Haemorrhage control in pelvic trauma

Abstract

A pelvic fracture usually indicates high energy transfer from a significant mechanism and a high likelihood of associated injuries. Mortality from pelvic trauma is usually due to massive haemorrhage mandating expedient resuscitation of the patient and immediate control of exsanguinating haemorrhage. Damage control resuscitation incorporates permissive hypotensive resuscitation and early replacement of clotting factors with early aggressive surgical control of bleeding. A commercially available pelvic binder provides circumferential compression and rapidly closes the pelvis, leading to fracture splintage and reduction in pelvic volume, both of which reduce haemorrhage. It is critical to distinguish ongoing bleeding due to a pelvic ring injury from intra-peritoneal haemorrhage. The identification of intra-peritoneal bleeding in a haemodynamically unstable patient mandates laparotomy. On-going haemorrhage from the pelvis requires diagnostic pelvic angiography, followed by selective embolisation if a source of bleeding is identified. If angiography is not available pelvic packing can be life-saving.

Embolization of Vascular Malformations via In Situ Photocrosslinking of Mechanically Reinforced Alginate Microfibers using an Optical‐Fiber‐Integrated Microfluidic Device

“…[ 1 ] Aneurysms are associated with a mortality rate of >40% upon rupture. [ 2 ] Embolization, which is a minimally invasive endovascular treatment, is a safe and effective procedure for treating aneurysms. This process involves inserting embolic materials into the aneurysm through a catheter to elicit ischemic necrosis by blocking blood supply.…”

The emergency radiology of pelvic trauma

“…Whether angiography should be considered before laparotomy in patients with combined pelvic and intraperitoneal bleeding remains controversial and pelvic packing remains an option when IR services are not available. 28 With advances in CT accuracy, the sensitivity of detecting contrast extravasation has increased and it has been suggested that the presence of small active extravasations does not necessarily mean that invasive intervention is always needed. 29 As ever, multidisciplinary decision-making is paramount.…”

Pre-hospital and emergency department management of pelvic fractures and major trauma centre status: Has practice changed?

“…Pelvic injuries follow a bimodal age distribution with peaks in young adults due to major trauma and as fragility fractures in the elderly. The former are often associated with major trauma and multiple associated injuries 4,5 and carry a high mortality of up to 40%, usually as a result of haemorrhagic sequelae. 6,7 Adequate management of these patients requires early identification of injuries, effective haemodynamic stabilisation and early definitive imaging.…”