Abstract

Most injuries in the United States result from blunt mechanisms, including motor vehicle crashes and falls as well as from interpersonal violence. Patients who suffer severe blunt trauma typically experience a significant force vector, rapid deceleration, or both. Under these circumstances, multiple potentially life-threatening injuries are likely, requiring careful prioritization of diagnostic and therapeutic interventions. In the unstable patient with multisystem blunt trauma, a useful team strategy: (1) rapidly identifies the cause(s) of traumatic shock, (2) identifies and prioritizes “time-dependent” injuries in need of definitive therapy, and (3) orchestrates an immediate care plan that thoughtfully matches ongoing resuscitation with the identified injuries and the patient’s clinical course. This issue of EMCC will provide a logical “menu” for the rapid evaluation and management of traumatic shock. Three “high-risk” clinical scenarios will then be discussed: blunt aortic injury (BAI), pelvic ring fractures, and blunt abdominal trauma. These scenarios were chosen because of their lethality and call for complex decision making. The essentials of emergency department (ED) diagnosis and management will be reviewed for each.

Keywords: traumatic shock, blunt aortic injury, BAI, pelvic ring fractures, blunt abdominal trauma, life-threatening shock, multisystem trauma