Blunt Abdominal Trauma EvaluationAPPROACH

TRAUMA AND WOUNDS · 19 SECTIONS

⚲

634 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

Motor Vehicle Collision Evaluation Chest Wall Trauma And Rib Injury Blunt Abdominal Trauma Evaluation Penetrating Trauma Evaluation Pediatric Minor Head Trauma Pediatric Head Trauma Facial Lacerations And Dental Trauma Hand Lacerations With Tendon Injury Concern Puncture Wounds And Retained Foreign Body Concern Electrical Injury Burn Injury Fall Evaluation Assault And Interpersonal Violence Evaluation Eye Trauma And Hyphema Concern

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx88

Mechanism and context

›Mechanism and context

›Blunt mechanism

›Motor vehicle collision

›Pedestrian struck

›Fall

›Assault

›Sport injury

›Energy transfer

›High speed impact

›Rollover

›Ejection

›Death in same vehicle

›Significant vehicle intrusion

›Restraints and surfaces

›Seatbelt use

›Airbag deployment

›Steering wheel impact

›Handlebar injury

›Timeline

›Time of injury

›Symptom trajectory since injury

›Prehospital course

›Reported hypotension

›Reported tachycardia

›Fluids

›Blood products

›Analgesia or sedation

Symptoms and OPQRST

›Symptoms and OPQRST

›Pain features when present

›Location

›Migration

›Radiation

›OPQRST

›Onset

›Immediate after impact

›Delayed onset

›Provocation and palliation

›Worse with movement

›Worse with deep breath

›Relief with stillness

›Quality

›Sharp

›Dull

›Cramping

›Region and radiation

›Diffuse abdominal

›Flank

›Shoulder tip pain

›Severity

›Current severity

›Peak severity

›Timing

›Constant

›Intermittent

›Progressive

›Associated symptoms

›Syncope or near syncope

›Dyspnea

›Chest pain

›Nausea

›Vomiting

›Hematemesis

›Hematochezia

›Melena

›Hematuria

›Dysuria

›Inability to void

›Back pain

›Headache

›Confusion

Special populations and modifiers

›Special populations and modifiers

›Pregnancy considerations

›Last menstrual period estimate

›Pregnancy symptoms

›Pediatrics

›Nonverbal pain cues

›Caregiver report reliability

›Older adults

›Baseline cognition

›Frailty and baseline function

›Anticoagulation and bleeding risk

›Warfarin

›DOAC

›Antiplatelet agents

›Intoxication and unreliable exam risk

›Alcohol

›Sedatives

›Head injury symptoms

02Alarm Features/alarm34

Hemodynamic and perfusion danger thresholds

›Hemodynamic and perfusion danger thresholds

›Shock physiology

›Systolic blood pressure under 90 mmHg

›Heart rate over 120

›Shock index over 0.9

›Altered mental status not otherwise explained

›Cool clammy skin

›Capillary refill delayed

›Immediate escalation triggers

›Persistent hypotension after fluid bolus

›Increasing vasopressor requirement

›Rapidly rising lactate

›Ongoing transfusion requirement

High risk history and exam findings

›High risk history and exam findings

›High risk mechanisms

›High speed collision

›Rollover

›Ejection

›Significant fall height

›High risk abdominal findings

›Peritonitis

›Rebound tenderness

›Guarding

›Abdominal distension with instability

›External markers of risk

›Seatbelt sign

›Abdominal wall ecchymosis

›Lower rib fractures

›Pelvic instability

›Unreliable examination

›Intoxication

›Altered mental status

›Spinal cord injury

›Distracting injuries

03Medications/meds28

Current medication exposure

›Current medication exposure

›Bleeding risk medications

›Warfarin

›Apixaban

›Rivaroxaban

›Dabigatran

›Edoxaban

›Aspirin

›Clopidogrel

›Ticagrelor

›Chronic disease medications relevant to shock

›Beta blockers

›Calcium channel blockers

›Diuretics

›Substance exposures

›Alcohol

›Opioids

›Stimulants

Contraindications and interaction traps

›Contraindications and interaction traps

›Analgesia cautions

›NSAID use with bleeding risk

›Opioid related hypoventilation risk

›Imaging contrast cautions

›Prior contrast reaction history

