Review Question - QID 109012

This patient is presenting after trauma with unstable vitals and a pelvic fracture. After a pelvic binder is placed and fluid resuscitation is started, the next best step in management if the bleeding does not stop on its own is interventional radiology vessel embolization.

In the setting of a pelvic fracture on radiograph (Figure A) a diagnosis of pelvic bleeding should be suspected. If the bleeding does not stop on its own with a pelvic binder in place, then the next step in management is interventional radiology embolization of the bleeding vessels. Stable patients can be imaged with CT angiography prior to embolization, or in an unstable patient fluoroscopic angiography can be utilizaed.

Figure A is a radiograph demonstrating a fracture of the pelvis.

Incorrect Answers:
Answer 2: Repeating a FAST exam would not give any additional information with regards to this patient’s source of bleeding and would not help with their current presentation.

Answer 3: Exploratory laparotomy would be needed if the patient had an abdominal source of bleeding that is not stopping on its own, or if there is an unknown source of abdominal bleeding.

Answer 4: Exploratory laparoscopy would not be indicated for acute trauma with pelvic bleeding.

Answer 5: Norepinephrine is a vasopressor that could be given to increase blood pressure via its alpha-1 agonism. However, it does not help stop the source of bleeding.

Bullet Summary:
Pelvic trauma is best managed with IV fluids and a pelvic binder to keep the pelvis in place. If the bleeding does not stop, the next best step in management is IR vessel embolization.