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Scan or surgery

  • scan first

    Votes: 1 50.0%
  • surgery first

    Votes: 1 50.0%

  • Total voters
    2
  • Poll closed .
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D

deleted547339

I'm just a lowly premed, wanted to know how one would 'traditionally' proceed.

Patient in a motorbike accident, said to have internal bleeding, as well a fractured pelvis. Would you move to have a scan done first, or immediately begin exploratory surgery to stop bleeding? Just curious. Please excuse my ignorance.

threw in a poll for giggles.

Depends on a lot of things. First off, how do you know they have internal bleeding? US? Clinical exam? Second, what's the clinical stability? Third, is a surgeon available? It's silly to do a ct at a hospital without a surgeon who can lap the patient. Third, is the surgeon in house? Does the patient have a hostile abdomen? What are the medical comorbidities? Is the patient anticoagulated? The list goes on and on.

Very unstable, belly full of blood --> straight to OR.

Hemodynamically rock solid --> CT.

Everything else depends on your hospital, your surgeon, your experience, the surgeons comfort with you, etc.
 
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SpartanWolverine

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I'm just a lowly premed, wanted to know how one would 'traditionally' proceed.

Patient in a motorbike accident, said to have internal bleeding, as well a fractured pelvis. Would you move to have a scan done first, or immediately begin exploratory surgery to stop bleeding? Just curious. Please excuse my ignorance.

threw in a poll for giggles.
What kind of scan? FAST or CT? How do you know they have internal bleeding?

Initial management is always ABCDEs. If the patient is unstable they go straight to OR. If they're stable, CT.

Edit: better said by @TimesNewRoman above.
 

alpinism

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Depends on many factors...

Regardless you should always resuscitate the patient before going to the OR or CT scanner (apply pelvic binder, give blood products, secure the airway, etc..).

At some advanced centers these patients are being managed inside a RAPTOR suite adjacent to the emergency department.
 
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