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A 60-year-old man is hit by a pickup truck and brought to the emergency department with a blood pressure of 70/0 mm Hg. Peritoneal lavage showed no blood in the abdomen. The blood pressure is elevated to 85 systolic following the administration of 2 L of Ringer’s lactate. An x-ray showed a pelvic fracture. What is the next step in management?

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Correct Answer:
External fixation of the pelvis
Description:
Early external fixation of the pelvis has been shown to reduce bleeding and mortality in patients in shock consequent to pelvic fractures. An unstable patient should not be sent for a CT scan. Selective angiography with embolization of the bleeding vessel may also be helpful in these patients. Laparotomy usually results in uncontrollable pelvic bleeding.
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