethral meatus and what clinical examination will you perform to confirm your suspicion?

Answer 2

• urethral injury
• PR: boggy, high riding prostate

Question 3

(c) give 2 examples of X rays that must be carried out during evaluation of any polytrauma pt

Answer 3

1. CXR (AP)
2. Pelvic X-ray (AP)

^{C-spine X-ray - AP, AP open mouth, lateral (C7-T1 must be visible) - no longer compulsory component of trauma series}

Question 4

(d) accepting that there are no associated injuries, describe 2 forms of rx that you would use to treat the uncontrolled haemorrhage in this pt?

Answer 4

• pelvic binder (stabilises pelvis –> stasis)
• fluids: O neg blood or cross match or fluids
• clotting factors: FFP cryoprecipitates, octoplex
• others: US / laparotomy / packing / angiogenic embolisation / ligation

Question 5

(e) what is the overall mortality rate associated with this injury?

Answer 5

10-30%

Question 6

(f) name 2 common causes of death

Answer 6

1. shock (hypovolaemia)
2. PE
3. infection