During your secondary assessment of a 30-year-old male who fell 25 feet, you note crepitus when palpating his pelvis. Your partner advises you that the patient's blood pressure is 80/50 mm Hg and his heart rate is 120 beats/min and weak. After completing your assessment, you should:

• A. Log roll the patient onto a long backboard and transport at once.
• B. Perform a focused physical exam with emphasis on the pelvis.
• C. Defer spinal immobilization and transport to a trauma center.
• D. Stabilize the pelvis with a pelvic binder and protect the spine.

Answer: (D)

When a patient has a suspected pelvic fracture from a high-energy fall and shows signs of shock, the immediate priorities are to control pelvic bleeding and protect the spine while getting him to definitive care. Applying a pelvic binder compresses the pelvic ring, reduces pelvic volume, and tamponades venous bleeding, which can be a major source of hemorrhage in unstable pelvic fractures. At the same time, maintain in-line spinal immobilization to prevent any movement from turning a potential spinal injury into a worse outcome. This approach addresses the life threats quickly: it stabilizes the pelvis to limit blood loss and preserves spinal integrity during movement, then you can expedite transport to a trauma center. Delaying stabilization for a focused exam or moving the patient without pelvic support risks ongoing hemorrhage and potential spinal injury.