Examkin

Soru

Zorluk: ZorInitial Stabilization and Triage

Following a high-speed collision with a concrete barrier, a 51-year-old female driver is extricated from her vehicle and arrives at the trauma resuscitation bay via a medical helicopter. She is fully awake but reports agonizing lower truncal pain.

Her vital signs are as follows:
Blood pressure: 64/34 mmHg
Heart rate: 144/min
Respiratory rate: 26/min
Oxygen saturation: 94% on supplemental oxygen

Physical examination reveals a mechanically unstable pelvic ring with severe crepitus elicited upon gentle bilateral compression of the iliac crests. The patient's abdomen is flat and non-tender. The focused assessment with sonography for trauma (FAST) reveals no pericardial effusion and no free fluid in the dependent abdominal recesses. Two large-bore peripheral intravenous lines are currently being established by the nursing staff.

Which of the following is the single most urgent initial step to stabilize this patient's condition?

  1. A
    Expedited transfer to the radiology suite for cross-sectional imaging of the abdomen and pelvis
  2. B
    Activation of the surgical team for an immediate exploratory laparotomy
  3. Application of a pelvic binder centered over the greater trochantersCevap
  4. D
    Initiation of a continuous intravenous norepinephrine infusion
  5. E
    Performance of a retrograde urethrogram to evaluate for genitourinary injury

Cevap

Application of a pelvic binder centered over the greater trochanters
This patient is in profound hemorrhagic shock due to an unstable pelvic fracture, as evidenced by mechanical instability, severe hypotension, and a negative FAST scan (which rules out significant intraperitoneal bleeding). In pelvic fractures, hemorrhage is most commonly venous (from the presacral plexus) or from fractured cancellous bone. The immediate priority in the resuscitation bay, even before definitive hemorrhage control like angiography or preperitoneal packing, is to reduce pelvic volume. Applying a pelvic binder mechanically stabilizes the fracture fragments, prevents dislodging of early clots, and creates a tamponade effect on venous bleeding. This intervention is rapid, noninvasive, and must be performed immediately.

Adım Adım Çözüm

1
Assess the patient's hemodynamic status and mechanism of injury.
The patient is in profound shock following high-speed blunt trauma.
Identifying life-threatening hemodynamic instability dictates an immediate transition to emergent resuscitation.
2
Localize the primary source of major hemorrhage.
The FAST exam is negative, but the pelvic exam shows gross mechanical instability.
A negative FAST in an unstable blunt trauma patient points to the retroperitoneum (pelvis) or thorax as the source of hidden blood loss.
3
Select the most urgent noninvasive intervention to control the identified hemorrhage source.
Application of a pelvic binder is chosen as the immediate next step.
A pelvic binder rapidly reduces pelvic volume, tamponading venous bleeding and stabilizing fracture fragments.

Anahtar Kavram

In a hemodynamically unstable patient with a pelvic fracture and a negative FAST exam, the most urgent initial stabilization step is the application of a circumferential pelvic binder to mechanically tamponade retroperitoneal bleeding.
Tahmini Süre:1m 30s
Bu soruyu puanla

Konular

Initial Stabilization and Triage

Bu konudan daha fazla soru