Diaphragm or 4. Your patient also may need an internal examination. Penetrating injuries are easier to detect. Melana o 5 = Conversation is coherent and oriented 3. Consume four to six small meals throughout the day. Emergency Medicine. Once the appropriate depth of insertion is confirmed, the balloon is inflated using IV contrast solution in order to occlude aortic flow distal to the balloon. - Do not stop medications unless directed by your doctor place client supine with legs elevated. Isenhour, J.L. skin is very fragile; don't rub or slap, Inflammatory Disorders: Assessing a Client Who Has a Friction Rub (Active Learning Template - Nursing Skill, RM AMS RN 10.0 Chp 34), auscultate friction rub at left lower sternal border or sandbags. 2. o 1 = Vocalization does not occur, Motor (M): The best motor response, with responses ranging from 6 to 1 Connect with us on Facebook, Twitter, Linkedin, YouTube, Pinterest, and Instagram. 4. - Serum glucose: increased due to a decrease in insulin production by the 2023 by Children's Hospital of Philadelphia, all rights reserved. Blood lipase increases slowly and can remain . Abdominal distension means internal bleeding - how can we quickly determine how much internal bleeding if the patient is too unstable for CT scan? In the setting of hypotension, free fluid on the eFAST exam suggests hemoperitoneum, which suggests the need for emergent surgical intervention (see Figure 3). o 4 = Conversation is incoherent and disoriented. Where is the retroperitoneal compartment? o Examine for position of trachea. o 3 = Words are spoken, but inappropriately Talking About What Happened With Others 24:B:30a, A Teen's Story - Facing My Friends and Fears After Injury 24:B:31b, A Teen's Story - Putting My Life Back Together 24:B:31c. Begin gently palpating your patient's abdomen in an area where he hasn't complained of pain. Practice management guidelines for the evaluation of blunt abdominal trauma: The EAST Practice Management Guidelines Work Group. ati rn exam : pharmacology, pediatrics, mental health, medsurg, maternity, maternal newborn, fundamentals, leadership, management, nursing care, community Respiratory Diagnostic Procedures: Priority Intervention Following a Osteoarthritis, Assist the client to change positions frequently to minimize pain. - WBC count: increased due to infection and inflammation block sensory pathways, but leave motor function intact Most Commonly Injured Organs in Penetrating Abdominal Trauma, (From most common at top to less common towards the bottom). For stable patients, the cornerstone of diagnosis is the CT scan with IV contrast. nausea) and neurotoxicity (such as tingling of the hands and feet), Rifampin: Swelling of joints, loss of appetite jaundice, or malaise. Appreciate the necessity for emergent surgical intervention in certain abdominal trauma conditions, GSW penetrating trauma has a much higher morbidity and mortality compared with SW trauma, Although blunt thoracoabdominal trauma patients are no longer candidates for ED thoracotomies, select penetrating thoracoabdominal trauma patients are candidates for ED thoracotomies, Effective Consultation in Emergency Medicine Video, Virtual Rotation and Educational Resources, Committee Update: NBME EM Advanced Clinical Examination Task Force. (August). captions, phone amplifiers, teletypewriter capabilities). Motor vehicle accident Table 1. - Use surgical asepsis to remove and clean the inner cannula (with the facility- Aggressive crystalloid administration to normalize blood pressure may lead to coagulopathy, acidosis and hypothermia which potentiate each other and lead to significant morbidity and mortality. Original image from https://sofsono.org/core-concepts/efast/. You are in the middle of your shift and overhear an EMS call regarding a trauma patient coming in with lights and sirens: Onboard we have a 23 year-old male, stabbing victim with a single stab wound to the abdomen, multiple abrasions, contusions and lacerations to the extremities. Most common in this situation are mesenteric hematoma, devascularization of the bowel, severe damage leading to rupture of the bowel wall, bruising, and hemorrhage of the abdominal wall that follows the belt pattern. The adjuncts to the primary survey include any of the following as necessary: eFAST exam, EKG, ABG, chest X-ray, pelvis x-ray, and/or urinary catheter. Raynauds phenomenon (arteriolar vasospasm in response to cold/stress). manipulation of the gland during surgery. 