Christine Gaarder, PhD, Departement of Traumatology Oslo University Hospital Ullevål Management of pelvic injuries
Christine Gaarder, PhD,
Departement of Traumatology
Oslo University Hospital Ullevål
Management of pelvic injuries
Treat physiology
Pelvic bleeding sources
Veins, arteries, bones
Associated injuries 90%
Extrapelvic bleeding 50%
Abdominal bleeding 30% Biffl WL et al. Ann Surg 2001
You don’t know what’s bleeding
…address all sources
A B C D E
Primary Survey
Secondary Survey
Treat physiology
Assume coagulopathy
Coagulopathy
Hypothermia Acidosis
Loss The treatment of bleeding
is to stop the bleeding!
MTP
C Lee and K Porter, Emerg Med J, 2007
Bottlang M et al. J Trauma 2002
Angio or Theatre ?
Angiographic
embolization works !
Total pelvic# <10%
HD unstable 50-80%
45 vs 130 mins
Osborn PM, et al. Injury 2008
45 vs 130 mins
J Trauma 2014
Why pelvic packing?
Why extraperitoneal…?
Intraperitoneal
doesn’t work!
..”always” preceded by
laparotomy..
..”and followed by AE”
Effect on arterial
bleeding ?
Ertel W et al. J Orthop Trauma 2001
Delayed flow in the internal iliac artery
Reduced
Pelvic Packing
Pelvic Packing –Do we need it?
Exsanguinating patient (before angio)
Before transfer if angio not available
Satsingsområde ?
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