The unstable pelvic fracture

Pelvic binder at the greater trochanters immediately — reduces the volume, tamponades the venous bleeding. MTP — blood products 1-to-1-to-1, TXA within 3 hours, permissive hypotension. FAST — likely negative (retroperitoneal). Pelvic radiograph — identify the pattern. Urethral injury — blood at the meatus; do NOT catheterise blindly; perform the retrograde urethrogram first. Angiographic embolisation — activate interventional radiology early for the arterial bleeding. REBOA Zone 3 for refractory bleeding. Rectal exam — tone, blood, prostate position. Associated injuries — bladder (CT cystography), rectal (diverting colostomy if injured), open fracture (very high mortality). Orthopaedic and urological teams involved early.^[1]