Dr. Ebraheim’s educational animated video describes fracture injury conditions of the pelvis associated with bleeding and hemorrhage.
Pelvic fractures may cause significant bleeding. The superior gluteal artery is responsible for the majority of bleeding in pelvic fractures with arterial injury. Most of the bleeding in pelvic fractures is from the veins and the fracture itself.
Hemorrhage is the most life-threatening complication associated with pelvic injuries. Approximately 10% of patients will have severe bleeding.
Sever bleeding usually occurs in fracture patterns that are highly unstable to both rotational and vertical forces.
1-APC III (open book like type). Symphysis pubic diastasis. Complete disruption of anterior SI, sacrotuberous and sacrospinous ligaments; disrupted posterior SI ligaments.
2-Vertical shear fracture: bad fracture. Complete disruption of the anterior and posterior ligaments; cephaloposterior displacement.
Anteroposterior compression or vertical shear injuries are consistently associated with a high risk of mortality from bleeding.
Mortality rate is directly related to shock at the time of presentation.
Bleeding of the superior gluteal artery could be fatal.
How do you treat patients with pelvic fracture and massive bleeding?
•Patient will lose approximately 35% of their blood volume with acute hemorrhage before a sustained decrease in systolic blood pressure occurs.
•Immediate application of a pneumatic antishock garment. Absolutely contraindicated in patient with a rupture of the diaphragm.
•Ringer’s lactate is the preferred initial fluid replacement used to resuscitate hypovolemic trauma patients in shock. Hypotensive blunt trauma patient is given initial fluid push with 2,000 ml of Ringer's lactate.
•Patient with bleeding and in shock will probably require O negative blood.
•If the patient is given 4 units of blood but remains hemodynamically unstable, then angiography and embolization are needed.
•Immediate application of an external fixator is another method to control bleeding, especially if the pelvis is unstable in external rotation.
•Abdominal and pelvic CT scan will clearly define the bony injury as well as the extent and source of bleeding.
•The best treatment for pelvic fractures with bleeding is a blood transfusion with correction of hypothermia and coagulopathy.
27 авг 2024
