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Old 07-18-2011
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Rheumatology/Orthopedics The best next step for this pelvic fracture

A 22 year old woman was hit by a car and brought to the ER with a BP of 62/40 mmHg. On examination she is unresponsive, her pupils are equally round and reactive , her distal pulses are weak, and her extremities are cold. X ray of the chest is normal. Peritoneal lavage shows no blood in the abdomen. After receiving 2 L of lactated ringer solution, her BP is 71/46 mmHg. The pelvis is unstable with compression, and an anterioposterior x-ray of the pelvis confirms a fracture. What is the best next step in management?

A. Application of an external fixation device
B. Exploratory laparatomy with packing of the pelvis
C. Open reduction and internal fixation of the fracture
D. Pelvic CT with contrast
E. Surgical exploration of pelvic hematoma
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Old 07-18-2011
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E. Surgical exploration of pelvic hematoma
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Old 07-18-2011
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Quote:
Originally Posted by aghammoud85 View Post
E. Surgical exploration of pelvic hematoma
OK , Time and again it has been mentioned in Kaplan step 2 ck surgery notes '' NEVER EXPLORE A PELVIC HEMATOMA '' it will resolve on its own ,
So the logical next step to do is '' EXTERNAL FIXATION OF THE PELVIS''
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Old 07-18-2011
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Answer is A.............
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Old 07-19-2011
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I also think a external fixation is the right answer :-)
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Old 07-19-2011
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The correct answer is A. An exsanguinating hemorrhage is likely when hypotension and shock are present in the setting of a pelvic fracture. Patients with evidence of unstable fractures of the pelvis associated with hypotension should be considered for some form of external stabilization, which has been shown to decrease mortality in these patients. The exact mechanism by which early pelvic stabilization is effective in promoting hemodynamic stability in patients with unstable pelvic fractures is not completely understood.
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