Emergency, Trauma and Complication Management
This domain tests embolisation for haemorrhage, trauma algorithms and recognition and management of procedural complications. Items are scenario-based and time-critical.
Core rules
- Gastrointestinal bleeding: localise with CT angiography or endoscopy; embolise the bleeding artery with coils or particles; avoid unnecessary bowel ischaemia.
- Splenic trauma: haemodynamically stable patients may be treated with splenic artery embolisation; unstable patients need surgery or resuscitation first.
- Pelvic trauma: angioembolisation for arterial bleeding after pelvic binder and resuscitation.
- Postpartum haemorrhage: uterine artery embolisation with gelatin sponge is effective for atony when medical measures fail.
- Complications: recognise dissection, perforation, pseudoaneurysm, contrast extravasation, compartment syndrome and cholesterol emboli; treat according to cause.
Worked example
A 30-year-old woman has severe postpartum haemorrhage after caesarean delivery despite uterotonics. Reasoning: resuscitate and activate the massive transfusion protocol; proceed to uterine artery embolisation with gelatin sponge; avoid hysterectomy if embolisation can be performed promptly. Confirm haemostasis angiographically.
Traps
Delaying embolisation while repeating ineffective medical treatment; embolising too distally in bowel; failing to resuscitate before the procedure; missing a pseudoaneurysm after access; ignoring signs of compartment syndrome.