Episode 24 - Hemodynamically Unstable Pelvic Fractures | Trauma ICU Rounds

The podcast explores the optimal management of hemodynamically unstable pelvic fractures, featuring Dr. Clay Cawthron Burlew, a trauma and acute care surgeon at Denver Health. Dr. Burlew discusses the evolution of their multidisciplinary approach, emphasizing the shift from angiography to preperitoneal packing combined with external fixation as the primary intervention. She highlights that venous and bony fracture-related bleeding are the main problem, not arterial bleeding. The conversation touches on the use of REBOA as a bridge to stabilize patients with severe pelvic fractures, incorporating it within a clearly defined algorithm. Dr. Burlew also addresses concerns about infection risks associated with pelvic packing, advocating for a single packing approach and good tissue debridement to minimize infectious morbidity.

Outlines

Part 1: Introduction, Historical Context

Part 2: Stabilization, Intervention Methods

Part 3: Surgical Strategies, Complications

Part 4: Resuscitation, Clinical Takeaways

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Episode 24 - Hemodynamically Unstable Pelvic Fractures

Trauma ICU Rounds

Part 1: Introduction, Historical Context

Introduction to Dr. Clay Cawthron Burlew and the Topic of Pelvic Fractures

Evolution of Pelvic Fracture Management: From Angiography to Pelvic Packing

The Shift to Pelvic Packing: Addressing the Source of Hemorrhage

Part 2: Stabilization, Intervention Methods

Pelvic Binding: Stabilizing the Pelvis to Prevent Further Damage

REBOA in Pelvic Fractures: A Bridge to Definitive Treatment

Hybrid ORs and the Importance of Multidisciplinary Buy-In for Pelvic Packing

Part 3: Surgical Strategies, Complications

Managing Combined Abdominal Injuries and Pelvic Fractures: Incision Strategies

Hypogastric Artery Ligation: A Less Necessary Procedure with Pelvic Packing

Infection Risk and Repacking: Minimizing Morbidity in Pelvic Packing

Open Pelvic Fractures and Antibiotic Slurries: Addressing Infection Risk

Part 4: Resuscitation, Clinical Takeaways

TEG and Hemostatic Resuscitation: Halting Bleeding as the Critical Factor

Key Take-Home Points: Algorithms, Resources, and Multidisciplinary Buy-In

Episode 24 - Hemodynamically Unstable Pelvic Fractures

Trauma ICU Rounds

Part 1: Introduction, Historical Context

00:12Introduction to Dr. Clay Cawthron Burlew and the Topic of Pelvic Fractures

Introduction to Dr. Clay Cawthron Burlew and the Topic of Pelvic Fractures

02:14Evolution of Pelvic Fracture Management: From Angiography to Pelvic Packing

Evolution of Pelvic Fracture Management: From Angiography to Pelvic Packing

03:56The Shift to Pelvic Packing: Addressing the Source of Hemorrhage

The Shift to Pelvic Packing: Addressing the Source of Hemorrhage

Part 2: Stabilization, Intervention Methods

06:35Pelvic Binding: Stabilizing the Pelvis to Prevent Further Damage

Pelvic Binding: Stabilizing the Pelvis to Prevent Further Damage

08:47REBOA in Pelvic Fractures: A Bridge to Definitive Treatment

REBOA in Pelvic Fractures: A Bridge to Definitive Treatment

12:14Hybrid ORs and the Importance of Multidisciplinary Buy-In for Pelvic Packing

Hybrid ORs and the Importance of Multidisciplinary Buy-In for Pelvic Packing

Part 3: Surgical Strategies, Complications

15:22Managing Combined Abdominal Injuries and Pelvic Fractures: Incision Strategies

Managing Combined Abdominal Injuries and Pelvic Fractures: Incision Strategies

18:43Hypogastric Artery Ligation: A Less Necessary Procedure with Pelvic Packing

Hypogastric Artery Ligation: A Less Necessary Procedure with Pelvic Packing

21:15Infection Risk and Repacking: Minimizing Morbidity in Pelvic Packing

Infection Risk and Repacking: Minimizing Morbidity in Pelvic Packing

24:02Open Pelvic Fractures and Antibiotic Slurries: Addressing Infection Risk

Open Pelvic Fractures and Antibiotic Slurries: Addressing Infection Risk

Part 4: Resuscitation, Clinical Takeaways

27:04TEG and Hemostatic Resuscitation: Halting Bleeding as the Critical Factor

TEG and Hemostatic Resuscitation: Halting Bleeding as the Critical Factor

29:29Key Take-Home Points: Algorithms, Resources, and Multidisciplinary Buy-In

Key Take-Home Points: Algorithms, Resources, and Multidisciplinary Buy-In