In suspected pelvic fracture after high-energy trauma, which assessment step is essential?

• A. Look for sources of hemorrhage
• B. DRE (look for tone, prostate height, bleeding)
• C. ORIF (open reduction internal fixation)
• D. Pelvic CT scan

Answer: (A)

Massive hemorrhage is the immediate life-threatening issue in high-energy pelvic trauma. The essential assessment is to quickly identify where bleeding is coming from so you can control it and guide resuscitation. By looking for sources of hemorrhage—external bleeding around the pelvis, perineum, or genital tract and signs of internal pelvic bleeding—you determine whether to prioritize rapid stabilization and hemorrhage-control measures (pelvic binder or stabilization, activation of interventional radiology for embolization, and blood product resuscitation). Imaging like a pelvic CT is helpful for planning, but it should not delay control of bleeding in a unstable patient. Procedures such as open fixation are definitive treatments, not initial assessment steps, and rectal examination lacks essential utility in this acute setting.