While driving home from the library, you see a rollover car accident, a 25 year old named Elle Macpherson is thrown from the car. The car subsequently lands on her and crushes her very long legs.
On physical examination in the emergency department, it is determined that she has a pelvic fracture, which is confirmed by portable x-rays done as she is being resuscitated.
Her initial blood pressure is 50/30 mm Hg, and her pulse is 160/min and barely perceptible.
Thirty minutes later, after 2 L Ringer's lactate and 2 U packed cells have been infused, her pressure is only 70/50 mm Hg, and her pulse is 130/min.
A sonogram done in the emergency department shows no intra-abdominal bleeding, and a diagnostic peritoneal lavage confirms that there is no blood in the abdomen (the recovered fluid is pink, but not grossly bloody). Rectal and vaginal exams show no injuries to those organs. There is no blood in her urine. Do you…
1-Give IV fentanyl first
2-Angiogram of torn vein vessels
3-Consult Orthopedics for “external fixation”
4- Consult Orthopedics for “internal fixation and open reduction”
6-Tylenol 3 by mouth
7-Advise bed rest due to her young age for 4 weeks