patient. Type-specific blood (eg, type A, Rh negative, unknown antibody) can
be provided by most blood banks within 30 minutes. This blood is compat-
ible with ABO and Rh blood types, but may be incompatible with other anti-
bodies. If type-specific blood is unavailable, type O packed cells are indicated
for patients who are unstable. Men should be administered type O, Rh-positive
blood. To reduce sensitization and future complications, type O, Rh-negative
blood is reserved for women of childbearing age.
(a)Fully cross-matched blood may take greater than 1 hour to pre-
pare, which is inappropriate for an unstable patient. (b)Whole blood is
rarely used by blood centers and was replaced by blood components, such
as packed RBCs. Whole blood is not used because the extra plasma can
contribute to transfusion associated circulatory overload, a potentially dan-
gerous complication. (c)Blood transfusion should not be delayed in the
unstable patient. As dictated in ATLS, if the individual does not respond to
2 to 3 L of crystalloid, blood transfusion should commence. (d)For life-
threatening blood loss, type O, Rh-negative blood is reserved for women of
childbearing age. This reduces complications of Rh incompatibility in
future pregnancies. However, if type O, Rh-negative blood is unavailable,
then type O, Rh-positive blood should be administered to women.
146.The answer is c.(Rosen, pp 625-641.)This patient is hemodynami-
cally unstable with a pelvic fracture. The retroperitoneum can accommodate
up to 4 L of blood after severe pelvic trauma. A few options are useful in
managing hemorrhage from an unstable pelvic fracture. However, the initial
and simplest modality to use in a patient in shock from a pelvis fracture is
placement of a pelvic binding garment. This device can be applied easily
and rapidly and is typically effective in tamponading bleeding and stabiliz-
ing the pelvis.
(a)Bilateral chest tubes would be appropriate if there was evidence for a
pneumo- or hemothorax. This patient has bilaterally equal breath sounds.
(b)Although external fixation is an effective method to stabilize the pelvis, it
may delay management of a trauma patient. Because a pelvic binding appa-
ratus is quick and simple, it is preferred. (d)The source of retroperitoneal
bleeding with pelvic fractures is typically the venous plexus or smaller veins.
However, venography is not useful in managing these patients: even when
venous bleeding is localized, embolization is ineffective because of the exten-
sive anastomoses and valveless collateral flow. (e)In contrast, arteriography
is a major diagnostic and therapeutic modality for the patient with severe
pelvic hemorrhage from arterial sources. Angiography is indicated when
Trauma Answers 163