A 40-year-old man sustains a pelvic fracture from a road traffic accident with a mechanically unstable pelvis (open book fracture, diastasis >2.5 cm). He is hemodynamically unstable with BP 70/40 despite 2L crystalloid. The correct ATLS sequence of hemorrhage control is:

• A Angioembolization → pelvic binding → laparotomy
• B Pelvic binder application → resuscitative endovascular balloon occlusion of aorta (REBOA) or external fixation → preperitoneal pelvic packing ✓
• C Emergency laparotomy to pack the pelvis → external fixation
• D CT angiography → angioembolization → pelvic binding

Explanation

For hemodynamically unstable pelvic fractures, the current hemorrhage control algorithm is: (1) immediate pelvic binder/sheet to reduce pelvic volume and tamponade venous bleeding, (2) REBOA (Zone III aorta, distal aorta/bifurcation level) as a bridge to hemorrhage control in extremis, or (3) preperitoneal pelvic packing (PPP) as the primary hemorrhage control in centers without REBOA capability. Angioembolization addresses arterial bleeding (20–25% of pelvic hemorrhage) and is performed after stabilization. CT angiography is not performed in hemodynamically unstable patients.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.