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Part one of trauma team leader Chris Hicks’ primer on managing severe pelvic fractures.
Great summary. Wished we had more specific information on empiric initial volume and or blood product recommendation in obvious pelvic fractures. And hey how about the old MAST Trousers? Dead and buried?
It might be coming in Part II -- but my pelvic fracture "test dose" is 2U PRBC, pelvic binder and TXA. If the patient remains unstable after this, one of two things is possible: a) This is an arterial bleed, and the patient needs angio/OR ASAP, or b) There is another hemodynamically significant injury present that hasn't been addressed yet. So if the patient remains HD unwell after that "test dose" I am doing two things: activating our massive transfusion protocol (if I haven't already) and mobilizing angio and/or OR resources.
MAST trousers are dead -- but wait another 5 years and they'll be back in vogue! Medicine just seems to work like that.
What you do matters.