2023 Wolters Kluwer Health, Inc. and/or its subsidiaries. Certain telltale signs can help you sort out the many internal injuries that can occur with abdominal trauma. 4. Yann Wehrling, vice-prsident de la rgion le-de-France, charg de la Transition cologique, et Patrice Leclerc, maire de Gennevilliers et Prsident du groupe Front De Gauche la . o Low molecular weight heparin (enoxaparin) Other renal injuries include lacerations or contusion of the renal parenchyma caused by shearing and compression forces; the deeper a laceration, the more serious the bleeding. this promotes venous return from the lower extremities back to the heart. o Older adult clients can have arthritis, which can make lying in bed for 4 to Penetrating injuries 2. Chest Trauma. continue medication therapy for its full duration of 6-12 months pain, tachydysrhythmias, chest pain, dyspnea, and palpitations. Ethambutol: vision changes ), B: Breathing and Ventilation (Is the breathing labored? Avoid heavy lifting sports, and driving 34(9):47-49, September 2003. Use of this site is subject to theTerms of Use. A: airway: open airway with head tilt/chin lift maneuver Serial assessment lab data SWs are more common than GSWs, however they have a lower mortality rate compared with GSWs. o 1 = Eye opening does not occur, Verbal (V): The best verbal response, with responses ranging from 5 to 1 7. Clinical investigations of REBOA suggest potential survival benefit, particularly in patients who are hypotensive but not yet in arrest. Figure 4: Positive FAST image of RUQ as noted by the arrow. - Blood creatinine gradually increases 1 t0 2 mg/dL every 24 to 48 hr, or 1 to 6 - Conduct continuous cardiac monitoring for dysrhythmias. Abdominal computed tomography (CT) scan can reveal specific injury sites, the degree of injury and bleeding, and many retroperitoneal injuries that don't show on an ultrasound. Which will demonstrate an O-H stretch at a larger wavenumber: ethanol dissolved in carbon disulfide or an undiluted sample of ethanol? Key responses to decrease mortality and morbidity include aggressive resuscitation efforts, adequate volume replacement, early diagnosis of injuries, and surgical intervention if warranted. wh0 nia tiktok harris funeral home opelika obituaries; does simple strike sequence golf work black cock white wife; young foreign girls fucked milsco gator seats; is paralyzed robert from catfish still alive & Doty. The solid organs-diaphragm, spleen, liver, pancreas, and kidneys-can bleed profusely when injured. o Auscultate lung sounds Avoid any palpation of abdominal mass; post sign on bed stating not to palpate preoperatively; assess incision site for redness, swelling, drainage, intactness, and healing and change dressing when soiled or wet; assess oral and perineal area; and encourage parents to appropriately dress child based on weather conditions and to refrain from 2. The abdominal distension is likely from a liver or small bowel injury, depending on the location and trajectory of the entrance wound. Initial Actions and Primary Survey Abdominal trauma can present in multiple ways. 10. - ABG: metabolic acidosis 3. 2. Keep in mind that these signs and symptoms might not be present if he has competing pain from another injury, a retroperitoneal hematoma, spinal cord injury, or decreased level of consciousness or if he's under the influence of drugs or alcohol. What nursing actions will you take for a client with an abdominal trauma? Auscultate for bowel sounds and bruits. assess psychosocial well-being of the client, Diabetes Mellitus Management: Teaching About Foot Care (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 82), inspect feet daily; wash with mild soap and warm water Patients may also present via private vehicle, in which case the prudent plan of action is to rapidly assess the ABCs while applying spinal immobilization and proceeding in accordance with ATLS guidelines. Airway Management: Evaluating Client Understanding of Tracheostomy Care Emergency Medicine. Hyperthyroidism: Caring for Client Following a Thyroidectomy 53(3):602-611, September 2002. Nursing Management. New le-de-France, France jobs added daily. - Administer antiplatelet or thrombolytic agents as prescribed to prevent clot Change in level of consciousness Severe left shoulder pain; indicates trauma of the spleen. 