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EMERGENCY DEPARTMENT
Level III 1- Well designed pseudo randomised controlled 2- Comparative studies with concurrent controls or case control studies not randomised 3 Comparative with historical control
Urgent surgical bleeding control - Grade I Damage control surgical approach and packing of pelvis Pelvic ring disruptions should be closed and stabilised FAST /CT to identify bleeding Urgent angiogram and embolisation if unstable
EAST Guidelines
Level III Early external stabilisation for Unstable pelvic fractures without hypotension but requiring steady and ongoing resuscitation No level III recommendations as to who requires urgent Angiography and Embolisation or urgent Laparotomy
Eastern Association for the Surgery in Trauma - 2001
Management
Management
IF Angiogram and embolisation not available within 30 mins - O.R. for haemorrhage control Pack external wounds Extra peritoneal packing Damage control laparotomy
Angio - embolisation
Major active bleeding is from branches of Internal Iliac artery Aggressive resuscitation with blood and blood products during the procedure Trauma team in attendance at the Angio suite Future - CT scans in Resuscitation Room and Hybrid Operating Suites with Angiography facilities
Australian Guidelines
NSW Institute of Trauma and Injury Management (ITIM ) and Liverpool Hospital Sydney (livtrauma.org ) December 2009 updated every 5 years Recommendations based on quality evidence available right now from all over the world
ITIM
ITIM
2. With two trauma team members cross the sheet across the pubic symphysis and pull the sheet firmly so it tightly fits around and stabilises
the pelvis
3. A third person should clamp the sheet at the four points shown (away from Laparotomy / angiography access points).
SAM SLING
N S
W G U I D E L I N E S
N S W
G U I D E L I N E S
SUMMARY
Very little good evidence
SUMMARY
Fix pelvis at the same time as laparotomy Hypotensive after external splint needs urgent angio /embolisation if available A Multidisciplinary TEAM approach
Thank you
Thank You !