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