Welcome to the bed. We'll go ahead and give you
the story. This is all going to happen super
fast. Welcome to the emergency room. Welcome
back to The Deep Dive, where we take the most
complicated, high stakes clinical sources and
just boil them down to what you absolutely need
to know. Our mission today is all about the trauma
bay. We are building the ultimate rapid review
guide for anyone, really, but especially the
medical surgical learner dealing with severe
trauma. And we're focusing specifically on abdominal
and pelvic injuries. And this is really where
the rubber meets the road. In trauma, time isn't
just money. It's survivability. Right. So we're
applying the Pareto principle here. We're looking
for that essential 20 % of knowledge. the critical
signs, the immediate things you have to do, and
maybe most importantly, the fatal mistakes that
give you 80 % of your success. That's the zone
we're targeting, that maximum leverage, because
trauma can be so overwhelming, but our focus
today is laser sharp on the one thing that causes
preventable death after these injuries. Unrecognized
internal bleeding. Unrecognized internal hemorrhage
and visceral damage. We're really looking at
the nursing implications here. What do you have
to assess? What are the immediate life -saving
steps? And what are those few things you absolutely
must not do? The things that can kill a patient
if you miss them. It's all about catching the
silent killers before they make themselves obvious.
So let's just jump right in. Primary survey and
the biggest concept, recognizing a cold hemorrhage.
So we always start with airway, breathing. But
when we get to see for circulation in a trauma
patient, especially with torso involvement, the
mindset has to be they're bleeding internally
until we prove they're not. That's the assumption,
100 percent. The sources are so clear on this.
Unrecognized abdominal and pelvic injuries are
the leading cause of preventable death after
truncal trauma. It's not a guess. It's a fact.
It's the primary risk. And the reason it's so
deadly is what you call this. the silence of
the loss right exactly the abdomen is i mean
it's a massive highly distensible cavity it's
not like a cut on the arm where you see the blood
pouring out you can't see it you can't you can
lose leaders i mean sometimes a patient's entire
circulating blood volume inside the abdomen or
the retroperitoneum before you see any dramatic
external sign no distension no obvious irritation
nothing That's terrifying. So you could be looking
at a patient who, on the surface, looks okay.
Maybe they're a little pale, maybe their pressure's
trending down just a bit. But inside, they're
exsanguinating. They're circling the drain. You
can't wait for the abdomen to look like a basketball
to start worrying. That's way too late. So that
lack of initial drama is the deadly pitfall.
It is. A quick exam might even be falsely reassuring.
but that slow, steady bleed from a solid organ,
you know, a liver or a spleen lac, that can go
on for hours unchecked. And you won't get those
classic signs of peritonitis until the situation
is already critical. Okay, let's talk about why
the assessment itself is so often unreliable.
We want patients to tell us, it hurts here, but
in trauma, that's often useless information.
It's totally unreliable. Think about the typical
patient. They might be intoxicated with alcohol,
they might be on other substances, or they could
have an altered mental status from a bad TBI
or a spinal cord injury. So they just can't give
you a reliable history. They can't. Or they can
feel pain, but it's from something else that's
screaming louder. you know, multiple nasty rib
fractures or a spinal fracture, that pain completely
masks the duller, deeper ache of an organ injury.
The noise from the ortho injury drowns out the
signal from the internal bleed. Precisely. Yeah.
Which forces you to rely almost entirely on the
mechanism of injury and their objective hemodynamic
status, which brings us to defining risk. So
who gets the full workup? What's the rule? The
rule is any patient with an injury to the torso.
a direct blow, a deceleration from a crash, a
blast, any penetrating wound in the zone between
the nipple line and the perineum. The nipple
line? They have to be considered to have a visceral,
vascular, or pelvic injury until you prove otherwise.
That nipple line is the absolute non -negotiable
upper border. Let's dig into that boundary because
for a learner, that might sound like a chest
injury. Why does an injury below the nipple line
demand a full abdominal workup? It's all about
the mechanics of the diaphragm. This is a classic
exam prep. People picture the diaphragm sitting
low, but during full expiration, when you breathe
all the way out, that diaphragm can rise dramatically.