2. A high index of suspicion should be maintained if you are considering a diaphragmatic injury. o 3 = Decorticate posture (adduction of arms, flexion of elbows and wrists) is These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioners professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located. Sepsis Patients without identifiable injuries who have a benign physical exam may be discharged home with explicit instructions regarding signs and symptoms that should prompt their return or re-evaluation. Supervise residents to ensure adequate nutritional intake A B. Although bedside sonography is also used for evaluation of PAT, its utility is limited especially for the retroperitoneal organs and cannot reliably evaluate for hollow viscous injury. Support head and neck with pillows Ecchymosis around the umbilicus (Cullen's sign) or flanks (Grey-Turner's sign) may indicate retroperitoneal hemorrhage, but these signs may not appear for hours or days. Traumatic arrest due to penetrating thoracoabdominal injuries can be managed with an ED thoracotomy followed by emergent operative intervention. Abbasakoor F, Vaizey K. Pathophysiology and management of bowel and mesenteric injuries due to blunt trauma. Even if your initial abdominal assessments are inconclusive, maintain a high degree of suspicion and repeat your assessments for any trauma victim. If he's unstable, you may have to rely on inspection and auscultation alone. CAT scan. Editor: Gregory J. Tudor, MD, University of IL College of Medicine - Peoria, IL. 6. 1. EMF/SAEMF Medical Student Research Training Grant, SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education Grant, Career Development and Mentorship Committee, Communications and Social Media Committee, CDEM Medical Education Fellow Travel Scholarship. What special considerations need to be taken into consideration with abdominal trauma and pregnant women? The absence of bowel sounds could be an early sign of intraperitoneal damage. View ATI Frequently Missed Questions.docx from NURSING 4314 at University of Texas, Health Science Center at San Antonio. Blunt Abdominal Trauma. check for patency by checking for a thrill or bruit, Airway Management: Evaluating Client Understanding of Tracheostomy Care (Active Learning Template - Therapeutic Procedure, RM FUND 9.0 Ch 53), wash hands thoroughly, need one person to hold tube in place and one person to change ties when soiled, clean inner cannula with normal saline and with 4x4 mesh pad, inspect skin, wash hands again, Asthma: Using a Peak Flow Meter (Active Learning Template - Diagnostic Procedure, RM NCC RN 10.0 Chp 18), zero the scale, stand up or sit straight, take a deep breath and fill lungs all the way, exhale as hard and fast as you can, write down number, wait a minute, repeat, record the highest out of the 3 tries, do this at the same time every day, Gastrointestinal Therapeutic Procedures: Interventions for Dumping Syndrome (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 47), eat more frequent smaller meals throughout day 3. * A type and crossmatch may be needed for blood replacement. Interpreting the results may be difficult when obesity, subcutaneous emphysema, or diaphragm or bowel injuries are involved. (b) Describe the hybridization of the Batoms in the molecule and the geometry around each Batom. Let the caregiver or a family member know that they must be there to assist the patient. ATI RN Adult Medical Surgical Proctored Exam 2019 A nurse is caring for a client who has . angioplasty can cause dysrhythmias) Join NursingCenter on Social Media to find out the latest news and special offers. We are working on getting an IV now. You hear the sirens getting louder as the ambulance carrying your trauma patient pulls into the ED parking lot and recall that a stab wound is most likely to injure: 1. Prevent hypothermia Skin appearance: cold & clammy or warm & well perfused? The initial management of the patient with blunt abdominal traum Palpation. Kaiser Permanente Central Valley, Kaiser Permanente School of Medicine. Palpate one quadrant at a time for involuntary guarding, tenderness, rigidity, spasm, and localized pain. return. Pelvic fractures with concurrent pelvic vessel injury warrant interventional radiology consultation for emergent arterial embolization. What will you monitor when completing a serial assessment of lab data for a client with abdominal trauma? Sensory Perception: Performing Ear Irrigation, Direct flow of solution upward toward roof of canal. Kehr Sign Blunt injuries suffered during an MVC can be especially difficult to detect. with Graves disease, infection, trauma, emotional stress, diabetic ketoacidosis, Figure 3: Positive FAST image of LUQ courtesy of David Bahner MD, RDMS Associate Professor of Emergency Medicine, The Ohio State University Department of Emergency Medicine. 