Clinical review: initial management of blunt pelvic trauma patients with haemodynamic instability.
Pelvic trauma can lead to severe, uncontrollable haemorrhage and death related to prolonged shock and multiple organ failure. Massive retroperitoneal haematoma should be assumed to be present in cases of post-traumatic haemodynamic instability associated with pelvic fracture in the absence of extrapelvic haemorrhagic lesions. This review describes the pathophysiology of retroperitoneal haematoma in trauma patient with blunt pelvic fracture, considering the roles of venous and arterial bleeding. Efficacy and safety of haemostatic procedures are also discussed, and particular attention is given to the efficacy of pelvic angiographic embolization and external pelvic fixation. A decision making algorithm is proposed for the treatment of trauma patients with pelvic fracture that takes haemodynamic status and associated lesions into account.
Geeraerts
Thomas
T
Département d'Anesthésie-Réanimation chirurgicale, Centre Hospitalier Universitaire de Bicêtre, Assistance Publique--Hôpitaux de Paris, Univ Paris Sud, Le Kremlin-Bicêtre, France. thgeeraerts@hotmail.com
Chhor
Vibol
V
Cheisson
Gaëlle
G
Martin
Laurent
L
Bessoud
Bertrand
B
Ozanne
Augustin
A
Duranteau
Jacques
J
D004621:Embolization, Therapeutic; D005592:Fracture Fixation / Q000379:methods; D050723:Fractures, Bone / Q000150:complications / Q000628:therapy*; D006406:Hematoma / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology; D006489:Hemostatic Techniques; D006801:Humans; D009104:Multiple Trauma / Q000628:therapy; D010384:Pelvic Bones / Q000293:injuries*; D012187:Retroperitoneal Space; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy*