Guidelines for the management of haemodynamically unstable pelvic fracture patients

ANZ Journal of Surgery
Martin J HeetveldMichael Sugrue

Abstract

Haemodynamically unstable pelvic fracture patients have a high mortality, and decision-making is crucial. The present article discusses key clinical practice guidelines and options in the early management of these challenging patients. A multidisciplinary consensus committee developed guidelines following standard scientific methodology, comprehensive Medline searches and level of evidence grading. Clinical practice guidelines and options addressed four key questions: (i) how to determine the source of haemorrhage?; (ii) how to control haemorrhage?; (iii) what is the optimal angiography and embolization technique?; and (iv) what is the optimal pelvic stabilization technique? The consensus best evidence recommends that the source of intra-abdominal haemorrhage should be assessed using diagnostic peritoneal aspiration and/or focused abdominal sonography in trauma within 30 min of patient arrival. Immediate laparotomy and concomitant pelvic stabilization control intra-abdominal haemorrhage and venous pelvic haemorrhage, followed by angiography if pelvic arterial bleeding is also present. If intra-abdominal bleeding is absent, non-invasive pelvic stabilization and transfer to angiography within 45 min of arrival is recommended to c...Continue Reading

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