That's high. Up to the level of the fourth intercostal
space. Wow. Which means a stab wound or even
a displaced rib fracture that looks like it's
just a low chest issue can actually pierce the
diaphragm and lacerate the dome of the liver
on the right or the spleen or stomach on the
left. So that tiny detail, the rising diaphragm,
turns a chest problem into a thoraco -abdominal
catastrophe. Instantly. And this all feeds into
our management priority, which is hemodynamic
status. In the unstable hypotensive patient,
everything is about speed. If they're crashing,
what's the one goal? The only goal is to rapidly
determine if the abdomen or pelvis is the source
of the hypotension. That's it. If it is, they
need hemorrhage control. And that almost always
means the operating room. And we find that out
with a fast scan. Usually, yes. Yeah. The focus
assessment with sonography for trauma. Or, less
commonly now, a DPL. We just need to know, is
there free blood in the belly? Yes or no? If
it's yes, they go to the OR. Okay, but here's
the critical distinction, the other side of the
coin. The hemodynamically normal patient. They
come in, they were in a bad crash, but their
vitals look good right now. What's the priority
for them? This is maybe the most important concept
for anyone not in the initial resuscitation pay.
Serial physical exams are a critical management
tool. Just because a patient is stable now doesn't
mean they're safe. So stability buys you time,
but you have to use that time to watch. Vigilantly.
That stable patient needs a detailed, repeated
evaluation, every few hours, usually over a 12
to 24 hour observation period. Why are those
repeat checks so vital? What are you looking
for? You're waiting for one of two things to
declare themselves. Either the slow, steady bleed
finally overwhelms their ability to compensate
and they crash, or more commonly, an injury to
a hollow organ, like a small bowel tear, starts
to leak. And that causes peritonitis. Delayed
peritonitis. If you check them once, say they're
fine, and walk away, you are almost guaranteed
to miss it. Yeah. The trauma literature is emphatic
about this. A single examination does not eliminate
the presence of a major injury. OK, so let's
build on that clinical suspicion. We need to
know the map, the anatomical zone, so we can
connect the mechanism of injury to what we should
expect to find. Right. So let's start with the
three critical zones. And the first one, the
biggest diagnostic challenge, is the retroperitoneal
space. We call it the hidden danger zone for
a reason. Why is it so hard to assess? It's location.
It's deep. It's posterior to the main peritoneal
lining, and it's packed with, I mean, the biggest,
most important stuff. The aorta, the IVC, the
kidneys, the ureters, the pancreas, most of the
duodenum. And the nursing implication here is
that these injuries are the ultimate silent killers.
They are. If the aorta or renal artery is bleeding,
that blood just collects in this deep, contained
space. It doesn't spill into the main abdominal
cavity, so you don't get that immediate peritonitis.
And our usual rapid tests don't work well here.
They don't. A DPL won't sample that area. And
a FAST scan is notoriously bad at visualizing
the deep retroperitonium, often because of overlying
bowel gas. So if you suspect a retroperitoneal
injury, your only truly reliable tool is a CT
scan. Which means the patient has to be stable
enough to get one. Exactly. Which is why pancreatic
and duodenal injuries are so famous for being
diagnosed late. Okay, zone number two. The pelvic
cavity. Right. This is the space surrounded by
the bony pelvis. It's got the rectum, bladder,
the big filiac vessels, and the reproductive
organs. And the primary danger here is hemorrhage.
Massive hemorrhage. You can bleed from the organs,
sure, but the truly life -threatening bleeds
often come from the bone itself. When that pelvic
ring fractures, it shears the dense venous plexus
on the back wall or tears branches of the iliac
arteries. This space can hide multiple liters
of blood very, very quickly. And finally, the
thoracoaptamen. We said this runs from the nipples
down to the bottom of the ribs. And the key takeaway
here, as we mentioned, is that diaphragm mobility.
You have to remember that injuries to the lower
ribs, ninth, tenth, eleventh, are not just rib
problems, They have to be investigated for abdominal
involvement because they sit right on top of
the spleen on the left and the liver on the right.
Never trust an injury below the nipple line to
be purely thoracic. Never. OK, so now we have
the map. Let's talk about the mechanism of injury
and the patterns to expect. Starting with blunt
trauma. This is the most common, right? MVCs,
falls, assaults. It is. And you have two main
forces. Compression, which crushes organs, and
deceleration, which causes shearing injuries.
So for blunt trauma, what are the top three organs
we need to be thinking about? The big three consistently
are the spleen that gets injured in up to 55
% of cases, then the liver up to 45%, and then
the small bowel, which is less common, maybe
five to 10%. Let's talk about that shearing mechanism.
This is where the body's own anatomy creates
failure points. Right. Think of an organ like
cargo in a truck that's tied down with straps.
