Assessment of pelvic injuries begins, as usual, with a close examination of the MOI; low energy events are unlikely to produce serious injuries. In the backcountry, falls from a height, high speed bicycle and ski/snowboard crashes, and avalanche are often mechanisms. Significant pelvic injuries are accompanied by severe pain and patients often faint (parasympathetic autonomic stress response).
Initially (early volume shock), as the patient bleeds internally, they are awake with increasing levels of anxiety with:
- increasing pulse and respiratory rates
- normal blood pressure
- pale to cyanotic skin
As bleeding continues (late volume shock), the patient will become voice responsive, pain responsive, and eventually unresponsive with:
- dramatically increasing pulse and respiratory rates
- falling blood pressure
- severe cyanosis
- cardiac arrest will ensue if bleeding continues
Things to consider during your physical exam:
- Abrasions and contusions may indicate an open fracture.
- An intact and stable pelvis is symmetrical; a rotated or elevated iliac crest indicates a serious fracture.
- Evaluate rotational stability of the pelvis by pressing in and down (back) on the iliac crests, and by pressing posteriorly on the symphysis pubis. Feel for crepitus and movement (there should be none).
- Isolated rotation of a lower extremity and/or a discrepancy in the length of a lower limb may be due to a hip injury, a femoral injury, or a vertically unstable pelvic injury.
- If the lower extremities are uninjured, assess the vertical stability of the patient's pelvis by applying gentle manual traction to each leg.
- Tenderness over the greater trochanter indicates an acetabular or femoral head injury.
- Red-brown colored urine is due to the presence of red blood cells and indicates a significant injury (see photo).