›Significant renal dysfunction history

›Anticoagulant reversal relevance

›Last dose timing estimate

›Availability of specific reversal agents local protocol dependent

04Diet/diet14

Recent intake and aspiration risk

›Recent intake and aspiration risk

›Last oral intake timing estimate

›Solid food

›Liquids

›Vomiting risk

›Active nausea

›Active emesis

Hydration and alcohol exposure

›Hydration and alcohol exposure

›Dehydration indicators

›Poor oral intake

›Reduced urine output

›Alcohol exposure

›Recent intake

›Intoxication affecting exam reliability

05Review of Systems/ros27

Cardiopulmonary and neurologic

›Cardiopulmonary and neurologic

›Cardiopulmonary

›Dyspnea

›Pleuritic chest pain

›Palpitations

›Syncope

›Neurologic

›Headache

›Confusion

›Focal weakness

›Seizure

Gastrointestinal and genitourinary

›Gastrointestinal and genitourinary

›Gastrointestinal bleeding

›Hematemesis

›Melena

›Hematochezia

›Hepatobiliary and pancreas clues

›RUQ pain

›Epigastric pain

›Genitourinary

›Hematuria

›Flank pain

›Inability to void

›Testicular pain

›Gynecologic

›Vaginal bleeding

›Pelvic pain

06Collateral History and Family History/chafh17

Collateral sources and reliability

›Collateral sources and reliability

›Source

›EMS report

›Bystander

›Family

›Police

›Reliability modifiers

›Intoxication

›Language barrier

›Baseline cognitive impairment

Family and social context

›Family and social context

›Family bleeding disorders

›Hemophilia

›Von Willebrand disease

›Social supports for discharge reliability

›Supervision available

›Ability to return if worse

07Risk Factors/rf26

Patient factors increasing missed injury risk

›Patient factors increasing missed injury risk

›Unreliable exam risk

›Altered mental status

›Intoxication

›Distracting injuries

›Bleeding risk

›Anticoagulation

›Antiplatelet therapy

›Chronic liver disease

›Immunocompromise and infection risk

›Steroids

›Chemotherapy

›HIV

Exposure and injury pattern risks

›Exposure and injury pattern risks

›Seatbelt sign risk pattern

›Hollow viscus injury

›Mesenteric injury

›Lower rib fracture risk pattern

›Splenic injury

›Hepatic injury

›Pelvic trauma risk pattern

›Retroperitoneal hemorrhage

›Bladder injury

›High energy deceleration risk pattern

›Aortic injury

›Solid organ laceration

08Differential Diagnosis/ddx55

Life threatening

›Life threatening

›Hemorrhagic shock from intraabdominal bleeding

›Solid organ injury

›Splenic laceration

›Hepatic laceration

›Renal injury

›Mesenteric vascular injury

›Rapid lactate rise

›Persistent tachycardia

›Hollow viscus perforation

›Peritonitis

›Delayed presentation possible

›Retroperitoneal hemorrhage

›Pelvic fracture association

›Flank ecchymosis association

›Abdominal compartment syndrome

›Rising airway pressures

›Worsening ventilation

›Oliguria

›Traumatic aortic injury

›High energy deceleration

›Chest findings coexisting

Common

›Common

›Abdominal wall contusion

›Localized tenderness

›Normal imaging

›Splenic injury

›LUQ tenderness

›Left shoulder tip pain

›Liver injury

›RUQ tenderness

›Transaminitis

›Renal contusion or laceration

›Flank pain

›Hematuria

›Musculoskeletal pain

›Rib fracture pain overlap

›Spine injury overlap

Less common and mimics

›Less common and mimics

›Pancreatic injury

›Epigastric pain

›Delayed enzyme rise possible

›Bladder rupture

›Gross hematuria

›Suprapubic pain

›Urethral injury

›Blood at meatus

›High riding prostate

›Nontraumatic mimics uncovered by trauma

›Ruptured ectopic pregnancy (O00)

›Positive pregnancy test

›Pelvic pain

›Abdominal aortic aneurysm rupture (I71.3)

›Older age

›Back or abdominal pain

09Past Medical History/pmh23

Relevant baseline conditions

›Relevant baseline conditions

›Bleeding and clotting history

›Prior major bleeding

›Prior VTE

›Liver disease

›Cirrhosis (K74.60)

