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Child with Suspected Pelvis Fracture — ATLS and Hemodynamic Stability — Clinical Pathway: Emergency

Pelvic Fracture Clinical Pathway — Emergency Department

ATLS and Hemodynamic Stability

Complete Primary and Secondary Survey

Attention to assess pelvis and hemodynamics

Inspect
  • Pelvis symmetry
  • Leg length shortening or rotation
  • Bruising, laceration
    • Buttocks, perineal, scrotal regions
  • Blood from meatus, vaginal introitus
  • Ability to bear weight
Palpate
  • Tenderness
  • Crepitus
  • Rectal exam
  • Stability
  • Apply AP and lateral pressure on the iliac wings
  • Avoid repeat maneuvers to avoid clot disruption
  • Apply sheets in Kocher if fracture is unstable
Neurovascular
  • Complete neurovascular exam of LE’s
    • Strength, sensory, DTRs, pulses, perfusion, compartments
Hemodynamics
  • HR, BP for age
  • Pulses, perfusion
  • Mental status

Vital Signs by Age Group

Age RR HR Systolic BP Diastolic BP Weight, kg HR > 2 SD from normal range
Newborn 30-50 120-160 50-70 30-60 2-3 > 180
Infant
1-12 mos
20-30 80-140 70-100 53-66 4-10 > 180
Toddler
1-3 yrs
20-30 80-130 80-110 53-66 10-14 > 140
Preschooler 20-30 80-120 80-110 55-69 14-18 > 140
School Age
6-12 yrs
20-30 70-110 80-120 57-71 20-42 > 130
Adolescent
> 13 yrs
12-20 55-105 110-120 66-80 > 50 > 110

 

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