The importance of fracture pattern in guiding therapeutic decision-making in patients with hemorrhagic shock and pelvic ring disruptions.

摘要: Background: Pelvic fractures may be associated with significant hemorrhage. Although this hemorrhage emanate from the pelvic vasculature, it also secondary to abdominal visceral injury. The purpose of study was determine factors and/or bleeding in hypotensive patients guide appropriate therapeutic intervention sequence for these difficult-to-manage patients. Methods: Medical records all (systolic blood pressure ≤ 90 mm Hg) seen at a Level I trauma center January 1995 December 1999 were evaluated. Records abstracted age, base deficit, 24-hour requirement, hemoperitoneum (positive ultrasound, diagnostic peritoneal lavage, or computed tomographic scan), discovered celiotomy, angiography, emergency department disposition, Injury Severity Score, and mortality. fracture categories derived by adapting Young-Burgess classification scheme. Lateral compression (LC) anteroposterior (APC) characterized as stable patterns (SFPs), APC II, III, LC vertical shear unstable (UFPs). Results: Of 231 patients, 38 died department, leaving 193 surviving initial resuscitation. One hundred seven stabilized (group I) transferred intensive care unit. Eighty-six II) required ongoing resuscitation underwent celiotomy angiography an attempt manage their Within group SFP population, responsible hypotension 34 40 (85%), 10 (25%). In UFP injury, predominantly source, shown 27 positive angiograms 46 (59%). Twenty-four (52%) died. UFP, 14 had both celiotomy. Four before one four (mortality, 25%) contrast, 6 60%). Conclusion: Patients signs shock injury require intervention, hemorrhagic focus is intraperitoneal. even presence hemoperitoneum, consideration should given