When the truck crashes to a sudden stop, the
car, the organ wants to keep moving forward.
All the stress goes on to the straps, which are
the ligaments. And they tear. They tear. This
causes lacerations right where the liver and
spleen are attached. For the small bowel, you
get what's called a bucket handle injury, which
is a tear in the mesentery that supplies his
blood. And a critical detail from MVCs, the seatbelt
sign. We know they save lives, but they also
create a very specific injury pattern. Absolutely.
If you see that transverse bruise, that ecomosis
across the abdomen from a lap belt, that is a
huge red flag. It's not just a bruise. What should
it make you think of? Two things, immediately.
First, a high risk of an intestinal injury, often
a perforation. And second, the specific type
of lumbar spine fracture called a chance fracture.
It's a distraction injury, and it's highly associated
with lap belts. That bruise means you need to
get specific imaging of the spine. And just to
bust a myth, what about airbags? Airbag deployment
does not, I repeat, does not rule out abdominal
injury. The forces involved are still massive
and can easily cause significant internal trauma.
Okay, shifting gears to penetrating trauma. A
stab wound versus a gunshot wound. Huge difference.
It's all about energy transfer. A stab wound
is a low -energy event. It lacerates and tears
what it touches. So the most commonly injured
organs are the ones right up front, the liver,
small bowel, diaphragm, and colon. Which means
you can sometimes manage them without surgery.
Right. Selective non -operative management is
often an option if the patient is stable and
has no signs of peritonitis, but gunshot wounds.
They are a different beast entirely because of
kinetic energy in cavitation. Explain cavitation.
A high -velocity bullet creates a temporary cavity.
a shockwave that is way, way bigger than the
bullet itself. It damages tissue far outside
the bullet's physical track. So the injury pattern
is much more widespread and devastating. Which
is why the most commonly injured organs are different.
Exactly. Small bowel is number one at 50 percent,
then the colon, then the liver, and a very high
rate of injury to the major abdominal blood vessels,
about 25 percent. And this leads to that clinical
rule. Almost all abdominal GSWs go to the ORs.
They do. With a 98 % chance of significant injury,
if the peritoneum is breached, you just can't
take the risk. But here's the nursing alert.
You can't trust the trajectory. It's not a straight
line. Never. Bullets tumble, they hit bone and
ricochet, they fragment. The entrance and exit
wounds might tell you very little about the path
of destruction inside. And lastly, blast injury.
This is a combination of everything. It is. You
get penetrating trauma from shrapnel, blunt trauma
from being thrown. But the unique danger is the
overpressure injury from the blast wave itself.
What does that affect? It injures air -containing
organs, the eardrums, the lungs, and the bowel.
And the learning point here is that the bowel
injury might have a delayed presentation. So
again, it comes back to that need for long, careful,
serial observation. OK, so let's move on to the
actual physical exam. This is the foundation,
and it has to be systematic. For the learner,
we have to follow the sequence. I -A -P -P. Inspection,
auscultation, percussion, and palpation. Always
in that order. For inspection, what are we looking
for? Patient has to be fully exposed, front and
back. You're looking for those external signs
of internal force, the seatbelt sign, any lacerations,
any protruding bowel or omentum, which is called
an evisceration. You have to inspect the flanks,
the scrotum, the erythromedas for blood. And
you have to see the back. A cautious log roll
is mandatory. You have to see the back. A penetrating
wound to the flank or buttock could easily have
entered the abdomen. The sources really stress
that a laceration of the perineum or buttocks
can indicate an open pelvic fracture, which has
a terrifyingly high mortality rate. Moving on
to auscultation and percussion. Auscultation.
You do it, but honestly, in a noisy trauma bay,
the presence or absence of vowel sounds is pretty
unreliable. Don't hang your hat on it. Percussion,
though, that's key for checking for peritoneal
irritation. And this brings us to a critical
do not for palpation. Yes. The reliable sign
you're looking for is involuntary muscle guarding.
That's when the patient's muscles tense up automatically
before you even touch them deeply. That's a true
sign. But once you elicit rebound tenderness,
that sharp pain when you quickly release pressure,
You're done. Stop the exam. Stop. Do not keep
pushing to find more evidence. It causes the
patient unnecessary pain, it serves no clinical
purpose, and it breaks their trust in you. You've
found peritonitis. Your exam is over. Move on
to the next step. That's a huge point. Okay,
let's focus on the pelvic and perineal assessment.
