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Trauma Grand Round - Pelvis
A 41-year-old male was dragged 150 meters by a bus and arrived at the hospital with a blood pressure of 70 and GCS of 15. Imaging revealed pelvic fractures and hemorrhage. The patient received blood transfusions but remained unstable and was found to have an arterial bleed, requiring embolization. A 21-year-old male fell 4 stories and presented with a GCS of 3 improving to 14. Imaging showed multiple injuries including pelvic and abdominal bleeding. The patient underwent angioembolization, surgery to repair arterial injuries, and fixation of fractures. Despite massive transfusion, he stabilized with correction of acidosis.
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Trauma Grand Round - Pelvis
- 1. Trauma Grand Round “ThePELVIS” April 2016 Fran O’Keeffe Joseph Mathew
- 2. Case 1 41 y/omale Working under bus, bus driven, pt dragged 150m At scene: Unrecordable BP then SBP 70 GCS 15 En route: 5L N.Saline, Ketamine R pneumocath (poor Sats, reduced a/e right) Pelvic binder
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- 4. On arrival… A Maintaining BSats 99% on 15L Oxygen • R pneumocath C sBP 80, HR 130 • 2 x 18G D GCS 14 E Massive truncal abrasions/degloving Large scalp wound
- 5. Arch Surg. 2012;147(9):813-818.Published online May 21, 2012
- 6. Cameron’s Textbook ofAdult Emergency Medicine, 4e, Fitzgerald et al, Chest Trauma
- 9. Resus Intubation Bilateral ICC’s Right LowerLimb splint Scalp wound closure IDC insertion – frank blood 6 x PRBCs, 2 x FFP, 1 x Plat – Transient responder, ++ blood dependent – sBP 90 ! 120 ! 70 – R Subclavian MAC line ! To CT pH 7.1 Base Excess -10 Bicarbonate 19 (24) INR 1.4 Lactate 6.9 (<2)
- 10. Initial binary decisiontree for pleural decompression, Fitzgerald et al, Pleural decompression and drainage during trauma reception and resuscitation. Injury 2008;39:9-20
- 11. Resus Intubation Bilateral ICC’s Right LowerLimb splint Scalp wound closure IDC insertion – frank blood 6 x PRBCs, 2 x FFP, 1 x Plat Transient responder, ++ blood dependent sBP 90 ! 120 ! 70 R Subclavian MAC line ! To CT pH 7.1 Base Excess -10 Bicarbonate 19 (24) INR 1.4 Lactate 6.9 (<2)
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- 13. SIJ disruption +fracture
- 14. CT scan Extraperitoneal bladder rupture withcontrast leak
- 15. OT Pelvic Ex-Fix NOF fixation Tib/FibIM Nail Overnight in ICU- tachycardia/low BP Rpt CT Abdo: progression pelvic haematoma
- 16. Blush = ArterialBleed Angio-embolisation Theatre if fails
- 20. Case 2 21 y/omale Fall from 4th floor balcony (drugs/ETOH) At scene: HR 120, sBP 120. GCS 3 ! 14 En route: Binder applied
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- 22. On arrival… A Maintaining BSats 98% on 15L Oxygen C sBP 110, HR 110 • eFAST +ve R PTx, abdomen • Binder D GCS 15 E Obvious bilateral closed femur #s R LL: short + ER
- 25. Resus 05.00 – 06.30 RICC RIC Line and Art Line Intubation 4 x PRBC, 2 x Plat ! Taken to CT…
- 26. Left sided retroperitoneal haematomawith active contrast blush
- 28. CT findings Head Parafalcine andtentorium SDH, SAH 4mm midline shift Chest Bilat Ptx (L = no ICC) Abdo/Pelvis Vertical shear pelvic # (symphysis disruption) Active blush small bowel mesentery Pelvic haematoma (bladder compression) Pelvic blush at pubic symphysis Psoas haematoma with active blush (L4/5)
- 29. Parafalcine SDH 4mm midlineshift Sulcal effacement
- 30. CT findings Head Parafalcine andtentorium SDH, SAH 4mm midline shift Chest Bilat Ptx (L = no ICC) Abdo/Pelvis Vertical shear pelvic # (symphysis disruption) Active blush small bowel mesentery Pelvic haematoma (bladder compression) Pelvic blush at pubic symphysis Psoas haematoma with active blush (L4/5)
- 31. Angio + IVCfilter Lumbar artery embolisation AV fistula left internal iliac-embolisation OT Pelvic ex-fix Laparotomy (colic artery repair) – 300ml blood Left NOF Femur ex-fix (concern for fat emboli) EVD insertion Total MTP = 18 PRBC, 11 FFP, 4 Plat, 2 Cryoprecipitate
- 32. CT findings Head Parafalcine andtentorium SDH, SAH 4mm midline shift Chest Bilat Ptx (L = no ICC) Abdo/Pelvis Vertical shear pelvic # (symphysis disruption) Active blush small bowel mesentery Pelvic haematoma (bladder compression) Pelvic blush at pubic symphysis Psoas haematoma with active blush (L4/5)
- 33. Angio + IVCfilter Lumbar artery embolisation AV fistula left internal iliac-embolisation OT Pelvic ex-fix Laparotomy (colic artery repair) – 300ml blood Left NOF Femur ex-fix (concern for fat emboli) EVD insertion Total MTP = 18 PRBC, 11 FFP, 4 Plat, 2 Cryoprecipitate pH 7.45 Base Excess 2 Bicarbonate 26 (24) INR 1.3 Lactate 3.2 (<2)
- 34.