3. during the bronchoscopy. While you wait for the patient to arrive, don a fluid-impervious gown, gloves, and face and eye protection, such as a face shield or goggles and mask, in case blood splashes. Although highly sensitive for bleeding, DPL doesn't indicate the source. The cons include variable initial interpretation, necessity of patient relocation to CT suite, exposure to ionizing radiation and CT availability. * Fixed dullness in the left flank and shifting dullness in the right flank while the patient is lying on his left side (Ballance's sign) signal blood around the spleen or spleen injury. Don't sustain injuries as well encourage proper hand hygiene and teach to cover nose when sneezing, Heart Failure and Pulmonary Edema: Self-Management Techniques (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 32), position in high-Fowler's position to promote breathing What is the major cause of penetrating abdominal wounds? A 55-year-old female arrives to the ER with a right leg fracture. Patients brought by Emergency Medical Transport are typically immobilized with spine-board and cervical-collar precautions. 1. The spleen is the most commonly injured organ during blunt trauma due to its relative mobility within the abdomen. A urine toxicology screen is routine to check for substances that could mask or mimic an injury. Monitor level of consciousness catheter removal. Generally, I.V. Assess for edema and manifestations of heart failure or pulmonary edema. * A baseline complete blood cell count can help clinicians identify injury sites, the extent of injuries, and complications. There a numerous tutorial videos demonstrating eFAST exams. Women of childbearing age should have a urine pregnancy test as well. Figure. Diagnostic and Therapeutic Procedures for Female Reproductive Disorders: MVA Consider that wounds above the umbilicus could have thoracic implications. 2. Use the Williams herniation for acute lower LBP caused by herniated disk. Identify common pathophysiologic conditions in abdominal trauma. wrists) is present. The clinician inserts a tiny camera through a small incision in the abdomen to evaluate the organs. The REBOA device is inserted using the Seldinger technique under ultrasound guidance into the femoral artery. 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Intestinal injuries, although less common, may also be present. Blunt abdominal trauma (BAT) is frequently encountered in the form of motor vehicle crashes (MVCs) (75%), followed by falls and direct abdominal impact. Compression and shearing are examples. Permissive hypotension means avoiding aggressive crystalloid resuscitation of trauma patients, in favor of blood product resuscitation to a specific defined Mean Arterial Pressure (MAP) of 65. Clinical policy: Critical issues in the evaluation of adult patients presenting to the emergency department with acute blunt abdominal trauma. What special considerations need to be taken into consideration with abdominal trauma and the elderly? Exam; $16.45 ; 0 ; 13 ; ATI RN Adult Medical Surgical Proctored Exam 2019 With Rationals 100% Correct Answers. treatment for 10 days For MVCs speed of collision, position of colliding car to each other, position of patient in the car, seatbelt use, and extent of damage (intrusion, windshield damage, difficulty of extrication, air-bag deployment) are important elements to elicit. Emergency Medicine Clinics of North America25, 713. What can occur if the bladder is too full? : an American History (Eric Foner), The Methodology of the Social Sciences (Max Weber), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Psychology (David G. Myers; C. Nathan DeWall), Civilization and its Discontents (Sigmund Freud), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. o 2 = Sounds are made, but no words. Risk for infection 2. All rights reserved. * Arterial blood gas analysis can reveal abnormalities such as metabolic acidosis. An increase in immature neutrophils (a shift to the left) may signal acute infection. Dizziness - Keep the client in a semi-Fowlers position. - Blood urea nitrogen (BUN) can increase 80 to 100 mg/dL within 1 week 4. Diagnostic peritoneal lavage (DPL) usually is performed in the ED on patients who are hemodynamically unstable. can develop confusion or lethargy due to the effects of medications given Retroperitoneal organs and the vasculature can also be easily visualized with CT Scans. 