This is where undiagnosed hemorrhage can kill
someone very quickly. It can. And sometimes the
only initial sign of a catastrophic pelvic fracture
is just unexplained hypotension. So what are
the physical exam findings that should scream
pelvic instability? You're looking for signs
of mechanical disruption and vascular injury.
So a big scrotal hematoma, any blood dripping
from the urethral meatus, a difference in the
length of their legs, or if one leg is rotated
abnormally without an obvious femur fracture.
Okay, and now... For maybe the biggest trauma,
do not. That prevents us from causing more harm.
This is non -negotiable. Avoid manually manipulating
the pelvis. Do not rock it. Do not push on it
to check for stability. Why not? Because the
body's first response to that massive venous
bleeding is to try and form a clot to tamponate
it. That clot is fragile. If you come in and
start rocking the pelvis, you will dislodge that
life -saving clot, and the patient will immediately
lose a massive amount of blood and crash. So
you treat suspected instability by stabilizing
it, not by testing it. Exactly. Now let's talk
about those urethral and genitourinary signs.
As we said, blood at the meatus or a massive
perineal hematoma strongly suggests a urethral
injury. And the absolute do not that follows
that finding. Do not place a urinary catheter.
Another critical one. If the urethra is partially
torn, blindly forcing a catheter in can turn
that partial tear into a complete transaction.
It's a devastating complication. So what's the
right move? They need a specialist evaluation
first, a retrograde urethragram, to see what's
going on. No tube goes in until that's done.
We also need to do rectal and vaginal exams when
indicated. What are we feeling for in the rectal
exam? We're checking sphincter tone, making sure
the rectal wall is intact, and feeling for any
palpable bony fragments from a pelvic fracture.
In penetrating trauma, the main thing is feeling
for gross blood, which means you've hit the bowel.
And a small detail for female patients. The vaginal
exam is looking for lacerations from bone fragments
or a trans pelvic gunshot wound. But the small,
easily missed detail is a check for a retained
tampon in an unresponsive menstruating woman.
Missing that can lead to delayed severe sepsis.
Okay, one last point in this section. Those seemingly
simple gluteal penetrating injuries. Massive
red flag. They fool people all the time. A penetrating
injury to the buttock area has up to a 50 % incidence
of significant intra -abdominal injury. 50%.
50%. The trajectory often goes up into the deep
pelvis or abdomen, hitting the rectum, iliac
vessels, or colon. The external wound looks minor,
but the internal damage can be catastrophic.
Evaluation is absolutely mandatory. Alright,
let's shift to the diagnostic tools we use after
the primary survey, our adjuncts. Starting with
the tubes and catheters. A gastric tube has a
few purposes. It relieves gastric distension,
which reduces aspiration risk, and it empties
the stomach before a DPL. What if you see blood
come out of it? It suggests an injury to the
esophagus or upper GI tract. But you first have
to make sure it's not just from trauma during
the insertion itself. And there's a vital safety
rule about how you insert it. A non -negotiable
one. If the patient has severe facial fractures
or you even suspect a basal or skull fracture,
the tube must be inserted orally through the
mouth. Why? Because if you go through the nose,
you risk passing the tube through the fractured
crib reform plate directly into the brain. It's
an absolute contraindication for nasal insertion
in that setting. Okay, next up, the urinary casseter.
Assuming we've cleared the urethra for injury,
what are its goals? Relieving retention, checking
for blood, and most importantly, monitoring their
urine output. That's our best real -time indicator
of tissue perfusion and whether a resuscitation
is working. And there's a small timing detail
related to the FAST scan. Yes, a small but important
one. A full bladder acts As an acoustic window,
it makes it much easier to see the pelvis on
the FAST scan. So if the patient is stable, you
should do the FAST before you place the catheter
to get the best possible images. Right. And just
to reiterate, blood in the urine confirms trauma,
but no blood does not rule it out. Exactly. You
can have a completely transected renal artery
and have no hematuria at all. OK. Let's talk
about the rapid screening tools, FAST versus
DPL. So FAST, the Focused Assessment with Sonography
for Trauma. The reason it's so popular is that
it's fast, it's non -invasive, you can do it
right at the bedside, and you can repeat it over
and over. And its only job is to answer one question.
One question. Is there free fluid, meaning blood,
in one of the major potential spaces? And which
four regions are we looking at? The pericardial
sac for tamponade, the hepatorenal fossa -Morrison's
pouch, the splenorenal fossa, and the pelvis.
A quick sweep takes just a couple of minutes.
