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A 79-year-old woman presented to the Emergency Department after a ground level fall. On arrival, the patient was hemodynamically normal with an unremarkable primary survey. The secondary survey demonstrated pelvic tenderness to palpation. A pelvic radiograph and subsequent computed tomography (CT) of the abdomen and pelvis demonstrated left inferior and superior rami, sacral wing, and iliac bone fractures with pelvic hematoma and a focus of contrast extravasation. Approximately 1 hour after initial presentation, the patient became hypotensive with a systolic blood pressure (SBP) of 76 mm Hg. The trauma surgery team was consulted. On evaluation, the patient was alert with appropriate mentation. The abdominal examination was notable for tenderness in the lower abdominal quadrants. Radial arterial line confirmed SBP <80 mm Hg, which was transiently responsive to intravenous fluid boluses. The patient carried a legal document and verbally stated that she was a Jehovah’s Witness and declined transfusion of all blood products; however, she would accept autologous transfusion or cell salvage.
What would you do?
Go to interventional radiology (IR) for angiography/embolization.
Go to the operating room (OR) for exploratory laparotomy with preperitoneal packing.
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).
Transfuse blood products.
What we did and why
Correct …