›Portal hypertension history

›Kidney disease

›Chronic kidney disease (N18.9)

›Solitary kidney history

›Cardiopulmonary disease

›Coronary artery disease (I25.10)

›Heart failure (I50.9)

Prior procedures and devices

›Prior procedures and devices

›Abdominal surgery

›Adhesion risk

›Altered anatomy

›Transplant history

›Immunosuppression

›Graft injury considerations

›Implanted devices

›IVC filter

›Ventricular assist device

10Physical Exam/exam40

Primary survey focused findings

›Primary survey focused findings

›Airway and breathing

›Work of breathing

›Asymmetric breath sounds

›Circulation and perfusion

›Pulse quality

›Skin temperature

›Capillary refill

›Disability

›GCS trend

›Pupils

›Exposure

›Full skin exam for bruising

›Seatbelt sign

Abdominal and pelvic exam

›Abdominal and pelvic exam

›Abdomen

›Distension

›Tenderness localization

›Guarding

›Rebound tenderness

›Rigidity

›Peritoneal signs

›Worsening with percussion

›Pain with heel jar

›Flanks and back

›Flank tenderness

›Flank ecchymosis

›Pelvis

›Pelvic stability

›Pelvic tenderness

Genitourinary and rectal when indicated

›Genitourinary and rectal when indicated

›External genital exam

›Blood at urethral meatus

›Scrotal hematoma

›Rectal exam selective

›Gross blood

›Prostate position

›Neurovascular lower extremities

›Distal pulses

›Sensation changes

11Lab Studies/labs36

Initial trauma labs

›Initial trauma labs

›CBC

›Baseline hemoglobin trend importance

›Leukocytosis nonspecific

›Electrolytes and renal function

›Creatinine for contrast planning

›Potassium abnormalities in shock

›Liver enzymes

›Transaminitis as solid organ injury clue

›Normal values do not exclude injury

›Coagulation studies

›INR

›aPTT

›Type and screen

›Crossmatch if unstable

›Massive transfusion activation local protocol dependent

Perfusion and bleeding assessment adjuncts

›Perfusion and bleeding assessment adjuncts

›Lactate

›Elevated suggests hypoperfusion

›Trend more useful than single value

›Venous blood gas

›Metabolic acidosis clue

›pCO2 for ventilation adequacy

›Thromboelastography local protocol dependent

›Coagulopathy phenotype

›Targeted blood component therapy

Pregnancy and urinary testing

›Pregnancy and urinary testing

›Pregnancy test in patients with uterus of childbearing potential

›CT imaging implications

›Ectopic pregnancy mimic risk

›Urinalysis

›Microscopic hematuria

›Gross hematuria

›Creatine kinase when crush or rhabdomyolysis risk

›Hyperkalemia risk

›Acute kidney injury risk

12Imaging/img58

Scoring Systems

›Scoring systems and classifications

›AAST Organ Injury Scale

›Spleen liver kidney 2018 revision

›Radiologic criteria incorporated

›Renal trauma OIS revision

›2025 version availability

›Use for urology communication

›WSES splenic trauma classification

›Integrates hemodynamics and anatomy

›Guides nonoperative management pathways

›Shock index

›Over 0.9 higher risk of occult hemorrhage

›Beta blocker use may blunt tachycardia

MRI

›MRI considerations

