Immediate life-saving interventions
›Hemorrhage control and resuscitation
›Pelvic binder early stabilization
›Greater trochanter placement
›Maintain until definitive stabilization plan
›Massive transfusion strategy
›Balanced product resuscitation aligned with local protocol
›Calcium repletion during massive transfusion per protocol
›Tranexamic acid in major trauma when within appropriate time window per trauma protocol
›1 g IV over 10 minutes
›Followed by 1 g IV over 8 hours
›Avoid initiation beyond protocol time window
›Hemorrhage control escalation
›If persistent shock then operative hemorrhage control pathway
›Preperitoneal pelvic packing when available and indicated
›External fixation or C-clamp stabilization when indicated
›If CT arterial extravasation then angioembolization pathway
›Early interventional radiology coordination
›If refractory shock and resources available then REBOA consideration by trained team
›Airway and ventilation
›If ongoing massive transfusion and altered mental status then early airway control pathway
›Ventilation targets aligned with trauma protocol
Immobilization and Splinting
›Pelvic stabilization
›Pelvic binder indications
›Suspected unstable pelvic ring injury with hemodynamic instability
›High-energy mechanism with pelvic pain and deformity
›Pelvic binder contraindications relative
›Protruding abdominal viscera in open injury context
›Skin breakdown risk requiring frequent reassessment
›Immobilization adjuncts
›Sheet wrap technique when commercial binder unavailable
›Hip and knee positioning aligned with comfort and neurovascular status
›Mobility restriction
›Non weight bearing or protected weight bearing based on pattern and stability plan
›Early physiotherapy involvement when stable
›Hip dislocation with pelvic trauma
›Emergent reduction pathway in posterior hip dislocation
›Time sensitive reduction to reduce avascular necrosis risk
›Neurovascular reassessment pre and post reduction
›Sedation and analgesia readiness
›Monitoring and airway readiness per procedural sedation standards
›Post reduction imaging confirmation
›Pelvic ring reduction principles
›Closed reduction attempts typically not ED based in unstable patterns
›External fixation alignment under trauma and orthopedics coordination
Open fracture medications and timing
›Open pelvic fracture pathway
›Antibiotics early
›Cefazolin 2 g IV
›Repeat dosing per operative timing and local protocol
›If severe beta lactam allergy then clindamycin 900 mg IV
›Add gram negative coverage per contamination and local protocol
›If farm or heavy contamination then add anaerobic coverage per local protocol
›Tetanus prophylaxis
›Tdap if immunization unknown or out of date
›Tetanus immune globulin if not immunized or incomplete series
›Wound management
›Sterile dressing
›Avoid aggressive bedside probing in unstable patient
DVT prophylaxis when relevant
›Venous thromboembolism risk in pelvic fractures
›High risk with pelvic ring and acetabular fractures
›Chemoprophylaxis timing aligned with bleeding control and surgical plan
›Prophylaxis options
›Low molecular weight heparin per trauma protocol when hemostasis achieved
›Mechanical prophylaxis when chemoprophylaxis contraindicated
›Contraindications
›Active bleeding
›Planned emergent surgery with uncontrolled hemorrhage