La gestione del paziente emodinamicamente instabile con frattura di bacino

Abstract

The hemodynamic status in patients with pelvic ring injuries is a major prognostic factor of an immediate mortality risk. In particular, patients “in extremis” are at high risk of dying. This patient group is characterised by absent vital signs or by being in severe shock with initial systolic blood pressure 12 blood transfusions within the first two hours after admission. The source of pelvic bleeding has in approximately 80–90% of cases a venous origin and relevant arterial bleeding accounts for 10–20%. Important parts of the initial treatment include mechanical pelvic ring stabilization combined with haemorrhage control concepts. Mechanical stabilization is performed non-invasively by pelvic binder application or invasively by classical anterior pelvic fixation (C-clamp), depending on local available resources. In patients “in extremis”, direct extraperitoneal pelvic packing is recommended, whereas in moderately unstable patients or in patients where persistent haemodynamic instability occurs despite shock therapy and mechanical stabilisation and pelvic packing, arterial injury is ruled out by angiography followed by selected embolisation of pelvic vessels.