But learners have to know the limitations. A
negative FAST can be a huge trap. It's the classic
false negative pitfall. The biggest limitation
is that FAST is terrible at diagnosing hollibuscus
injury, a bowel tear. It's looking for a large
amount of fluid, not the tear itself. So a small
leak won't show up. It's also less reliable in
obese patients. So a negative FAST doesn't mean
you're in the clear. Not at all. It just means
you don't see a lot of blood right now. You still
need a high index of suspicion and probably repeat
scans. Okay, what about DPL? Diagnostic peritoneal
lavage. It's less common now, but still has a
role. It does. It's an invasive surgical procedure,
but it's extremely sensitive. It's most useful
in an unstable blunt trauma patient when you
don't have FAST or CT available or the FAST scan
was unclear. What are the critical nursing prep
steps for a DPL? You have to make sure the stomach
and bladder are completely empty. If they're
full, you can easily puncture them during the
procedure, which is a major complication. So
gastric tube in, Foley in. And what DPL findings
mean an immediate trip to the OR? If you aspirate
anything that looks like GI contents, bile, or
vegetable fibers, that's a direct ticket. For
blood, the rule is if you get 10 cc or more of
gross blood back in an unstable patient, they
go to the OR for a laparotomy. Okay, let's move
to advanced imaging. CT scan is the gold standard
for defining injury, but it comes with a huge
non -negotiable caveat. The rule is absolute.
CT is for hemodynamically normal, stable patients
only. Why? Because the time it takes to transport
a patient to the CT scanner, get them on the
table and complete the scan. That time is lethal
for an unstable patient. The scanner is not a
resuscitation room. Stability buys you a CT scan.
Instability buys you a trip to the OR. But in
that stable patient, it's incredibly valuable.
Oh, it's amazing. It gives you precise organ
injury grading, which you need for non -operative
management. And it's the only good way to diagnose
those hidden retroperitoneal and pelvic injuries
that fast and the physical exam miss. What are
its weaknesses? It can still miss diaphragmatic
tears, and it's not great for subtle pancreatic
or small bowel injuries. But here's a key interpretation
tip. If the CT shows free fluid in the abdomen,
but no visible injury to the liver or spleen,
that fluid had to come from somewhere. The bowel
or the mesenteric? Exactly. And that almost always
means they need an operation anyway. We still
use plain x -rays, too. What's the highest yield
one? The AP pelvic x -ray. If you have an unstable
patient with pelvic pain, you need one immediately
to see if a pelvic fracture is the source of
their bleeding. But conversely, an alert, a wake
patient with no pelvic pain doesn't need one.
You can save time and radiation. Finally, let's
nail down the specifics of contrast studies because
the technical details here are prime exam material.
Absolutely. For urethrography, to check for urethral
injury, the technique matters. You use a small
eight French catheter and you gently instill
30 to 35 millideals of undiluted contrast. Small
catheter, small volume to avoid causing more
damage. And for a cystogram to diagnose a bladder
rupture. Here, volume is everything. You have
to put in a large volume 350mm of water soluble
contrast plus another 50mm for maximal distension.
You have to fully stretch the bladder wall to
force contrast out of any small holes. If you
underfill it, you will get a false negative.
And there's a critical step about which x -rays
to take. You need three views. A pre -drainage
film, the filled film, and a post -drainage view.
That last one is essential. Sometimes a small
leak only shows up after the pressure's off and
the bladder's empty. Missing that post drainage
film is a major error. And if CT isn't an option
for checking the kidneys? Then you fall back
on an IVP, intravenous pyrogram. The critical
finding to know here is that non -visualization
of the renal system after just two minutes suggests
a major injury, like a renal artery thrombosis
or a shattered kidney. Okay, so we have a diagnosis.
Let's talk about definitive management, starting
with the big one. who goes straight to the operating
room. This is the survival guide list. These
are the absolute indications for an immediate
laparotomy. For blunt trauma, what are the triggers?
Any patient who is hypotensive and has a positive
fast scan, or any hypotensive patient with clear
clinical signs of internal bleeding where you
can't find another source, unstable and bleeding
in the belly means surgery, period. and for penetrating
trauma. Hypotension is always number one. A gunshot
wound with a transparent needle trajectory is
almost always an indication, given that 98 %
injury rate. Obvious signs of peritonitis that
rigid guarding or visible evisceration are absolute
triggers. Got it. Now let's focus on managing
pelvic fractures and hemorrhage. This is a top
priority because the mortality is so high. It
is, about one in six overall, but it can be as
high as 50 % for open pelvic fractures. Hemorrhage
is the factor we can actually do something about.
