Suspected haemorrhagic pelvic fracture — MRCEM SBA MCQ

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EasyResuscitation and critical illnessSuspected haemorrhagic pelvic fractureMRCEM SBA

A 38-year-old pedestrian is brought to the emergency department after being struck by a car. He is alert and breathing adequately but has severe pelvic pain. His pulse is 136/min and blood pressure is 78/44 mmHg. There is tenderness over the pubic symphysis, with no major external haemorrhage. No pelvic binder has been applied. Intravenous access is established, the major haemorrhage protocol has been activated, and a purpose-made pelvic binder is available. Which management sequence is most appropriate now?

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Correct answer: E — Apply the pelvic binder, then obtain indicated imaging.

The high-energy blunt mechanism and focal pelvic tenderness make a pelvic fracture plausible. Marked hypotension and tachycardia, without major external blood loss, raise concern for active pelvic haemorrhage. NICE recommends a purpose-made pelvic binder when bleeding from a pelvic fracture is suspected after blunt high-energy trauma; fracture confirmation is not required first. The binder should be applied now while blood-product resuscitation proceeds, with imaging selected according to his response. ([nice.org.uk](https://www.nice.org.uk/guidance/ng37/chapter/recommendations)) A radiograph (A) may help direct later intervention but must not delay the binder. An eFAST scan (B) can assess for other injuries, yet a negative result does not exclude retroperitoneal haemorrhage. CT (C) is appropriate for an adult with suspected high-energy pelvic fracture when sufficiently stable for scanning, not as a prerequisite to immediate haemorrhage control in this hypotensive patient. Tranexamic acid (D) should be given promptly for suspected active bleeding, but its infusion need not finish before the binder is applied. These investigations and treatments complement, rather than precede, immediate pelvic haemorrhage control. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/recommendations))

Reference: NICE NG39: Major trauma: assessment and initial management, recommendations 1.5.3–1.5.4 and 1.5.28–1.5.33 (17 February 2016) — https://www.nice.org.uk/guidance/ng39/chapter/recommendations NICE NG37: Fractures (complex): assessment and management, recommendations 1.1.7 and 1.2.14 (23 November 2022) — https://www.nice.org.uk/guidance/ng37/chapter/recommendations