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EM@3AM: Pelvic Ring Fracture

A 23-year-old male is brought in by EMS from the scene of a severe accident. He is hypotensive and tachycardic, with a mangled right lower extremity and right upper extremity. EMS applied a tourniquet to both the right upper and lower extremity. Your initial primary survey reveals properly placed tourniquets. With inward pressure on the iliac wings, you detect pelvic instability. What’s the diagnosis, and what’s your next step in your evaluation and treatment?