NYU Langone Orthopedic Trauma Service Algorithm for Evaluation

NYU Langone Orthopedic Trauma Service Algorithm for Evaluation - Flowchart

«Flowchart»

Primary survey-ABCs

Hemodynamically stable

Hemodynamically stable Hemodynamically stable

Hemodynamically unstable

Hemodynamically unstable Hemodynamically unstable

End

Secondary survey
Consider blood Tx.

Secondary survey

SI joint involvement—consider iliac injury.

Classify fracture.

Anterior/posterior compression

Lateral compression

Pelvic Fx

Risk factors for pelvic fracture

Motorcycle collision
Car versus pedestrian
Fall-15 ft (4.6 m)
Lateral impact
MVC

Pelvic Fx

Risk factors for pelvic fracture

Motorcycle collision
Car versus pedestrian
Fall-15 ft (4.6 m)
Lateral impact
MVC

Motorcycle collision
Car versus pedestrian
Fall-15 ft (4.6 m)
Lateral impact
MVC Pelvic Fx

No fracture

CT scan

Pelvic Fx

Risk factors for pelvic fracture

Motorcycle collision
Car versus pedestrian
Fall-15 ft (4.6 m)
Lateral impact
MVC

Pelvic Fx

Risk factors for pelvic fracture

Motorcycle collision
Car versus pedestrian
Fall-15 ft (4.6 m)
Lateral impact
MVC

Motorcycle collision
Car versus pedestrian
Fall-15 ft (4.6 m)
Lateral impact
MVC Pelvic Fx

No fracture

Angio

External compression

Classify fracture.
CXR, FAST, DPL (supraumbilical)

Other type

Open book

HD Stable

HD Unstable

ICU

Consider exploration.

ICU

Angio

Stable

Continued bleeding

Operative exploration

Reassess; continue resuscitation.

CXR, FAST, DPL (infraumbilical)

Positive

Positive Positive

Negative

Negative Negative

Physical findings:

Pelvic pain
Neurologic deficits
Laceration and/or ecchymosis at bony prominence
Scrotal and/or perineal ecchymosis
Blood at urethral meatus
Blood at rectum
abnormal prostate
Unequal leg length
Unstable pelvis

Physical findings: