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22 y.o male, jumped from 3rd floor. awake, alert. stable vs.

any taker?

iva
ivf
o2
o2 sat
ekg
bp monitor
cardiac monitor

PE

unstable----portable x ray, usg
stable ct pelvis / abd
cbc
pt/ptt
bmp
lfts
amylase
lipase
blood group and save
ua----hematuria....gross dont put foleys....
if not foleys
cxr
morphine



r/v result

orthopedic consult
surgical consult
npo

transfer to icu


lnternal fixation........pelvis( need to be done first to make stop bleeding)

then voiding urethrogram if suspect urethral injury
if kidneys affected .....? surgical correction...( i dont know what to put the order)

once r/v patient after surgery
repeat cbc
pt/ptt
if needs transfusion ......

monitor urine output
if feels better change dc saline and start oral intake..

5 min

physiotherapy
safe drive
if alcoholic...

Good job smith

I am thinking to add ..drug alcohol level, urine toxicology, depression score, psychiatry consult to rule out severe depression n suicidal attempts.

Pelvic fracture usu come with shock n internal bleeding, need blood G n M initially with iv access , NSS.

Good job guys..

I think we also need spine xray or maybe skeletal survey because of fall..

spine x ray, ct head if loc, depr index, bal, urine tox, suicide contract, psych consult

uro consult ,

..

bedside sitter b/c suicidal attempt, suicide precautions

here are additional more information regard mngt of pelvic fracture


Which patients with pelvic fracture warrant early external stabilization?

a) Patients with evidence of unstable fractures of the pelvis associated with
hypotension should be considered for some form of external pelvic
stabilization.

b) Patients with evidence of unstable pelvic fractures who warrant laparotomy
should receive external pelvic stabilization prior to laparotomy incision.
----------------------------------------------------------------------------------------------
2) Which patients warrant angiography and possible embolization?

a) Patients with a major pelvic fracture who have signs of on going bleeding
after non-pelvic sources of blood loss have been ruled out should be
considered for pelvic angiography and possible embolization.

b) Patients with major pelvic fracture who are found to have bleeding in the
pelvis, which cannot be adequately controlled at laparotomy, should be
considered for pelvic angiography and possible embolization.

c) Patients with evidence of arterial extravasation of intravenous contrast in
the pelvis by computed tomography should be considered for pelvic
angiography and possible embolization.
--------------------------------------------------------------------------------------------------------

3) Which patients with pelvic fracture warrant urgent or emergent laparotomy?

a) Patients with hypotension and gross blood in the abdomen or evidence of
intestinal perforation warrant emergent laparotomy.

b) The diagnostic peritoneal tap appears to be the most reliable diagnostic
test for this purpose. Urgent laparotomy is warranted for patients who
demonstrate signs of continued intra-abdominal bleeding after adequate
resuscitation, or evidence of intestinal perforation.

thanks, sami!

so if pt is hypotensive, do ABC..
then if DPL is (+), external stabilization of fx before laparotomy..
if still w/ bleeding , do angiogarphy and possible embolization..