›Limited role in acute blunt abdominal trauma

›Hemodynamically stable only

›Alternative when CT contraindicated selective

›Pregnancy selective use

›Noncontrast protocols preferred

›Gadolinium avoidance unless essential

›Biliary and pancreatic duct evaluation selective

›MRCP for suspected duct injury

›Often delayed or inpatient pathway

›CT abdomen pelvis with IV contrast

›Indications

›Hemodynamically stable with concerning mechanism or exam

›Unreliable exam

›Positive FAST in stable patient

›Protocol pearls

›IV contrast preferred for solid organ and vascular injury

›Oral contrast not routine in initial trauma pathways

›Key findings

›Active contrast extravasation

›Solid organ laceration grade

›Free fluid without solid organ injury

›Pneumoperitoneum

›Mesenteric hematoma

›Limitations and pitfalls

›Hollow viscus injury may be missed early

›Serial exam and repeat imaging when worsening

›Evidence notes

›EAST guideline archived notes CT sensitivity 92 to 97.6 percent

›EAST guideline archived notes CT specificity up to 98.7 percent

Ultrasound

›Ultrasound and FAST

›FAST protocol

›RUQ view

›LUQ view

›Pelvic view

›Pericardial view

›Interpretation pearls

›Positive FAST in unstable suggests hemorrhage source

›Small volume hemoperitoneum can be missed

›False negatives and false positives

›Early bleeding below detection threshold

›Obesity and subcutaneous air limit views

›Extended FAST adjunct

›Pleural fluid

›Pneumothorax findings

13Special Tests/spec20

Bedside and procedural diagnostics

›Bedside and procedural diagnostics

›Serial abdominal exams

›Repeat after analgesia

›Repeat after resuscitation

›Repeat FAST

›Worsening vitals

›Increasing abdominal distension

›Diagnostic peritoneal aspiration or lavage selective

›Unstable with equivocal FAST

›Positive result supports operative management

Genitourinary injury evaluation

›Genitourinary injury evaluation

›Retrograde urethrogram indication

›Blood at meatus

›Perineal hematoma

›CT cystography indication

›Gross hematuria with pelvic fracture

›Inability to void with pelvic trauma

›Foley catheter cautions

›Defer until urethral injury excluded when high suspicion

›Urology involvement when uncertain

14ECG/ecg17

When ECG is relevant in blunt abdominal trauma

›When ECG is relevant in blunt abdominal trauma

›Shock or syncope

›Arrhythmia screen

›Ischemia screen

›Chest pain or significant thoracoabdominal trauma

›Myocardial contusion consideration

›Concurrent ACS consideration in older adults

High risk ECG patterns and actions

›High risk ECG patterns and actions

›STEMI patterns

›Immediate reperfusion pathway

›Coordinate with trauma priorities

›Wide complex tachycardia

›Unstable cardioversion pathway

›Electrolyte causes evaluation

›Bradycardia with hypotension

›High grade AV block

›Pacing pathway local protocol dependent

15Assessment/ax24

Problem representation and severity

›Problem representation and severity

›Blunt abdominal trauma with suspected intraabdominal injury (S39.91XA)

