Trauma Assessment - Pelvic Fracture Scenario

This video - produced by students at Oxford University Medical School in conjunction with the faculty - demonstrates how to perform the initial assessment of a patient with suspected traumatic injury. This scenario is of a patient with a suspected pelvic fracture and internal haemorrhage.
Videos on this channel are linked to Oxford Medical Education (www.oxfordmedicaleducation.com)
This video was produced in collaboration with Oxford Medical Illustration - a department of Oxford University Hospitals NHS Trust. For more information, please visit www.oxfordmi.nhs.uk

[@OxfordMedicalVideos]

This video was produced in 2012, and the guidance for fluids in trauma has progressed since then. Notably - as per ATLS 10th edition - the initial resuscitation with crystalloid fluid still begins with a 1 litre bolus. However, large volume fluid resuscitation is not a substitute for prompt control of haemorrhage, and infusion of more than 1.5 liters of crystalloid fluid has now been associated with increased mortality. The principals of ATLS demonstrated in this video still apply, but an initial 2 litres of crystalloid is no longer recommended. Always ensure you use the latest guidance to provide optimal patient care.

[@ammar3465]

thank you

[@OxfordMedicalVideos]

Absolutely. This video is just to demonstrate the system of trauma life support but you're quite right - symptom-relief is hugely important.

[@JW-eh4ze]

Patient answering relevant to the question given --> airway clear & patient's alert

[@daltonater1212]

I love this scenario. Clearly the med student does not know what the exact injury was and is practicing a full assessment in order to narrow down what exactly it is.

[@jsen4737]

This is a brilliant demonstration. However, as part of the initial assessment and management of a trauma patient, would you not also need to administer some analgesia to relieve his pain?

[@dr.lokeshsharoff9987]

Great basic demonstration

[@goldenmustang1231]

best video god bless you

[@kazzakhs]

If he's being given 2L of fluid and shock is also suspected, you'd want to monitor urine output too by asking the nurse to put in a catheter, right? (Genuinely asking for learning purposes rather than trying to be critical - this video is incredibly helpful!)

[@OxfordMedicalVideos]

Thanks for your comment. Absolutely right. If a patient is acutely shocked a reliable measurement of urine output is essential and a catheter is the best way of recording this. In this scenario the benefit has to be weighed against the risks of meatal, urethral or bladder injury which can occur in pelvic trauma. If there is no sign of this then a catheter would be entirely appropriate.

[@kazzakhs]

Oxford Medical Videos Thanks for the very swift and informative reply. I completely forgot to appreciate the risks of a catheter in the setting of pelvic trauma.

[@davidhenriksen5947]

The correct answer should have been to stop the 2L fluid right away.

[@3066961]

this is exactly what i want !!

[@davidw.9711]

what about alleviating the pain/stress of the pt? maybe i missed it, but wouldnt it be prudent to administer some pain meds?:D

[@32ahmmed]

Thx

[@shaeclark1354]

Really appreciate the video but there seems to be something wrong with it at 10min 46 sec, its supposed to go for 15min but cant seen to get past this point

[@sealark1719]

Ok, so having got an initial verbal reponse from the patient was there a need to assess for breathing although guessing this is a mandatory part of the student's assessment?

[@kaeltaylor430]

How come the video before I clicked on it has it going for 15 mins but when it plays it is a bit less . Great video by the way :)

[@OxfordMedicalVideos]

+KAEL TAYLOR Not sure I'm afraid, but thanks very much for the support.

[@jeremygattolliat9432]

🛢bien

[@dineshpathiraja]

why no FAST scan?

[@user-ju3eo1pm7s]

Why should we do LFTs and amylase in this situation?

[@monkiram]

I presume to check for liver or pancreatic rupture from the trauma

[@davidhenriksen5947]

this video is so out of date it should be taken down or redone completely. Anyone following elements of this would fail ATLS. All he is doing with the 2L crystalloid is acceleration the bleeding and worsening possible acidosis while further causing coagulopathy, worsening the pelvic bleeding. Permissive hypotension (accepting a systolic pressure of 80) has a much better outcome than crystalloid resuscitation. Plasma would be a much better option in this case while waiting for blood. The patient should also receive TXA as soon as hypotension, bleeding and trauma are suspected.

[@caitlinwigham3554]

I understand this video is a few years old and that autonomous practice differs but why apply a collar when he didn’t have one in the first place? Why apply a collar and then towels and tape over his head? Why apply a collar and then check his neck?! The use of a collar, if you research enough, has been proven to have no benefit to immobilisation of the C-spine, and any further movement of the spine or C-spine will not be near as damaging as the initial injury. The use of a collar in this scenario seems pointless, and I would be interested to hear his justification on apply it.

[@endliberalism382]

what kind of medics didnt put him in a collar?

[@KikumaruXFuji]

lol, probably the kind that didn't exist (in this scenario since he's getting tested).they don't even have a trauma team.

[@tomasgimenez4592]

And a pelvic binder?

[@dissanayakedmcm9865]

first ABC ?

[@chillimilli1479]

Why oxygen supply when saturation is maintained??

[@meharabchoudhury38]

all acutely unwell patients get oxygen 15L via NRB

[@iamsomniferum]

Pelvic binder as part of ABC; come on, Oxford Medicine Dept.

[@pauljenkinson5974]

What about TXA?

[@iamsomniferum]

Paul Jenkinson CAB

[@monkiram]

It's to keep him from hemorrhaging. Blood loss is part of C

[@DanchoIgnatov]

Does not seems real life scenario as this patient did not scream on moving his broken pelvis. There was no any analgesia given

[@mannys9130]

Of course it's a training exercise. The narrator out of frame is reading off predetermined scripted stats and findings.

[@tomasgimenez4592]

He is a very tough patient

[@m7mdsmn]

they should taken care of the fracture site first...right???

[@Katsukisaud]

No, must be ABC first. Followed by IV fluid and early Blood trans

[@st05002125]

Maybe time to remove this as the practice of 2lt of clear fluids in trauma is a bit outdated

[@PaddyMcQueen]

Why oxygen is given if there's no sign of RI ?

[@paramedicomexicanoenaleman8274]

massive blood loss

[@OrganicStuff1]

That guy and hot nurse killed it

[@glorychukwuma3264]

Apt

[@Agtsmirnoff]

When that ER Nurse walks in, there is suddenly some serious Porno Vibes LOL