Introduction

1. Immediate management
   • Control of haemorrhage
   • Use of pelvic binder
   • REBOA
2. Management of stable VS unstable fracture
3. Management of closed VS open fracture
4. Other injuries

Immediate management

• Coordinated and structured approach (eg. ATLS approach)
• C-ABCDE assessment as per any other patients
  • Pelvic stabilisation as part of C (eg. Pelvic binder)
  • Examine perineum, genitalia and rectum for blood which suggests an open pelvic fracture
  • DO NOT spring/rock the pelvis may dislodge clots and promote further bleeding

DO NOT log roll if there is suspicion of pelvic fracture as it can cause dislodge clot and cause further haemodynamic compromise (unless there are active bleeding stab wounds suspected on the back or airway compromise. If necessary to log-roll, maximum 15 tilt should be adopted). Below is guidance taken from NICE Guideline 37 (3).

• If bleeding is suspected, give IV tranexemic acid 1g bolus followed by infusion if within 3 hours of injury and activate your local Major Haemorrhage Protocol for an unstable patient requiring blood transfusion
• Analgesia: IV morphine first line/ IN diamorphine or ketamine (4)
• Cross match blood along with organising other laboratory blood tests (VBG, lactate, FBC, U&E, Clotting profile)
• Imaging with CT. Contrast extravasation on CT is also called CT blush which suggests active bleeding during the arterial phase and is likely to need angiographic embolization.

Learning bite

Avoid unnecessary movement of the patient. DO NOT spring the pelvis on examination and DO NOT log-roll if pelvic injury suspected.