“Pelvis And Hip Injuries” … Case Conclusion December 6, 2010
Posted by ebmedicine in Orthopedic Emergencies, Traumatic Emergencies.add a comment
The conclusions are…
On his arrival in the ED, the 20-year-old male was hypotensive and combative. Aggressive resuscitation was continued and his airway was immediately secured using rapid-sequence intubation, while being careful with drug doses in the setting of hemorrhagic shock. The examination of the head, neck, chest, and extremities were normal. There was bruising to the lower abdomen with blood at the urethral meatus. A chest x-ray was normal and a pelvis x-ray revealed a severely displaced AP-compression injury with 4 cm of pubic diastasis. A FAST exam was negative for intraperitoneal fluid. Recognizing the severity of the patient’s injuneurovascular injuries, immediate transport to the trauma center was arranged. Prior to his departure, a sheet was wrapped tightly around his pelvis to reduce the diastasis, while carefully creating symmetrical alignment of the lower extremities. One unit of uncrossmatched blood was hung and a second unit was given to the paramedics. At the trauma center, the patient remained unstable and a repeat FAST remained negative. The patient was taken for immediate angiography and pelvic embolization.
The 14-year-old female suffered an avulsion injury to her anterior superior iliac spine. She was treated with conservative measures and was able to be discharged home.
The 80-year-old male incurred a lateral compression Type I injury. No other injuries were identified on examination or CT. When his blood pressure dropped, he was transfused and taken emergently to angiography, where his obturator artery was embolized.
Congratulations to Dr. Lomberg and Dr. Patel — this week’s winners of Emergency Medicine Practice’s “An Evidence-Based Approach To Managing Injuries Of The Pelvis And Hip In The Emergency Department (Trauma CME)!” For an evidence-based review of hip and pelvis injuries, read the December 2010 issue of Emergency Medicine Practice, “An Evidence-Based Approach To Managing Injuries Of The Pelvis And Hip In The Emergency Department (Trauma CME).”
Pelvis And Hip Injuries… November 15, 2010
Posted by ebmedicine in Orthopedic Emergencies, Traumatic Emergencies.2 comments
You have started your shift and things are relatively quiet until the paramedics radio that they are bringing in a 20-year-old male who was struck by a car while crossing the street. The patient is complaining of severe lower abdominal and groin pain, and he cries out upon any attempts to manipulate his pelvis. He is tachycardic, and his blood pressure is 90 mm Hg systolic. The paramedics have started 1 large-bore IV.
While a room is being prepared for this young man, a 14-year-old girl with sharp right-sided pelvic pain is brought back from triage. You stop in her room for a quick assessment and see that she is still wearing her soccer uniform and is in a moderate amount of discomfort. When asked about the location of the pain, she points directly to her lateral beltline. You have just begun to examine her when another paramedic crew arrives with an elderly male.
The crew has just transported an 80-year-old man who fell from a standing position and landed on his left hip/flank area. His vitals are stable, and he describes pain around his left pelvic area. You finish taking his history and complete the physical, concluding that this gentleman has significantly injured himself. You are then called away upon the arrival of a 20-year-old who suffered a motor vehicle accident…
How will you manage these injuries?
(Enter to win the latest issue of Emergency Medicine Practice, including CME, by submitting your answer(s). To do so, simply enter your response in the comments box. The deadline to enter is December 6th.)
