Review Question - QID 109011

This patient is presenting after a motor vehicle accident with signs of pelvic trauma. The best initial step in management is placement of a pelvic binder.

Pelvic trauma typically presents status post motor vehicle accident. Patients will typically have bruising, erythema, or edema of the pelvis as well as signs of pelvic instability on physical exam. Whenever a pelvic fracture is suspected, the best initial step in management is to place a pelvic binder. IV fluids should then be started and an assessment should be completed to determine if there is bleeding from any other source (head to toe exam, FAST exam, etc.).

Figure A is a radiograph demonstrating a pelvic fracture. Figure B is a normal chest radiograph.

Incorrect Answers:
Answer 1: CT scan of the abdomen and pelvis is a diagnostic test that could be performed in a stable patient after a pelvic binder has been placed.

Answer 3: Embolization of the pelvic vessels would be indicated after a pelvic binder has been placed, and if the bleeding in the pelvis does not stop on its own.

Answer 4: Large needle decompression of the 4th intercostal space would be indicated in a patient presenting with a tension pneumothorax (shortness of breath, JVD, absent unilateral breath sounds and hyperresonance to percussion).

Answer 5: Immediate blood transfusion could be indicated given that this patient’s vitals seem to be staying the same/worsening; however, stabilizing the pelvis takes precedence over transfusion, in particular considering that the patient has already been started on fluid resuscitation.

Bullet Summary:
Pelvic trauma presents with erythema, edema, and instability of the pelvis, and the best initial step in management is placement of a pelvic binder.