Trauma & Abdominal Injury
Prioritise life threats, identify concealed injury and choose investigation according to physiological stability.
Quick revision ↓ Medical Dictionary
01Use a coordinated primary survey
Control catastrophic external bleeding and assess airway, breathing and circulation with spinal precautions when indicated. Prevent hypothermia, expose sufficiently to identify injuries and reassess after each intervention. Mechanism suggests risk but does not replace examination. A trauma team approach allows resuscitation, monitoring and preparation for definitive care to proceed together, with a clear leader and structured communication.
02Look beyond external wounds
Blunt trauma can damage solid organs, bowel, mesentery or the retroperitoneum without a large surface injury. Seat-belt marks, abdominal tenderness, pelvic injury and evolving physiology matter. Penetrating wounds may have an uncertain track. Do not probe wounds casually to determine depth. Repeated examination is valuable because bowel or mesenteric injury may become more apparent after an initially inconclusive assessment.
03Choose imaging by stability
Bedside ultrasound can rapidly identify some free fluid but a negative examination does not exclude abdominal injury, especially hollow-viscus or retroperitoneal injury. CT is useful in suitably stable patients and helps guide selective management. An unstable patient with suspected major bleeding needs a rapid senior decision about haemorrhage control rather than a reflex trip to CT that delays treatment.
04Understand selective non-operative care
Some solid-organ injuries can be managed without immediate surgery in selected stable patients with appropriate monitoring and rapid access to intervention. Selection depends on physiology, associated injuries, imaging and local capability. Non-operative care is active surveillance, not discharge by default. Increasing pain, falling haemoglobin with clinical concern or haemodynamic deterioration may require angiographic or operative control.
05Complete the secondary and tertiary surveys
After immediate threats are addressed, review the history, head-to-toe examination and relevant imaging. Repeat assessment can detect injuries missed during resuscitation or masked by intoxication and distracting pain. Document neurovascular findings and analgesia response. Plan transfer with suitable monitoring, personnel and handover, and communicate unresolved concerns rather than assuming the receiving team will infer them from scans alone.
High-Yield Revision
- A negative FAST examination does not exclude abdominal injury.
- Stability and local capability govern non-operative management.
- Repeated surveys reduce missed injuries.
Common Pitfalls
- Do not delay necessary bleeding control for unsafe imaging.
- Do not probe penetrating wounds casually.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.