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Severe pelvic fractures are a major cause of morbidity and mortality in trauma patients. As hemorrhage is the main cause of mortality in pelvic trauma, it is critical to assess hemodynamic stability and identify ongoing bleeding in the chest, abdomen and long bones. If no clear source of hemorrhage is identified and a patient remains unstable, suspicion for primary pelvic hemorrhage should be high. Suspect pelvic fracture in all cases of serious or multisystem trauma patients.
In pelvic trauma, there is a high incidence of associated injuries; therefore, special attention should be paid to the rectal and urogenital examinations. The most commonly used classification system for pelvic fractures is the Young–Burgess system. This system categorizes injuries on the basis of mechanism of injury and can be used to predict the risk of blood loss.
This chapter discusses the basic methods and principles of monitoring for proper management of the critically ill patient in the emergency setting. Pulse oximetry provides continuous measurement of a patient's oxygenation status in the case of respiratory monitoring. Capnography measures the partial pressure or concentration of expired carbon dioxide (CO2), the end-tidal carbon dioxide (EtCO2). Ultrasonography of the inferior vena cava (IVC) can be useful in determining fluid responsiveness during non-invasive hemodynamic monitoring. Invasive hemodynamic monitoring provides data via catheters inserted in central veins or arteries. Central venous pressure is obtained by placing a central venous catheter (CVC) in the internal jugular or subclavian vein. The CVP should be interpreted with caution in critically ill patients that have known heart disease or structural cardiac anomalies. Pulse pressure variation (PPV) and systolic pressure variation (SPV) can be used to determine fluid responsiveness in a mechanically ventilated patient.