SAQ 1 - Trauma - Model Answer:

1-    Life threatening massive pelvic diastasis (open book fracture, APC II) that requires immediate reduction and radiological investigation to identify any ongoing pelvic haemorrhage.

2-    Pelvis arterial or venous haemorrhage

       Intra-abdominal haemorrhage

      Spinal injury causing neurogenic shock

      Long bone fracture

      Tension pneumothorax

      Massive haemo-thorax

3-    Activate Full trauma team including surgeon , orthopaedics and interventional radiologist

          A/B – give o2 15L/min via Hudson mask.

          C – wide bore iv acces x2 – give NSaline or O negative blood – 20ml-   40/kg ; Control of external haemorrhage

          Apply pelvic blinder

          Call blood bank - Activation of massive blood transfusion protocol

          Keep patient normothermic – warm all fluid – use warming blanket

4-    O –ve blood transfusion initialy

          Then use cross matched blood aiming for SPB > 90

        Massive blood transfusion blood products in a ratio of: 1:1:1 FFP, Platelets, packed cells

        Tranexamic acid 2 g IV

5. If FAST +ve, need expedite theatre for damage control surgery and pelvic packing.

    If FAST –ve, expedite Interventional Radiology for embolization


Knowledge Required:

·      Classification of pelvic fracture

·      Signs of pelvic fracture

·      Investigation of pelvic fracture

·      Major Pelvic trauma algorithms

·      Complications of pelvic fracture