Pelvic Fracture Hemorrhage

Standardize treatment of traumatic pelvic injuries with hemorrhage.

AHS Official

Updated: 04/28/2025

PelvisBinderIRPPPTXA

On this page3 sections

⚠️ ALL pelvic fractures require immediate orthopedic surgery consultation.

🩸Initial Resuscitation

▼

2 large bore IVs (IJ/subclavian > femoral)
Early MTP — 1:1:1. TXA 2g IV all at once.
Avoid crystalloid

🦺Pelvic Binder

▼

All unstable (SBP <90) patients
Position over greater trochanters
Repeat XR to confirm reduction — leave until ortho evaluation
Do NOT remove for procedures

📈Escalation for Continued Instability

▼

Preperitoneal Packing (PPP)

Hemodynamically unstable not responding to binder + resus.

External Fixation

Ortho + trauma attending discretion.

Angioembolization (IR)

CT extravasation / large hematoma / ongoing instability.

Internal Iliac Ligation

Salvage only — patient in extremis.

💊

Open Pelvic Fx Antibiotics: Cefazolin 2g IV (3g if >120kg) within 1h. Vaginal/rectal involvement: add Metronidazole 500mg IV. PCN allergy: Vancomycin.

Status: AHS Official Protocol
Source: Management_of_Pelvic_Injuries_3_2025.docx
Last reviewed / updated: 04/28/2025