You mentioned two main mechanisms. First, the
open book, or AP compression. Right. This is
from a head -on crash. The pelvis is forced open
like a book. This tears the vessels in the back.
And because the volume of the pelvis actually
increases, it can hold a massive amount of blood.
It's a setup for rapid catastrophic hemorrhage.
And that's different from lateral compression.
Very different. That's from a side impact. The
force pushes the sides of the pelvis inward,
which actually reduces the pelvic volume. The
bleeding is often less severe initially, but
this mechanism has a very high risk of driving
bone fragments into the bladder and urethra,
causing a lot of long -term problems. But for
either one, the first step is hemorrhage control.
Yes, and that is where the critical nursing management
step comes in. Mechanical stabilization with
a pelvic binder or simple bed sheet. This is
a temporary, life -saving emergency procedure.
Wasn't that the goal? To squeeze the pelvis closed.
You internally rotate the legs and wrap the binder
or sheet tightly to reduce the pelvic volume
and splint the frasher, which helps tamponade
the bleeding. And now for the small detail that
makes it work. This is a huge high -yield point.
Placement is everything. The binder or sheet
must be centered over the greater trochanters
of the femur, not up high on the iliac crests
on the hips. Why the trochanters? Because the
trochanters act as levers. By squeezing them
together, you are internally rotating the entire
leg and hip unit, which effectively closes the
open book fracture. If you put it too high on
the iliac crests, you're just squeezing soft
tissue. It does nothing. And what are the cautions?
It's a temporary device. If it's too tight or
left on too long, it will cause severe skin breakdown
and pressure ulcers. You have to monitor the
skin underneath. If the binder isn't enough,
then we have to escalate. Right, and that usually
means a trauma center with resources for angiographic
embolization or pre -peritoneal packing. The
key is recognizing the need for transfer early.
Let's finish up by highlighting a few of those
sneaky injuries that are often diagnosed late.
Right. First, holoviscus injuries, so the intestines.
Diagnosis is tough because they don't cause a
big early bleed. You have to be suspicious if
you see a sepal sign or a chance fracture on
imaging. Peritonitis is often delayed by hours.
Next, diaphragm injuries. Most common on the
left side. The classic pathognomonic sign on
a chest x -ray is seeing the gastric tube curled
up in the chest cavity. But sometimes the initial
x -ray is normal and the bowel only herniates
through the tear hours or days later. And finally,
the toughest one of all, pancreatic injuries.
These come from a direct hard blow to the epigastrium
that crushes the pancreas against the spine.
And here's the critical alert everyone has to
know. An early normal serum amylase level does
not rule out major pancreatic trauma. It's unreliable
early on. Completely. And to make it worse, the
CT scan might not even show the injury for up
to eight hours. So if the mechanism was bad enough,
even with normal labs and a maybe normal CT,
you still have to be incredibly suspicious. So
we've covered a huge amount of ground here, but
we've really distilled it down. For the learner,
that 80 % understanding comes down to mastering
triage and observation. That's right. It starts
with prioritizing that primary survey, always
assuming there's an occult bleed, especially
in that silent retroperitoneal space. If the
patient is unstable, the answer is always speed
and hemorrhage control. And let's just hammer
home those three critical do -nots one more time,
the things that prevent us from causing a catastrophe.
One. Do not place an unverified Foley catheter
if there are any signs of urethral injury. Two,
do not manually rock or distract the pelvis if
you suspect it's unstable. And three, Do not
keep palpating for rebound tenderness once you've
already established that they have peritonitis.
And for the stable patient, their life depends
on the quality of your meticulous serial exams,
just watching and waiting for those delayed injuries
to show themselves. Exactly. Trauma management
is really organized chaos. You have to be able
to apply the binder, draw the blood, get the
fast scan, and call the surgeon all at the same
time. So we'll leave you with this final thought
to take into your practice. We always talk about
time is tissue, meaning that acting fast saves
organs. But in an unstable trauma patient, the
biggest threat is often the delay caused by chasing
a perfect diagnosis with a time -consuming test,
like a CT scan, when what they really need is
immediate surgical control of their bleeding.
So the question is, how does that concept of
time is tissue force the trauma team to prioritize
action over information? And how do you, as a
learner, integrate that necessary high -risk
trade -off into your own decision -making flow,
that complex balance, expert trauma care.