We recently had a case of a pedestrian run over by own car and suffered major pelvic fractures ( ant and post), a liver laceration and major chest injuries. The Surgical team decided that there was no major thoracic or abdominal souce of bleeding although a FAST or DPL was not done. The Orthopaedic team decided that pelvic angiography and embolisation was the way to go for control of the major pelvic bleeding.
The patient was initially stable after intubation, fluid and blood resuscitation, but became very unstable in the Angio suite and had a hypovolaemic arrest in radiology. She was resuscitated with fluids, blood and adrenaline and the radiologist was then able to complete the angio ( after about an hour) and successfully embolise 2 major arterial bleeders.
She then went to the OT and had Ext Fixateurs appllied and eventually had a laparotomy which revealed a liver laceration which the surgeons tell me was not a major source of blood loss. Unfortunately she had a further cardiac arrest on the operating table and was not able to be resuscitated.
Can anyone tell me if there are any Randomised controlled trials out there which compare External or Internal Fixation of Unstable Pelvic fractures v Pelvic Angio / embolisation for the major shocked patient with ongoing bleeding. Is there a place for taking this patient straight to the OT for application of Ext Fix and laparotomy with packing of the pelvis? Is there any evidence for this which I believe is done in some Trauma Centres in Europe. Sorry its a bit long winded but we were unable to obtain consensus at out trauma audit
The patient was initially stable after intubation, fluid and blood resuscitation, but became very unstable in the Angio suite and had a hypovolaemic arrest in radiology. She was resuscitated with fluids, blood and adrenaline and the radiologist was then able to complete the angio ( after about an hour) and successfully embolise 2 major arterial bleeders.
She then went to the OT and had Ext Fixateurs appllied and eventually had a laparotomy which revealed a liver laceration which the surgeons tell me was not a major source of blood loss. Unfortunately she had a further cardiac arrest on the operating table and was not able to be resuscitated.
Can anyone tell me if there are any Randomised controlled trials out there which compare External or Internal Fixation of Unstable Pelvic fractures v Pelvic Angio / embolisation for the major shocked patient with ongoing bleeding. Is there a place for taking this patient straight to the OT for application of Ext Fix and laparotomy with packing of the pelvis? Is there any evidence for this which I believe is done in some Trauma Centres in Europe. Sorry its a bit long winded but we were unable to obtain consensus at out trauma audit
