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This article compiles practical, experience-driven guidance from a lunch session at the American Association for the Surgery for Trauma Annual Meeting 2024, covering preperitoneal pelvic packing, trauma video review, video-assisted thoracic surgery for retained hemothorax, and laparoscopic common bile duct exploration. Across topics, the shared focus is refining technical precision, strengthening team performance, and improving patient outcomes through deliberate practice, including detailed operative steps and key pitfalls for preperitoneal pelvic packing.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/high-impact-technical-and-patient-management-tips-from-the-2024-aast-continuous-certification-course-practical-insights-for-trauma-and-acute-care-surgery/434905/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/high-impact-technical-and-patient-management-tips-from-the-2024-aast-continuous-certification-course-practical-insights-for-trauma-and-acute-care-surgery/434905.png","ImageObject",300,407,{"name":92,"@type":93},"McQueen","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why is preperitoneal pelvic packing important in pelvic fracture hemorrhage?","Question",{"text":112,"@type":113},"A subset of pelvic fracture patients develops significant hemorrhage with high mortality risk. Preperitoneal pelvic packing has demonstrated shorter time-to-intervention and shorter time required for intervention compared with angioembolization, supporting its inclusion for serious bleeding management.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What are the core steps of preperitoneal pelvic packing?",{"text":117,"@type":113},"The pelvis is externally stabilized to reduce volume and provide a stable tamponade surface. A midline incision is made to access the preperitoneal space, the pelvic hematoma is unroofed, and laparotomy pads are placed posteriorly in the presacral space then moved anteriorly around the bladder; placement is repeated on both sides with suprapubic catheter placement when needed.",{"name":119,"@type":110,"acceptedAnswer":120},"What is the main pitfall of preperitoneal pelvic packing and how is it avoided?",{"text":121,"@type":113},"A major pitfall is decompression of the pelvic hematoma into the peritoneal cavity or externally. The text advises using a separate, more lateral stab incision for suprapubic catheter needs and creating a cranial separate incision above the umbilicus if a laparotomy is required.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},434905,1791068740,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},5909890329169,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Open access Review  \n High-impact technical and patient management tips from the 2024 AAST Continuous Certification Course:  \npreperitoneal pelvic packing, trauma video review, video-assisted thoracic surgery for retained hemothorax, and laparoscopic common bile duct exploration  \nClay Cothren Burlew  Emma Gilman Burke  Matthew J Martin  6  \n, 1 Whitney Renee Jenson  ,2 Katherine Cironi  ,3 ,4 Ryan Peter Dumas  ,4 Rachel D Appelbaum  ,5  \n1Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA  \n2Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA 3University of Southern California, Los Angeles,  \nCalifornia, USA  \n4Surgery, Baylor College of Medicine, Houston, Texas, USA 5Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA  \n6Division of Acute Care Surgery, University of Southern California Keck School of Medicine, Los Angeles, California, USA  \nCorrespondence to  \nDr Whitney Renee Jenson; whitney.jenson@cuanschutz. edu  \nReceived 2 May 2025  \nAccepted 23 November 2025  \n© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.  \nTo cite: Burlew CC, Jenson WR, Cironi K, et al. Trauma SurgAcute Care Open 2025;10:e001910 .  \nSUMMARY  \nTrauma and acute care surgeons are constantly balancing the need for rapid, decisive intervention with the ongoing evolution of surgical technique and cuttingedge technology. This article presents a collection of practical, experience-driven insights across four topics that reflect the modern breadth of trauma and acute care surgery presented during a lunch session at the American Association for the Surgery for Trauma Annual Meeting 2024: preperitoneal pelvic packing, trauma video review, video-assisted thoracic surgery for retained hemothorax, and laparoscopic common bile duct exploration.  \nAlthough seemingly disparate, these topics are united by a common goal: enhancing technical precision, team performance, and patient outcomes through deliberate, refined practice.  \nPACK LIKE A PRO: PREPERITONEAL PELVIC PACKING AND CONTROL OF PELVIC FRACTUREASSOCIATED HEMORRHAGE  \nWhile the majority of pelvic fractures result from low energy mechanisms and do not result inhemodynamic instability, a subgroup of patients will experience significant pelvic fracture-related hemorrhage resulting in mortality rates as high as 32%–41%.1–3 There are multiple options for the management of patients with serious bleeding secondary to pelvic fractures, primarily consisting of preperitoneal pelvic packing (PPP), angioembolization (AE), and resuscitative balloon occlusion of the aorta (REBOA). PPP has repeatedly been demonstrated to have a shorter time-to-intervention as well as time required for intervention compared with AE2 4–7 and, as such, should be in the armamentarium of all surgeons.  \nTechnique  \nPPP is performed by first externally stabilizing the pelvis to both reduce the pelvic volume and provide a stable surface against which tamponade can be created. Pelvic stabilization is ideally performed  \nwith an external fixator or a c-clamp. The specific conformation of the external fixator should be discussed with the orthopedic team prior to placement, particularly if an exploratory laparotomy is to be performed so that the crossbar does not obscure the operative field. If external fixators orc-clamps are not available, the pelvic binder should be repositioned so that the superior margin is below the pubic symphysis and out of the operative field. When extrapelvic sources of hemorrhage exist, these may be addressed while the pelvis is stabilized by the orthopedic team.  \nA midline incision is made from the pubic symphysis superiorly extending approximately 6–8 cm. The subcutaneous tissue and the midline fascia are divided, leaving the underlying peritoneum intact. At this point, the pelvic hematoma is usually encountered. If the ","cbCaiorf253ZphYF","https://ap.wps.com/l/cbCaiorf253ZphYF","pdf",826227,"English","# Summary\n## Preperitoneal pelvic packing and control of pelvic fracture-associated hemorrhage\n## Technique\n## Major pitfalls\n## Operative timing and follow-up\n# Additional topics from the course session\n## Trauma video review\n## Video-assisted thoracic surgery for retained hemothorax\n## Laparoscopic common bile duct exploration","[{\"question\":\"Why is preperitoneal pelvic packing important in pelvic fracture hemorrhage?\",\"answer\":\"A subset of pelvic fracture patients develops significant hemorrhage with high mortality risk. Preperitoneal pelvic packing has demonstrated shorter time-to-intervention and shorter time required for intervention compared with angioembolization, supporting its inclusion for serious bleeding management.\"},{\"question\":\"What are the core steps of preperitoneal pelvic packing?\",\"answer\":\"The pelvis is externally stabilized to reduce volume and provide a stable tamponade surface. A midline incision is made to access the preperitoneal space, the pelvic hematoma is unroofed, and laparotomy pads are placed posteriorly in the presacral space then moved anteriorly around the bladder; placement is repeated on both sides with suprapubic catheter placement when needed.\"},{\"question\":\"What is the main pitfall of preperitoneal pelvic packing and how is it avoided?\",\"answer\":\"A major pitfall is decompression of the pelvic hematoma into the peritoneal cavity or externally. The text advises using a separate, more lateral stab incision for suprapubic catheter needs and creating a cranial separate incision above the umbilicus if a laparotomy is required.\"}]","High-impact technical and patient management tips from the 2024 AAST Continuous Certification Course - Practical insights for trauma and acute care surgery | PDF",1790671079,18]