Pelvic Fractures in the ED Part2

Closing the ring is only half the battle. In Part 2 we move from mechanics to chemistry: damage-control resuscitation, the evolving evidence on TXA and REBOA, definitive hemorrhage control, and the injuries that travel with a broken pelvis. From the presentation by Dr. Nasser Hassan Abdalrady, Emergency Medicine Consultant & Educator, based on Tintinalli's and Rosen's and current international guidelines. 📌 In this part Damage-control resuscitation and permissive hypotension The lethal diamond: hypothermia, acidosis, coagulopathy, hypocalcemia TXA: CRASH-2 vs PATCH-Trauma, and why the evidence is evolving REBOA: what the UK-REBOA trial showed Definitive hemostasis: preperitoneal packing vs angioembolization Associated injuries: the pelvis rarely travels alone Blood at the meatus: why the urethrogram comes before the catheter Open pelvic fractures and sepsis risk Special populations: older adults on beta-blockers or anticoagulants, and children Key takeaways and a closing reflection on how trauma systems change the evidence ⏱️ Chapters 0:00 Damage-control resuscitation 0:23 Permissive hypotension 1:17 The lethal diamond 2:11 Tranexamic acid and CRASH-2 2:38 PATCH-Trauma: evolving evidence 4:14 REBOA explained 4:52 The UK-REBOA trial 6:00 Packing and angioembolization 6:22 Fastest definitive hemostasis wins 6:34 Associated injuries 6:54 Urethral injury: stop before the catheter 7:54 Open pelvic fractures 8:16 Older adults 9:16 Children 10:04 Key takeaways 11:05 Closing reflection ◀️ Missed Part 1? Watch it first for anatomy, classification and the pelvic binder. 📚 Key references Tintinalli's Emergency Medicine, 9th ed. Rosen's Emergency Medicine, 10th ed. ATLS Advanced Trauma Life Support, 11th ed. Coccolini F, et al. Pelvic trauma: WSES classification and guidelines. World J Emerg Surg 2017. Rossaint R, et al. European guideline on major bleeding and coagulopathy following trauma, 6th ed. Crit Care 2023. CRASH-2 collaborators. Lancet 2010. PATCH-Trauma Investigators. N Engl J Med 2023. Jansen JO, et al. UK-REBOA trial. JAMA 2023. ⚠️ For medical education only. This video is not a substitute for clinical judgment or your institution's protocols. No drug doses are given; follow your local protocol. #EmergencyMedicine #Trauma #PelvicFracture #TXA #REBOA #FOAMed #EDME #MedicalEducation #EMResidents