›Hemodynamic status classification

›Exam reliability classification

›Hemorrhage risk stratification

›Unstable

›Transient responder

›Stable

›Complications to exclude

›Ongoing hemorrhage

›Hollow viscus injury

›Retroperitoneal bleed

›Abdominal compartment syndrome

Working diagnoses with supporting features

›Working diagnoses with supporting features

›Solid organ injury suspected

›LUQ or RUQ tenderness

›FAST positive

›Hollow viscus injury suspected

›Seatbelt sign

›Peritonitis

›Free fluid without solid organ injury on CT

›Genitourinary injury suspected

›Hematuria

›Pelvic fracture

16Plan/plan69

Approach to the critical patient

›Approach to the critical patient

›First 5 minutes workflow

›Resuscitation bay criteria

›Hypotension

›Altered mental status

›Respiratory distress

›Monitoring

›Cardiac monitor

›Continuous pulse oximetry

›Noninvasive blood pressure cycling

›IV access

›Two large bore peripheral IV

›Intraosseous if IV access delayed

›Labs and blood

›Type and screen

›Crossmatch if unstable

›Imaging priority

›FAST early

›CT only if stable

›Hemorrhage control and transfusion

›Massive transfusion protocol activation local protocol dependent

›Balanced blood products local protocol dependent

›Calcium replacement during large volume transfusion local protocol dependent

›TXA consideration

›Suspected major hemorrhage within 3 hours

›Contraindications local protocol dependent

Diagnostic sequencing

›Diagnostic sequencing

›Hemodynamically unstable pathway

›FAST first line

›Immediate surgical consultation

›OR if positive FAST with instability

›Hemodynamically stable pathway

›CT abdomen pelvis with IV contrast when concern persists

›Observation with serial exams when low risk and reliable exam

›Unreliable exam pathway

›CT favored when stable

›FAST plus CT complementary when indicated

Analgesia and supportive care

›Analgesia and supportive care

›Pain control principles

›Avoid masking peritonitis concern via reassessment loop

›Reassess exam after analgesia

›Adult dose examples

›Fentanyl IV 25 to 50 micrograms

›Repeat every 5 to 10 minutes to effect

›Caution in hypoventilation risk

›Hydromorphone IV 0.2 to 0.5 mg

›Repeat every 10 to 15 minutes to effect

›Reduce dose in older adults

›Acetaminophen PO 1000 mg

›Maximum 4000 mg per day

›Lower maximum in chronic liver disease

›Antiemetic adult dose examples

›Ondansetron IV 4 mg

›Repeat once if needed

›QT prolongation risk

Reassessment loop

›Reassessment loop

›Timing

›Every 15 minutes in unstable or borderline

›Every 30 to 60 minutes in stable observation

›What to repeat

›Vitals and shock index

›Abdominal exam

›Mental status

›Urine output when catheterized

›Escalation triggers

›New peritonitis

›Rising lactate

›Increasing transfusion requirement

›Worsening pain despite stable imaging

17Disposition/dispo25

ICU and operative criteria

›ICU and operative criteria

›Immediate OR criteria

›Hemodynamic instability with positive FAST

›Peritonitis

›Evisceration

›ICU criteria

›Ongoing vasopressor need

›Ongoing transfusion requirement

›Severe solid organ injury with high grade bleeding risk

›Severe traumatic brain injury with concurrent abdominal injury

Admission and observation criteria

›Admission and observation criteria

›Inpatient admission criteria

›Solid organ injury requiring monitoring

›Concern for delayed hollow viscus injury

›Significant comorbid bleeding risk

›Observation pathway criteria

›Stable vitals

›Reliable serial exam capability

›Pain controlled

›Discharge criteria

›Hemodynamically stable

›Reliable exam

›No concerning imaging findings

›Ambulation acceptable

›Reliable return precautions and supervision

18Discharge Instructions/di26

Copy discharge instructions

›Copy discharge instructions

›Summary

›You were evaluated after a blow to the abdomen

›Your tests today did not show a dangerous internal injury

›Medications

›Use acetaminophen as directed on the label unless told otherwise

›Avoid alcohol if using pain medicines that cause drowsiness

›Avoid NSAIDs if you were told you have bleeding risk or are on blood thinners

›Activity

›Rest for 24 hours

›No contact sports until cleared by a clinician if you had any organ injury concern

›Follow up

›Primary care or clinic follow up within 24 to 72 hours

›Earlier follow up if pain is worsening

›Return to the emergency department now for

›Fainting

›New or worsening shortness of breath

›New or worsening abdominal pain

›Vomiting that does not stop

›Blood in vomit

›Black stools

›Red blood in stool

›Blood in urine

›New confusion

›Weakness

›Fever

19References/r7

Guidelines and key sources

›Guidelines and key sources

›Project instructions source

›American College of Surgeons Committee on Trauma ATLS program information 2025

›EAST Practice Management Guidelines Blunt Abdominal Trauma Evaluation 2001 archived

›WSES Splenic trauma classification and guidelines 2017

›AAST Organ Injury Scale spleen liver kidney revision 2018

›AAST Organ Injury Scale renal trauma revision 2025

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Blunt Abdominal Trauma EvaluationAPPROACH

