management of pelvic injuries - cpb-eu-w2.wpmucdn.com
Post on 06-Jan-2022
2 Views
Preview:
TRANSCRIPT
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 ?
Gaustad_med_lokk_cropped_re[1].jpg
top related