skip to main content

Suspected haemorrhagic pelvic fracture — MRCEM SBA MCQ

Instant feedback + full explanation. One question, done properly.

EasyTraumaSuspected haemorrhagic pelvic fractureMRCEM SBA

A 42-year-old man arrives at a major trauma centre after being struck by a van. He is alert, with a patent airway and normal breath sounds. His heart rate is 128 beats/min and blood pressure is 84/50 mmHg. He has marked pelvic pain and bruising over the pubis, without an obvious external source of bleeding. Blood-component resuscitation is starting. No pelvic binder has been applied, and pelvic imaging has not yet been performed. What is the most appropriate immediate plan for pelvic stabilisation?

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

Reveal the answer and explanation

Correct answer: C — Apply a pelvic binder over the greater trochanters before imaging.

The high-energy blunt mechanism, pelvic findings and shock together make active bleeding from a pelvic fracture sufficiently likely to warrant immediate circumferential stabilisation. Apply a purpose-made pelvic binder now, centred over the greater trochanters, while blood-component resuscitation continues. Confirmation of a fracture is not required before application. NICE recommends a binder when active bleeding is suspected from a pelvic fracture after blunt high-energy trauma; UK trauma-network guidance specifies placement at the greater trochanters. ([nice.org.uk](https://www.nice.org.uk/guidance/ng37/chapter/recommendations)) A is tempting because CT is first-line imaging for a suspected high-energy pelvic fracture in an adult, but imaging must not delay this immediate haemorrhage-control measure. B similarly offers rapid diagnostic imaging, yet waiting for a radiograph leaves suspected pelvic bleeding unstabilised. Either imaging plan becomes appropriate after the initial stabilisation and resuscitation steps, according to the patient's condition. D gets the timing right but places the binder too high: it should sit over the greater trochanters, not the iliac crests. E correctly recognises the need for blood components, but makes binder application conditional on persistent hypotension despite resuscitation; the current findings already justify it. Blood replacement and binder application should proceed concurrently. ([nice.org.uk](https://www.nice.org.uk/guidance/ng37/chapter/recommendations))

Reference: NICE NG37: Fractures (complex): assessment and management — recommendations (2016) — https://www.nice.org.uk/guidance/ng37/chapter/recommendations Sussex Trauma Network: Guidelines for Management of Severe Pelvic Fractures including Urethral Injury (May 2024) — https://www.uhsussex.nhs.uk/wp-content/uploads/2024/06/STN-Guideline-Severe-Pelvic-Fractures-including-Urethral-Injury-ACTIVE-v1.0-1.pdf