Immediate life-saving interventions
›Hemorrhage and shock control
›If major traumatic hemorrhage suspected, activate MTP
›Balanced blood product transfusion per local ratio
›Calcium replacement per transfusion protocol
›If pelvic ring injury suspected, pelvic binder over trochanters
›Avoid binder over iliac crests
›Hip dislocation urgent reduction pathway
›If suspected hip dislocation, urgent reduction after imaging as appropriate
›Neurovascular exam documented pre reduction
›Reduction timing goal within hours to reduce AVN risk
Immobilization and Splinting
›Immobilization principles
›Strict non weight bearing until definitive plan
›Pain limited positioning with pillows and neutral hip alignment
›Temporary stabilization options
›Knee immobilizer if associated knee injury or significant pain with movement
›Traction options when femoral head migration or severe spasm
›Skeletal traction decision typically orthopedics guided
›Indications for reduction
›Hip dislocation on imaging or strong clinical suspicion
›Neurovascular compromise with dislocation pattern
›Threatened skin compromise from deformity
›Contraindications or caution triggers
›Suspected femoral neck fracture
›Hemodynamic instability needing resuscitation first
›Inadequate sedation and airway resources
›Analgesia and anesthesia
›Multimodal analgesia baseline
›Acetaminophen PO or IV per local protocol
›NSAID if no contraindication
›Opioid titration options
›Fentanyl IV incremental dosing with monitoring
›If older adult or frail, lower initial dose and slower titration
›Hydromorphone IV incremental dosing with monitoring
›If renal impairment, cautious titration
›Procedural sedation pathway for reduction
›Etomidate IV single bolus sedation option
›Myoclonus and adrenal suppression considerations
›Ketamine IV sedation option
›If hypertension or ischemic heart disease, risk benefit discussion
›Propofol IV titrated option
›Hypotension risk mitigation with fluids and vasopressors ready
›Reduction technique principles
›Traction and countertraction with pelvis stabilized
›Gentle sustained force rather than repeated forceful attempts
›If failed attempt, stop and escalate to orthopedics
›Post reduction requirements
›Immediate neurovascular reassessment
›Post reduction pelvis AP and Judet views
›Post reduction CT to assess congruity and fragments
Open fracture medications and timing
›Open fracture pathway if open wound communicates with fracture
›Antibiotics as early as possible
›Cefazolin IV typical first line for low contamination
›If severe contamination or high grade suspicion, add gram negative coverage per local protocol
›If penicillin anaphylaxis, alternative regimen per local protocol
›Tetanus prophylaxis per immunization status
›Tetanus toxoid booster if not up to date
›Tetanus immune globulin if unknown or incomplete series with dirty wound
›Sterile dressing and avoid aggressive ED debridement
›Irrigation only if gross contamination and delayed OR expected
DVT prophylaxis when relevant
›Venous thromboembolism risk management
›High risk features
›Pelvic or acetabular fracture with reduced mobility
›Surgery planned
›Prior VTE or thrombophilia
›Pharmacologic prophylaxis per trauma or ortho protocol
›Low molecular weight heparin typical first line when bleeding risk acceptable
›If active bleeding risk, mechanical prophylaxis until safe
›Documentation elements
›Risk benefit rationale
›Start timing and hold parameters