Download - Trauma Grand Round - Pelvis
Case 141 y/o male 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
On arrival…
A Maintaining B Sats 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
ResusIntubation Bilateral ICC’s Right Lower Limb 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 7.1Base Excess -10Bicarbonate 19 (24)INR 1.4Lactate 6.9 (<2)
Initial binary decision tree for pleural decompression, Fitzgerald et al, Pleural decompression and drainage during trauma reception and resuscitation.
Injury 2008;39:9-20
ResusIntubation Bilateral ICC’s Right Lower Limb 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 7.1Base Excess -10Bicarbonate 19 (24)INR 1.4Lactate 6.9 (<2)
OT
Pelvic Ex-Fix NOF fixation Tib/Fib IM Nail
Overnight in ICU- tachycardia/low BP Rpt CT Abdo: progression pelvic haematoma
Case 221 y/o male Fall from 4th floor balcony (drugs/ETOH)
At scene: HR 120, sBP 120. GCS 3 ! 14
En route: Binder applied
On arrival…
A Maintaining B Sats 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
CT findingsHead Parafalcine and tentorium 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)
CT findingsHead Parafalcine and tentorium 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)
Angio + IVC filter 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
CT findingsHead Parafalcine and tentorium 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)
Angio + IVC filter 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 7.45Base Excess 2Bicarbonate 26 (24)INR 1.3Lactate 3.2 (<2)