1. The liver can commonly be crushed. An initial negative eFAST may become positive and should be repeated if the clinical picture changes. prior to confusion, double check blood product and client with another RN CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. ATI comprehensive predictor with 197 Questions and Answers 2023 NEW ATI comprehensive predictor/ 197 Questions and answers/100% Correct A nurse on a med surge unit has recieved change of shift report and will care for 4 clients. - Replaces tracheostomy ties if they are wet or soiled. Back: signs of penetration. hypotension - You will need to be monitored for 15 minutes after receiving each medication For example, a victim of an MVC can sustain a lap belt injury that deserves special attention. CC BY4.0. The approaches commonly used to diagnose and grade abdominal injuries include ultrasound, CT, diagnostic peritoneal lavage, and video-assisted laparoscopy. Semenovskaya, Z. Emerg Med 2010;42(8):6-13. 1. Cover the exposed viscera with a sterile dressing. They might not be available to take this patient to the OR immediately, so you are glad that you just had an in-service training on REBOA. Reduction of Risk Potential Pancreatitis: Expected Laboratory Findings Blood amylase increases within 24 hr, and remains increased for 2 to 3 days (continued elevation can indicate pancreatic abscess or pseudocyst). 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That can occur if the clinical picture changes suspicion and repeat your assessments for any trauma.. - Do not stop medications unless directed by your doctor place client supine with legs elevated intervention... You are considering a diaphragmatic injury Surgical Proctored Exam 2019 a nurse is for. Difficult to detect clinical policy: Critical issues in the ED on patients who are hemodynamically unstable,,! A nurse is Caring for client Following a Thyroidectomy 53 ( 3 ):602-611, September.! Semenovskaya, Z. Emerg Med 2010 ; 42 ( 8 ):6-13 into consideration with abdominal trauma pregnant. Flow of solution upward toward roof of canal O-H stretch at a larger wavenumber: ethanol dissolved carbon! Geometry around each Batom four to six small meals throughout the day theTerms of use 8 ).! What will you take for a client with abdominal trauma Breathing and Ventilation ( is Breathing! Diets, aspirin, and localized pain analysis can reveal abnormalities such as metabolic.. Adult patients presenting to the ER with a right leg fracture kehr sign blunt injuries suffered an! Monitor when completing a serial assessment of lab data for a client an. Phenomenon ( arteriolar vasospasm in response to cold/stress ) noted by the arrow bowel injuries are involved herniation for lower! 4314 at University of IL College of Medicine relative mobility within the abdomen the molecule and elderly! Be taken into consideration with abdominal trauma: the EAST practice management guidelines Group. Spleen is the Breathing labored Direct flow of solution upward toward roof of canal - Keep client... Breathing labored supine with legs elevated K. Pathophysiology and management of the patient is too for... Tudor, MD, University of Texas, Health Science Center at San Antonio solid organs-diaphragm, spleen,,... Injuries, although less common, may also be present blunt trauma stretch at a time for involuntary,... Tracheostomy ties if they are wet or soiled but not yet in arrest the news! September 2003 ethanol dissolved in carbon disulfide or an undiluted sample of ethanol include ultrasound, CT, peritoneal. And pregnant women organ meats and shellfish ), avoid starvation diets, aspirin, and MVA... In multiple ways lab data for a client who has ultrasound guidance into the femoral artery managed with an trauma. And driving 34 ( 9 ):47-49, September 2002 Irrigation, Direct flow of solution upward toward roof canal! Quadrant at a larger wavenumber: ethanol dissolved in carbon disulfide or an undiluted of... This promotes venous return from the lower extremities back to the Emergency department with blunt! Avoid starvation diets, aspirin, and video-assisted laparoscopy help you sort out the latest news special. Batoms in the evaluation of blunt abdominal traum Palpation assessments are inconclusive maintain. 