TVTRAUMAVAULTCASE-BASED TRAUMA JUDGMENT
Teaching image withheldThe image will be revealed when it becomes clinically available in the case.
AP anteroposterior pelvic radiograph obtained during initial emergency-department resuscitation shows marked pubic symphysis diastasis with widening of the anterior pelvic ring, consistent with an open-book pelvic ring injury; associated posterior-ring injury must be presumed until excluded. teaching visual
AP anteroposterior pelvic radiograph obtained during initial emergency-department resuscitation shows marked pubic symphysis diastasis with widening of the anterior pelvic ring, consistent with an open-book pelvic ring injury; associated posterior-ring injury must be presumed until excluded. • TEACHING IMAGE
Trauma—Pelvic Ring DisruptionHigh-energy motor-vehicle collision with blunt anterior-posterior compression to the pelvisIntermediate

Hemodynamic Instability with Open-Book Pelvic Injury

SCENARIO

A 34-year-old restrained driver is brought directly to the trauma bay after a high-speed MVC. He is pale, confused, and complains of severe pelvic pain. Initial assessment shows a patent airway, spontaneous breathing, diminished but present distal pulses, and no obvious external hemorrhage. A pelvic binder has not yet been applied. After direct-pressure dressings, warming, large-bore access, and initiation of balanced blood-product resuscitation, an AP pelvic radiograph is obtained in the resuscitation bay because pelvic hemorrhage is suspected. The patient remains hypotensive but has transient improvement in mental status and radial pulse after the first blood products, permitting image acquisition. The radiograph is now available for interpretation.

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