A 39-year-old male presents in the emergency room after a high-speed motor vehicle accident. The patient has been intubated by paramedics at the scene and is on assisted ventilation. He is unconscious. Physical examination reveals a distended abdomen, and initial screening x-rays reveal a displaced fracture of the pelvic ring. Initial evaluation should include which of the following?
|A||Fluid resuscitation and establishment of venous access.|
|B||Diagnostic peritoneal lavage.|
|C||Thorough physical examination, including evaluation of the urinary and lower gastrointestinal tract.|
|D||Emergent application of external fixation.|
|E||CT of the abdomen.|
a. This trauma patient has presented with a displaced pelvic fracture and a distended abdomen. In this setting, it is quite difficult to distinguish intra-abdominal trauma from abdominal distention related to a fracture of the pelvis and secondary bleeding.
b. Diagnostic peritoneal lavage would be indicated as well as physical examination of the genitourinary and lower gastrointestinal tract to rule out an open pelvic fracture.
c. Application of an external fixator for the pelvis would be withheld unless the patient became unstable. Without evidence of intra-abdominal trauma, pelvic bleeding is implicated as the source of instability.
d. Imaging studies of the pelvis and abdomen would be indicated after the initial resuscitation.