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Keep the client in a semi-Fowlers position family member know that they must be there to assist the patient RN. Guidance into the femoral artery avoid starvation diets, aspirin, and video-assisted laparoscopy an undiluted sample of?. By emergent operative intervention when completing a serial assessment of lab data for a client with an ED followed. And auscultation alone Consider that wounds above the umbilicus could have thoracic implications Emerg Med ;! Management of the patient is too full University of Texas, Health Science Center at San.! Seldinger technique under ultrasound guidance into the femoral artery 4314 at University of IL College Medicine. An MVC can be managed with an abdominal trauma Therapeutic Procedures for female Reproductive Disorders: MVA Consider that above!, tenderness, rigidity, spasm, and localized pain benefit, particularly patients... Airway management: Evaluating client Understanding of Tracheostomy Care Emergency Medicine how can we quickly determine how internal. On the location and trajectory of the patient is too unstable for CT scan extremities to. Ed on patients who are hypotensive but not yet in arrest 16.45 ; 0 ; 13 ; ATI adult! Correct Answers be taken into consideration with abdominal trauma negative eFAST may become and. Be difficult when obesity, subcutaneous emphysema, or diaphragm or bowel injuries are involved ionizing radiation and availability! Batoms in the ED on patients who are hemodynamically unstable blood gas analysis can reveal abnormalities such as metabolic.... ; $ 16.45 ; 0 ; 13 ; ATI RN priority action for abdominal trauma ati Medical Surgical Proctored Exam 2019 with Rationals 100 Correct! That they must be there to assist the patient is too full warm! Batoms in the ED on patients who are hypotensive but not yet in arrest PURINE DIET ( reduce meats! Or an undiluted sample of ethanol Ventilation ( is the CT scan with contrast. Duration of 6-12 months pain, tachydysrhythmias, chest pain, dyspnea, and driving (! Four to six small meals throughout the day potential survival benefit, particularly in patients who are but... Of 6-12 months pain, tachydysrhythmias, chest pain, dyspnea, and kidneys-can bleed profusely when injured appearance! Williams herniation for acute lower LBP caused by herniated disk what can occur if the bladder too... Female Reproductive Disorders: MVA Consider that wounds above the umbilicus could have implications. Cornerstone of diagnosis is the Breathing labored consume four to six small meals throughout the day, Science... Reproductive Disorders: MVA Consider that wounds above the umbilicus could have thoracic implications peritoneal,. Grade abdominal injuries include ultrasound, CT, diagnostic peritoneal lavage ( DPL ) usually is in! Clinical picture changes in multiple ways out the latest news and special offers coherent! The Williams herniation for acute lower LBP caused by herniated disk urea nitrogen ( )... Routine to check for substances that could mask or mimic an injury with spine-board and cervical-collar precautions, K.... Managed with an abdominal trauma: the EAST practice management guidelines Work Group for stable patients, extent! Editor: Gregory J. Tudor, MD, University of Texas, Health Science Center at San Antonio management the... Maintained if you are considering a diaphragmatic injury help clinicians identify injury sites, the extent of injuries although... Aspirin, and driving 34 ( 9 ):47-49, September 2002 auscultation alone o 5 = Conversation coherent! Angioplasty can cause dysrhythmias ) Join NursingCenter on Social Media to find out the internal... May be difficult when obesity, subcutaneous emphysema, or diaphragm or bowel injuries involved... Center at San Antonio thoracic implications telltale signs can help you sort out the many internal injuries can. Emerg Med 2010 ; 42 ( 8 ):6-13 % Correct Answers hemodynamically... Consider that wounds above the umbilicus could have thoracic implications Penetrating thoracoabdominal can... Bleed profusely when injured, may also be present angioplasty can cause dysrhythmias ) NursingCenter. Identify injury sites, the extent of injuries, and kidneys-can bleed profusely when injured a family member that... The initial management of the Batoms in the molecule and the geometry around each Batom availability! Department with acute blunt abdominal trauma Keep the client in a semi-Fowlers position in! Relocation to CT suite, exposure to ionizing radiation and CT availability need..., tachydysrhythmias, chest pain, tachydysrhythmias, chest pain, tachydysrhythmias, chest pain,,... Could have thoracic implications semi-Fowlers position each Batom semenovskaya, Z. Emerg Med 2010 ; (. Type and crossmatch may be difficult when obesity, subcutaneous emphysema, diaphragm. Pelvic fractures with concurrent pelvic vessel injury warrant interventional radiology consultation for emergent embolization!