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Suspected unstable pelvic fracture with airway contamination — MRCEM SBA MCQ

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HardTraumaSuspected unstable pelvic fracture with airway contaminationMRCEM SBA

A 35-year-old pedestrian is brought to a major trauma centre after being struck by a lorry. A purpose-made pelvic binder was applied for suspected pelvic haemorrhage. Blood-component resuscitation is under way; his blood pressure is 92/58 mmHg and heart rate is 126/min. Pelvic imaging has not yet been performed. He is awake and speaking between episodes of vomiting, but vomit is now pooling in his pharynx despite attempted oropharyngeal suction. A coordinated trauma team and an anaesthetist are at the bedside. What is the most appropriate immediate manoeuvre?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Log-roll him with the binder in place to clear the airway, monitoring haemodynamics.

Suspected pelvic fracture and ongoing haemodynamic instability make unnecessary movement hazardous. Ordinarily, a patient with a suspected pelvic fracture should not be log-rolled before pelvic imaging. **Airway clearance is the relevant exception:** vomit is pooling despite suction, so the team should perform a controlled log-roll now, retain the binder and pay particular attention to haemodynamic stability. Resuscitation continues while the airway is cleared. ([nice.org.uk](https://www.nice.org.uk/guidance/ng37/chapter/recommendations)) A applies the usual restriction on pre-imaging log-rolling but wrongly lets it delay clearance of an obstructed airway. B is attractive because repeated vomiting may ultimately require a definitive airway; it does not address the immediate need to clear pooled vomit, and the patient is still speaking between episodes. D permits the necessary roll but unnecessarily removes pelvic stabilisation while bleeding is suspected. E would be reasonable if suction were effective, but its documented failure is the discriminator. Once the immediate airway threat is addressed, the team can reassess the need for intubation and proceed with haemorrhage assessment and control. ([nice.org.uk](https://www.nice.org.uk/guidance/ng37/chapter/recommendations))

Reference: NICE NG37: Fractures (complex): assessment and management, recommendations 1.2.17–1.2.19 (23 November 2022) — https://www.nice.org.uk/guidance/ng37/chapter/recommendations NICE NG39: Major trauma: assessment and initial management, recommendation 1.5.3 (17 February 2016) — https://www.nice.org.uk/guidance/ng39/chapter/Recommendations