TRAUMA AND WOUNDS · 19 SECTIONS

⚲

634 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx88

Mechanism and context

›Mechanism and context

›Blunt mechanism

›Motor vehicle collision

›Pedestrian struck

›Fall

›Assault

›Sport injury

›Energy transfer

›High speed impact

›Rollover

›Ejection

›Death in same vehicle

›Significant vehicle intrusion

›Restraints and surfaces

›Seatbelt use

›Airbag deployment

›Steering wheel impact

›Handlebar injury

›Timeline

›Time of injury

›Symptom trajectory since injury

›Prehospital course

›Reported hypotension

›Reported tachycardia

›Fluids

›Blood products

›Analgesia or sedation

Symptoms and OPQRST

›Symptoms and OPQRST

›Pain features when present

›Location

›Migration

›Radiation

›OPQRST

›Onset

›Immediate after impact

›Delayed onset

›Provocation and palliation

›Worse with movement

›Worse with deep breath

›Relief with stillness

›Quality

›Sharp

›Dull

›Cramping

›Region and radiation

›Diffuse abdominal

›Flank

›Shoulder tip pain

›Severity

›Current severity

›Peak severity

›Timing

›Constant

›Intermittent

›Progressive

›Associated symptoms

›Syncope or near syncope

›Dyspnea

›Chest pain

›Nausea

›Vomiting

›Hematemesis

›Hematochezia

›Melena

›Hematuria

›Dysuria

›Inability to void

›Back pain

›Headache

›Confusion

Special populations and modifiers

›Special populations and modifiers

›Pregnancy considerations

›Last menstrual period estimate

›Pregnancy symptoms

›Pediatrics

›Nonverbal pain cues

›Caregiver report reliability

›Older adults

›Baseline cognition

›Frailty and baseline function

›Anticoagulation and bleeding risk

›Warfarin

›DOAC

›Antiplatelet agents

›Intoxication and unreliable exam risk

›Alcohol

›Sedatives

›Head injury symptoms

02Alarm Features/alarm34

Hemodynamic and perfusion danger thresholds

›Hemodynamic and perfusion danger thresholds

›Shock physiology

›Systolic blood pressure under 90 mmHg

›Heart rate over 120

›Shock index over 0.9

›Altered mental status not otherwise explained

›Cool clammy skin

›Capillary refill delayed

›Immediate escalation triggers

›Persistent hypotension after fluid bolus

›Increasing vasopressor requirement

›Rapidly rising lactate

›Ongoing transfusion requirement

High risk history and exam findings

›High risk history and exam findings

›High risk mechanisms

›High speed collision

›Rollover

›Ejection

›Significant fall height

›High risk abdominal findings

›Peritonitis

›Rebound tenderness

›Guarding

›Abdominal distension with instability

›External markers of risk

›Seatbelt sign

›Abdominal wall ecchymosis

›Lower rib fractures

›Pelvic instability

›Unreliable examination

›Intoxication

›Altered mental status

›Spinal cord injury

›Distracting injuries

03Medications/meds28

Current medication exposure

›Current medication exposure

›Bleeding risk medications

›Warfarin

›Apixaban

›Rivaroxaban

›Dabigatran

›Edoxaban

›Aspirin

›Clopidogrel

›Ticagrelor

›Chronic disease medications relevant to shock

›Beta blockers

›Calcium channel blockers

›Diuretics

›Substance exposures

›Alcohol

›Opioids

›Stimulants

Contraindications and interaction traps

›Contraindications and interaction traps

›Analgesia cautions

›NSAID use with bleeding risk

›Opioid related hypoventilation risk

›Imaging contrast cautions

›Prior contrast reaction history

›Significant renal dysfunction history

›Anticoagulant reversal relevance

›Last dose timing estimate

›Availability of specific reversal agents local protocol dependent

04Diet/diet14

Recent intake and aspiration risk

›Recent intake and aspiration risk

›Last oral intake timing estimate

›Solid food

›Liquids

›Vomiting risk

›Active nausea

›Active emesis

