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Pelvic fracture bleeding control: What you need to know
Todd W Costantini1, Clay Cothren Burlew, Whitney R Jenson
1From the Division of Critical Care and Acute Care Surgery, Department of Surgery (T.W.C.), University of Minnesota Medical School, Minneapolis; Division of Acute Care Surgery (T.W.C.), North Memorial Health, Robbinsdale, Minnesota; Division of Gastrointestinal, Trauma, and Endocrine Surgery, Department of Surgery (C.C.B., W.R.J.), University of Colorado, Aurora, Colorado; Department of Trauma Surgery (R.P.), University Hospital Zurich; Harald-Tscherne Laboratory for Orthopaedic and Trauma Research (F.K.-L.K.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Division of Vascular and Endovascular Trauma (R.K.), R Adams Cowley Shock Trauma Center, University of Maryland Medical Center; Department of Surgery (T.M.S.), R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, Maryland; and Riverside University Health System (R.C.), Loma Linda University School of Medicine, Riverside, California.
Significant bleeding due to pelvic fracture is associated with high mortality and must be treated promptly to optimize outcomes. The initial evaluation should focus on hemostatic resuscitation, placement of a pelvic binder, and evaluation for additional nonpelvic sources of hemorrhage. There are several options for pelvic hemorrhage control including external fixator placement, angioembolization, preperitoneal pelvic packing, and open internal iliac ligation or surgical embolization of the internal iliac artery. The specific hemorrhage control intervention selected to control pelvic bleeding must be tailored to the patient's physiologic status and local resource availability. This article discusses "What You Need to Know" to provide optimal care for patients with hemorrhage due to severe pelvic fracture.
Significant bleeding due to pelvic fracture is associated with high mortality and must be treated promptly to optimize outcomes. The initial evaluation should focus on hemostatic resuscitation, placement of a pelvic binder, and evaluation for additional nonpelvic sources of hemorrhage. There are several options for pelvic hemorrhage control including external fixator placement, angioembolization, preperitoneal pelvic packing, and open internal iliac ligation or surgical embolization of the internal iliac artery. The specific hemorrhage control intervention selected to control pelvic bleeding must be tailored to the patient's physiologic status and local resource availability. This article discusses "What You Need to Know" to provide optimal care for patients with hemorrhage due to severe pelvic fracture.
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