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Pelvis

a) Pelvic XR (AP)

  • If the pelvis is mechanically unstable on initial assessment, or there is concern that occult pelvic injury is present and responsible for occult hemorrhage, a pelvic binder should be applied prior to bedside pelvic imaging
  • If CT imaging is anticipated immediately following initial assessment, then plain XR of the pelvis is not indicated on an emergent basis
  • May also be useful to determine if pelvic binding is needed prior to transfer to CT
b) Standard trauma imaging CT protocol:

  • The basic set of CT imaging that will most often be used and should be considered the starting point for CT imaging of the severely injured patient
  • Includes the pelvis with IV contrast
  • Non-contrast CT examinations of the pelvis is considered inadequate unless there is a history of allergy to iodinated contrast and other imaging modalities are not available
  • Criteria for the ordering of this standard CT protocol can be found in Appendix C
c) Extended Focused Assessment with Sonography for Trauma (E-FAST)

  • E-FAST is not necessary in primary or secondary surveys but if CT is not readily available, clinicians should consider E-FAST even in stable patients (E-FAST is low-cost and clinicians can benefit from maintaining their skill with this modality)
  • If CT is readily available, however, clinicians should forego E-FAST as the latter does not contribute to decision-making
  • Standard E-FAST (see Appendix F) to visualize free fluid in the pleural, pericardial, perihepatic, perisplenic, and pelvic locations or pneumothorax in the anterior pleura
  • E-FAST is also useful in triage of multiple severely injured patients simultaneously
d) Delayed phase CT imaging of pelvis

  • Generally not necessary
  • Consider if patient is hemodynamically unstable and pelvis is suspected to be a source of active bleeding
  • Delay: 2-5 minutes after injection
e) CT cystogram

  • To be used in a clinical setting of suspected bladder rupture, which is usually associated with sever pelvic fractures and hematuria (see Appendix A for discussion of evidence on CT cystography)
  • If no Foley catheter has been placed by clinician, antegrade with delays through bladder (15-20 minutes)
  • If Foley catheter has been placed by clinician, can be retrograde
  • If tolerable, administer retrograde contrast consisting of either
    • 300cc iothalamate meglumine injection USP 17.2% (Cysto-Conray®), or
    • 300-500cc mixture of one part iohexol (Omnipaque 350®) to 2.5 parts water
f) Volume rendered reconstructions

  • For unstable pelvic fractures
  • Can use data already obtained from initial CT
SOURCE: Pelvis ( )
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