Hydration and alcohol exposure

›Hydration and alcohol exposure

›Dehydration indicators

›Poor oral intake

›Reduced urine output

›Alcohol exposure

›Recent intake

›Intoxication affecting exam reliability

05Review of Systems/ros27

Cardiopulmonary and neurologic

›Cardiopulmonary and neurologic

›Cardiopulmonary

›Dyspnea

›Pleuritic chest pain

›Palpitations

›Syncope

›Neurologic

›Headache

›Confusion

›Focal weakness

›Seizure

Gastrointestinal and genitourinary

›Gastrointestinal and genitourinary

›Gastrointestinal bleeding

›Hematemesis

›Melena

›Hematochezia

›Hepatobiliary and pancreas clues

›RUQ pain

›Epigastric pain

›Genitourinary

›Hematuria

›Flank pain

›Inability to void

›Testicular pain

›Gynecologic

›Vaginal bleeding

›Pelvic pain

06Collateral History and Family History/chafh17

Collateral sources and reliability

›Collateral sources and reliability

›Source

›EMS report

›Bystander

›Family

›Police

›Reliability modifiers

›Intoxication

›Language barrier

›Baseline cognitive impairment

Family and social context

›Family and social context

›Family bleeding disorders

›Hemophilia

›Von Willebrand disease

›Social supports for discharge reliability

›Supervision available

›Ability to return if worse

07Risk Factors/rf26

Patient factors increasing missed injury risk

›Patient factors increasing missed injury risk

›Unreliable exam risk

›Altered mental status

›Intoxication

›Distracting injuries

›Bleeding risk

›Anticoagulation

›Antiplatelet therapy

›Chronic liver disease

›Immunocompromise and infection risk

›Steroids

›Chemotherapy

›HIV

Exposure and injury pattern risks

›Exposure and injury pattern risks

›Seatbelt sign risk pattern

›Hollow viscus injury

›Mesenteric injury

›Lower rib fracture risk pattern

›Splenic injury

›Hepatic injury

›Pelvic trauma risk pattern

›Retroperitoneal hemorrhage

›Bladder injury

›High energy deceleration risk pattern

›Aortic injury

›Solid organ laceration

08Differential Diagnosis/ddx55

Life threatening

›Life threatening

›Hemorrhagic shock from intraabdominal bleeding

›Solid organ injury

›Splenic laceration

›Hepatic laceration

›Renal injury

›Mesenteric vascular injury

›Rapid lactate rise

›Persistent tachycardia

›Hollow viscus perforation

›Peritonitis

›Delayed presentation possible

›Retroperitoneal hemorrhage

›Pelvic fracture association

›Flank ecchymosis association

›Abdominal compartment syndrome

›Rising airway pressures

›Worsening ventilation

›Oliguria

›Traumatic aortic injury

›High energy deceleration

›Chest findings coexisting

Common

›Common

›Abdominal wall contusion

›Localized tenderness

›Normal imaging

›Splenic injury

›LUQ tenderness

›Left shoulder tip pain

›Liver injury

›RUQ tenderness

›Transaminitis

›Renal contusion or laceration

›Flank pain

›Hematuria

›Musculoskeletal pain

›Rib fracture pain overlap

›Spine injury overlap

Less common and mimics

›Less common and mimics

›Pancreatic injury

›Epigastric pain

›Delayed enzyme rise possible

›Bladder rupture

›Gross hematuria

›Suprapubic pain

›Urethral injury

›Blood at meatus

›High riding prostate

›Nontraumatic mimics uncovered by trauma

›Ruptured ectopic pregnancy (O00)

›Positive pregnancy test

›Pelvic pain

›Abdominal aortic aneurysm rupture (I71.3)

›Older age

›Back or abdominal pain

09Past Medical History/pmh23

Relevant baseline conditions

›Relevant baseline conditions

›Bleeding and clotting history

›Prior major bleeding

›Prior VTE

›Liver disease

›Cirrhosis (K74.60)

›Portal hypertension history

›Kidney disease

›Chronic kidney disease (N18.9)

›Solitary kidney history

›Cardiopulmonary disease

›Coronary artery disease (I25.10)

›Heart failure (I50.9)

