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trauma-list Digest, Vol 154, Issue 3

Errington Thompson errington at erringtonthompson.com
Fri Apr 15 19:52:24 BST 2016

Here's the xray and a slice from the CT scan. 

I think that the way that this case should have gone would be - because of
persistent hypotension in spite of PRBC, FFP and plts, I should have taken
this patient to the OR. I should have tried to pack the pelvis with combat
gauze and lap pads. If the bleeding would have slowed at all, I should have
taken the patient to IR for bilateral internal iliac embolization with some
type of temporary agent like gelform. If we could have gotten the bleeding
to slow or stop then we should have taken the patient back to the OR for
foley placement and repair of his bladder. Once this was done then we needed
to have a conversation about revascularizing the left leg. Axillary -
femoral bypass? Temporarily occluding retrograde flow into the left iliac?
Also would have called ortho to place some type of ex-fix.


Errington C. Thompson, MD
Trauma/Acute Care Surgery
Marshall University

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of John Hall
Sent: Friday, April 15, 2016 10:47 AM
To: trauma-list at trauma.org
Subject: Re: trauma-list Digest, Vol 154, Issue 3

Reducing the pelvic fracture does not stop the venous bleeding.  It does
prevent further damage when the patient is moved

Sent from my iPhone
John R. Hall, M.D., FACS, FCCM
Professor of Surgery

> On Apr 15, 2016, at 6:31 AM, trauma-list-request at trauma.org wrote:
> What you have not told us is what you did do! Firstly it depends if you
have rapid IR access - this usually takes 30-60 minutes to get set-up. If
you have reduced the pelvis (binder around upper thighs), checked to ensure
you are not missing an abdominal bleeder or chest bleeder and then done
extraperitoneal pelvic packing I would say you have done what you can in
most circumstances.
> You could also have open ligated both IIA's but embolization is a good
option if you get that far. I am not going to even go in to REBOA, but that
is an emerging option too.
> Regards,
> Tim
> Dr Timothy Hardcastle

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