Trauma Management in Urgent Care - Component 8

Pelvic Injuries

• Pelvic fractures account for approximately 3-6% of adult fractures.
• Occurrences of pelvic injuries are present in 20% of all polytrauma cases.
• 75% of pelvic injury cases involve males.
• Haemorrhage is the leading cause of death in 40% of patients with pelvic trauma.

Causes of Pelvic Injuries

• Significant high-energy transfers, such as road traffic collisions (RTCs).
• Falls from heights and crush injuries are also common causes.
• Simple falls can cause pelvic injuries, particularly in high-risk groups like the elderly and those with degenerative bone diseases or undergoing radiotherapy.

Complications from Pelvic Injuries

• Increased pelvic volume from fractures can lead to severe haemorrhage.
• Vascular injuries may occur, causing further bleeding.
• Urogenital injuries, such as bladder ruptures, arise in about 10% of cases.
• Patients may present with other serious injuries, including intra-thoracic or intra-abdominal damage.

Signs & Symptoms of Pelvic Injuries

• Common signs include bruising, swelling, and deformity.
• May experience bleeding from the rectum, vagina, or urethra.
• Signs of hypovolemic shock and altered sensation in limbs are critical indicators.
• Characteristic pain is felt in the hips, groin, or lower back.

Management of Pelvic Injuries

• Follow JRCALC guidelines emphasizing DRABC (Danger, Response, Airway, Breathing, Circulation).
• Immediate immobilization is vital, including using pelvic splints to stabilize.
• Control catastrophic haemorrhage and ensure high-flow oxygen delivery.
• Do not remove a pelvic splint once applied, to avoid exacerbating injuries.
• Minimize movement and avoid repeated examinations.

Pelvic Splint Information

• Pelvic splints are single-use devices designed to fit a range of patients from pediatric to bariatric sizes.
• Essential for immediate stabilization during transport to a major trauma center (MTC).

Spinal Injuries

• Common mechanisms include hyperflexion, hyperextension, rotation, and compression.
• Falls account for approximately 46% of spinal injuries, with many occurring from heights under 2 meters.
• Road traffic collisions contribute to 40% of spinal injuries, with 3% from sports activities.

Types of Spinal Injuries

• Dislocation, fracture, or displacement of vertebrae can lead to spinal cord injury (SCI) due to compression or stretching of the cord.

Complications Associated with Spinal Injuries

• Can result in spinal cord damage, spinal shock, neurogenic shock, respiratory complications, and cauda equina syndrome.
• Spinal shock presents as loss of motor and possibly sensory function, with lengthy recovery potential.
• Neurogenic shock leads to impaired tissue perfusion from loss of sympathetic tone.

Clinical Signs of Spinal Injury

• Presenting symptoms include pain along the spine, loss of limb sensation or movement, and altered trunk sensation.
• Hypotension may also be a significant indicator of severity.

Cauda Equina Syndrome

• Results from severe compression or inflammation of lower spinal nerves.
• Can manifest acutely or chronically and requires urgent surgical intervention for decompression.
• Significant clinical red flags include saddle anesthesia, bladder/bowel dysfunction, and lower limb weakness.

Summary

• Pelvic injuries pose a high risk of fatal haemorrhage; immediate splinting and careful transport are essential.
• Spinal injuries require acute recognition and management to prevent irreversible damage and complications.