血动力学不稳定的患者的不稳定骨盆骨折:全球治疗争议
Zsolt J Balogh1, Kornelis J Ponsen2, Katherine R Miclau3
1Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia.
OTA international : the open access journal of orthopaedic trauma
|October 16, 2025
概括
管理血液动力学不稳定的骨盆骨折需要一个多学科的方法. 早期稳定,复苏和出血控制是改善这些关键创伤患者治疗结果的关键.
科学领域:
- 整形外科创伤手术 整形外科创伤手术
- 紧急医疗 紧急医疗
- 创伤护理 创伤护理
背景情况:
- 带有血液动力学不稳定的骨盆骨折是危及生命的,死亡率高达30%.
- 有效的管理需要一个协调的,多学科的战略.
- 目前的建议是基于2024年国际骨科创伤协会 (IOTA) 年度会议的骨盆研讨会.
研究的目的:
- 审查当前基于证据的建议,用于管理血液动力学不稳定的骨盆骨折.
- 概述恢复,机械稳定和出血控制的最佳策略.
- 根据最近的研讨会发现,为创伤护理提供者提供指导.
主要方法:
- 在2024年IOTA年度会议盆腔研讨会上提出的当前文献和指导方针的审查.
- 简要的初始管理策略,包括非侵入性的骨盆结合.
- 复苏技术的讨论:低血压和损伤控制复苏.
- 血液控制选项的概述:血管栓塞和腹前骨盆包装.
- 对目前关于骨盆结合物移除和最终固定时间的证据的分析.
主要成果:
- 最初的稳定通常涉及非侵入性的骨盆结合剂 (床单,商业结合剂).
- 复苏策略包括低血压复苏和损伤控制复苏.
- 建议早期实证平衡血液产品输血,以大规模输血协议和护理点检测为指导.
- 血管栓塞对于动脉出血是有效的; 腹前盆腔包装对于静脉/骨出血是有用的,特别是在资源较低的环境中.
- 新出现的证据支持在受伤后24小时内进行早期的最终内部固定.
结论:
- 多学科的方法对于管理血液动力学不稳定的骨盆骨折至关重要.
- 早期的骨稳定,适当的复苏和及时的出血控制显著影响患者的结果.
- 最近的证据有利于早期确定的内部固定,以改善患者管理.
更多相关视频
04:41Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
882
06:10Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
3.6K
相关概念视频
01:26Flail Chest-II
520
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
520
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
311
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
311
01:27Fractures: Bone Repair
5.0K
Treatment for a fracture is based on the type of break, the bone affected, and the patient's age.
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
Minor fractures with no bone displacement are treated by immobilizing the fractured bone using a cast or splint. However, in the case of fractures with displaced bones, the broken bones are repositioned before immobilization to ensure successful healing without deformation and loss of function. The realignment of fractured bone ends is performed through a process called reduction. If the...
5.0K
01:30Venous Thrombosis IV: Nursing Management
192
Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
192
01:26Cardiac Catheterization IV: Nursing Management
638
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
638
01:24Blood Pressure Imbalances and Circulatory Shock
1.5K
Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
1.5K