Fluid volume deficit related to active hemorrhage secondary to pelvic fracture and adjacent vascular structures
704 Pelvic Fractures
OUTCOMES. Fluid balance; Circulation status; Cardiac pump effectiveness; Hydration
INTERVENTIONS. Bleeding reduction; Fluid resuscitation; Blood product administration; Intravenous therapy; Circulatory care; Shock management
Maintenance of airway, breathing, and circulation are the highest priority. Many patients are in hypovolemic shock (see Hypovolemic/Hemorrhagic Shock, p. 505) and require fluid resuscitation. Patients with stable pelvic fractures can be managed with bedrest alone, and early ambulation is guided by their level of pain or associated injuries. Patients with unstable pelvic fractures can also be managed with bedrest, spica casts, or sling traction, but there is an increasing risk of complications associated with prolonged bedrest. Movement, weight-bearing restrictions, and head of bed elevation are prescribed by the orthopedic surgeon. The physician often prescribes sequential compression devices to prevent venous stasis.
External immobilization helps decrease pain, reduce the amount of blood transfusions, and facilitate early ambulation. Immobilization can be achieved through the use of several devices that can be applied externally or percutaneously to the pelvis through the skin into the bony structure. This type of fixation can be performed at the scene of the injury in an attempt to decrease bleeding and to immediately immobilize bony deformities. A pneumatic antishock garment (PASG) immobilizes unstable bony injuries and provides a tamponade effect, but it is a controversial intervention because its use has been associated with an increase in prehospital time and hemodynamic abnormalities. External stabilization can also be accomplished through the use of an external skeletal fixation device.
Surgical open reduction and internal fixation of pelvic ring disruptions are accomplished with the use of a variety of plates and screws that are secured internally. The goal of internal fixation is to restore the pelvis to its original anatomic configuration. When to perform the open reduction and internal fixation is controversial. Monitor for erythema, drainage, and edema at all wound sites, incision sites, and external fixator appliance insertion sites every 4 hours. Perform pin care as prescribed every 4 to 6 hours.
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