You arrive at the trauma bay in the evening just as a 24-year-old man is brought in by ambulance following a scooter accident against a moving car. He arrives with spinal precautions, and EMS reports transient hypotension en route that resolved with a 500-cc bolus of normal saline. The paramedics add that he is complaining about severe pelvic and diffuse abdominal pain, and they noted tenderness on palpation, with deformity and ecchymosis of his entire right pelvis. EMS has bound his pelvis with a sheet. His blood pressure on arrival is 86 mm Hg and he is tachycardic, but IV fluids are running in. You wonder if a FAST would be helpful in this case, but do you have enough have time to perform one? Should you even consider a CT? How do you determine whether the hemodynamic instability is due to hemorrhage from a primary abdominal or pelvic source? Will he need to go to the operating room or interventional radiology?
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