Bleeding Pelvic Injuries - Diagnosis and Emergency Management

Description

In this talk, Ashok Gavashar discusses the emergency management of patients with exanguinating pelvic injuries. He emphasizes the importance of timely assessment and intervention over extensive imaging, particularly in the context of pelvic fractures that can result in significant mortality. He presents alarming statistics, noting that mortality rates for such injuries can be as high as 60% in cases of open pelvic injury. Gavashar outlines key principles of management, including the significance of quick decision-making from pre-hospital care through to definitive treatment in the hospital, focusing on the collaborative efforts of the medical team.



The talk covers imaging protocols, suggesting that quick portable pelvic radiographs are often more effective than extensive CT scans for unstable patients. Gavashar additionally highlights the necessity for simultaneous diagnostic procedures that do not delay resuscitation.



Discussion continues on identifying bleeding sources, primarily through ultrasound and diagnostic peritoneal taps, while cautioning against unnecessary delays with CT scans. Gavashar stresses the rapid identification of bleeding origins—whether from the pelvis or elsewhere, such as the abdomen or thorax.



Gavashar evaluates treatment options, comparing pre-peritoneal packing with external fixation to angiographic interventions. He presents evidence supporting the efficacy of pelvic packing, noting that it can substantially reduce the need for blood transfusions and lower mortality rates. The protocol for pelvic packing involves a rapid surgical procedure that effectively controls bleeding, allowing for patient stabilization before further interventions.



The presentation wraps up with an emphasis on the importance of timing and the necessity for institutional protocols to ensure efficient management of such critical injuries. Ashok concludes by summarizing the essential steps for handling unstable patients with bleeding pelvic fractures, advocating for a balance between immediate intervention and thorough follow-up imaging depending on the patient's stability.

Specialties