An Evidence-Based Approach To Managing Injuries Of The Pelvis And Hip In The Emergency Department

Fiechtl, James F. MD
Gibbs, Michael A. MD, FACEP
Cameron, Peter MD
Decker, Wyatt MD
Radeos, Michael MD, MPH

¹Assistant Professor, Department of Emergency Medicine, Vanderbilt University Medical Center; Nashville, TN
²Professor and Chief, Department of Emergency Medicine, Maine Medical Center, Portland, ME; Tufts University School of Medicine, Boston MA
³Academic Director, The Alfred Emergency and Trauma Centre, Monash University, Melbourne, Australia
⁴Professor of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN
⁵Assistant Professor of Emergency Medicine, Weill Medical College of Cornell University, New York; Research Director, Department of Emergency Medicine, New York Hospital Queens, Flushing, New York

Emergency Medicine Practice 12(12):p 1-23, December 2010.

You have started your shift and things are relatively quiet until the paramedics radio that they are bringing in a 20-year-old male who was struck by a car while crossing the street. The patient is complaining of severe lower abdominal and groin pain, and he cries out upon any attempts to manipulate his pelvis. He is tachycardic, and his blood pressure is 90 mm Hg systolic. The paramedics have started 1 large-bore IV.

While a room is being prepared for this young man, a 14-year-old girl with sharp right-sided pelvic pain is brought back from triage. You stop in her room for a quick assessment and see that she is still wearing her soccer uniform and is in a moderate amount of discomfort. When asked about the location of the pain, she points directly to her lateral beltline. You have just begun to examine her when another paramedic crew arrives with an elderly male.

The crew has just transported an 80-year-old man who fell from a standing position and landed on his left hip/flank area. is vitals are stable, and he describes pain around his left pelvic area. You finish taking his history and complete the physical, concluding that this gentleman has significantly injured himself. You are then called away upon the arrival of a 20-year-old who suffered a motor vehicle accident.

Awesome! It looks like an orthopedic type of shift tonight….