This chapter reviews the pelvic and genitourinary physical examination in the setting of pelvic trauma, the types of pelvic fractures, and diagnostic tests available, including ultrasound, plain radiography, and computed tomography, to evaluate for pelvic injuries. It discusses the management principles of fluid resuscitation and hemorrhage control with an unstable pelvis, including consideration of consultation with trauma surgery, orthopedic surgery, and interventional radiology. It examines the types of concomitant injuries that may be expected, including splenic, hepatic, urethral, and rectal injuries and emphasizes the need for individualized workup and management for each patient based on a thorough physical examination. The indications for a retrograde urethrogram and treatment options for pelvic fractures are also briefly reviewed.
Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for all patients who have been intubated pre-hospital providing no contraindications were present. Our aim was to ascertain any influence of the protocol change on the rate of VAP. We conducted a retrospective medical record review of trauma patients who were intubated in the field or ED and seen at our institution (an accredited Level 1 trauma center) from 2012 to 2018. Applying the current definition of VAP from the Centers for Disease Control and Prevention (CDC) to data collected from the CMMC trauma registry, we observed a 13% lower VAP rate in the bronchoscopy group ( YB) as compared to the group that did not receive bronchoscopy (NB) ( P < .025). Based on our results, we determined that bronchoscopy performed in this setting does support a statistically significant decrease in the rate of ventilator-associated pneumonia.
A radiographic indicator of increased operative complexity in pelvic trauma surgery