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
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