3. Steps

a. Make a longitudinal low, vertical midline incision between the umbilicus and pubis.

b. Divide the rectus sheath along the linea, to enter the pre-peritoneal space (Space of Retzius), taking care to avoid entering the peritoneal space.

c. Evacuate pelvic hematoma if present.

d. Place 3-4 packs on each side of the retroperitoneal space to tamponade bleeding. Place the packs posteriorly and deep.

e. Close fascia or skin over the packs.

4. Pearls/Pitfalls

a. Do not place packs intra-peritoneal, this will not tamponade the targeted bleeding.

b. Ensure packs are rolled so you can more effectively roll them posteriorly into the retroperitoneal space.

c. Be sure to also stabilize the pelvis with a sheet/binder or external fixator.