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Pelvic Fracture Haemorrhage — FRCA Final MCQ

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HardTrauma & Emergency AnaesthesiaPelvic Fracture HaemorrhageFRCA Final

A 24-year-old man weighing 70 kg is brought to a major trauma centre after a high-speed road traffic collision. An unstable pelvic fracture is suspected and a correctly positioned pelvic binder has been applied. His initial heart rate is 138 beats min−1, blood pressure 78/46 mmHg, lactate 6.8 mmol L−1 and base excess −10 mmol L−1. The major haemorrhage protocol is activated. After the first pack of warmed blood components, his blood pressure improves to 104/66 mmHg and remains stable during reassessment. An eFAST examination is negative. What is the most appropriate next step?

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Correct answer: D — Continue fixed-ratio major haemorrhage resuscitation and perform immediate contrast-enhanced whole-body CT

The correct answer is D. He has major traumatic haemorrhage but has become a sustained responder to blood-component resuscitation. NICE recommends immediate CT in patients with suspected haemorrhage who respond to resuscitation, and whole-body CT for adults with blunt major trauma and suspected multiple injuries. Resuscitation must continue during transfer and imaging. A negative eFAST does not exclude intraperitoneal or retroperitoneal bleeding. Isolated pelvic CT is inadequate in high-energy multisystem trauma. Angiographic embolisation is indicated once active arterial pelvic haemorrhage is identified and laparotomy is not required. Emergency laparotomy is not justified solely by the initial shock or negative eFAST. Immediate extraperitoneal packing may be considered within a damage-control pathway for a non-responder requiring operative haemorrhage control, but is not the next step in this sustained responder.

Reference: National Institute for Health and Care Excellence. NG39: Major trauma—assessment and initial management, sections 1.5.27–1.5.40. 2016. https://www.nice.org.uk/guidance/ng39/chapter/recommendations