Prior procedures and devices

›Prior procedures and devices

›Abdominal surgery

›Adhesion risk

›Altered anatomy

›Transplant history

›Immunosuppression

›Graft injury considerations

›Implanted devices

›IVC filter

›Ventricular assist device

10Physical Exam/exam40

Primary survey focused findings

›Primary survey focused findings

›Airway and breathing

›Work of breathing

›Asymmetric breath sounds

›Circulation and perfusion

›Pulse quality

›Skin temperature

›Capillary refill

›Disability

›GCS trend

›Pupils

›Exposure

›Full skin exam for bruising

›Seatbelt sign

Abdominal and pelvic exam

›Abdominal and pelvic exam

›Abdomen

›Distension

›Tenderness localization

›Guarding

›Rebound tenderness

›Rigidity

›Peritoneal signs

›Worsening with percussion

›Pain with heel jar

›Flanks and back

›Flank tenderness

›Flank ecchymosis

›Pelvis

›Pelvic stability

›Pelvic tenderness

Genitourinary and rectal when indicated

›Genitourinary and rectal when indicated

›External genital exam

›Blood at urethral meatus

›Scrotal hematoma

›Rectal exam selective

›Gross blood

›Prostate position

›Neurovascular lower extremities

›Distal pulses

›Sensation changes

11Lab Studies/labs36

Initial trauma labs

›Initial trauma labs

›CBC

›Baseline hemoglobin trend importance

›Leukocytosis nonspecific

›Electrolytes and renal function

›Creatinine for contrast planning

›Potassium abnormalities in shock

›Liver enzymes

›Transaminitis as solid organ injury clue

›Normal values do not exclude injury

›Coagulation studies

›INR

›aPTT

›Type and screen

›Crossmatch if unstable

›Massive transfusion activation local protocol dependent

Perfusion and bleeding assessment adjuncts

›Perfusion and bleeding assessment adjuncts

›Lactate

›Elevated suggests hypoperfusion

›Trend more useful than single value

›Venous blood gas

›Metabolic acidosis clue

›pCO2 for ventilation adequacy

›Thromboelastography local protocol dependent

›Coagulopathy phenotype

›Targeted blood component therapy

Pregnancy and urinary testing

›Pregnancy and urinary testing

›Pregnancy test in patients with uterus of childbearing potential

›CT imaging implications

›Ectopic pregnancy mimic risk

›Urinalysis

›Microscopic hematuria

›Gross hematuria

›Creatine kinase when crush or rhabdomyolysis risk

›Hyperkalemia risk

›Acute kidney injury risk

12Imaging/img58

Scoring Systems

›Scoring systems and classifications

›AAST Organ Injury Scale

›Spleen liver kidney 2018 revision

›Radiologic criteria incorporated

›Renal trauma OIS revision

›2025 version availability

›Use for urology communication

›WSES splenic trauma classification

›Integrates hemodynamics and anatomy

›Guides nonoperative management pathways

›Shock index

›Over 0.9 higher risk of occult hemorrhage

›Beta blocker use may blunt tachycardia

MRI

›MRI considerations

›Limited role in acute blunt abdominal trauma

›Hemodynamically stable only

›Alternative when CT contraindicated selective

›Pregnancy selective use

›Noncontrast protocols preferred

›Gadolinium avoidance unless essential

›Biliary and pancreatic duct evaluation selective

›MRCP for suspected duct injury

›Often delayed or inpatient pathway

›CT abdomen pelvis with IV contrast

›Indications

›Hemodynamically stable with concerning mechanism or exam

›Unreliable exam

›Positive FAST in stable patient

›Protocol pearls

›IV contrast preferred for solid organ and vascular injury

›Oral contrast not routine in initial trauma pathways

›Key findings

›Active contrast extravasation

›Solid organ laceration grade

›Free fluid without solid organ injury

›Pneumoperitoneum

›Mesenteric hematoma

›Limitations and pitfalls

›Hollow viscus injury may be missed early

›Serial exam and repeat imaging when worsening

›Evidence notes

›EAST guideline archived notes CT sensitivity 92 to 97.6 percent

›EAST guideline archived notes CT specificity up to 98.7 percent

Ultrasound

›Ultrasound and FAST

›FAST protocol

›RUQ view

›LUQ view

›Pelvic view

›Pericardial view

›Interpretation pearls

›Positive FAST in unstable suggests hemorrhage source

›Small volume hemoperitoneum can be missed

›False negatives and false positives

›Early bleeding below detection threshold

›Obesity and subcutaneous air limit views

›Extended FAST adjunct

›Pleural fluid

›Pneumothorax findings

13Special Tests/spec20

Bedside and procedural diagnostics

›Bedside and procedural diagnostics

›Serial abdominal exams

›Repeat after analgesia

›Repeat after resuscitation

›Repeat FAST

›Worsening vitals

›Increasing abdominal distension

›Diagnostic peritoneal aspiration or lavage selective

›Unstable with equivocal FAST

›Positive result supports operative management

Genitourinary injury evaluation

›Genitourinary injury evaluation

›Retrograde urethrogram indication

›Blood at meatus

›Perineal hematoma

›CT cystography indication

›Gross hematuria with pelvic fracture

›Inability to void with pelvic trauma

›Foley catheter cautions

›Defer until urethral injury excluded when high suspicion

›Urology involvement when uncertain

14ECG/ecg17

When ECG is relevant in blunt abdominal trauma

›When ECG is relevant in blunt abdominal trauma

›Shock or syncope

›Arrhythmia screen

›Ischemia screen

›Chest pain or significant thoracoabdominal trauma

›Myocardial contusion consideration

›Concurrent ACS consideration in older adults

High risk ECG patterns and actions

›High risk ECG patterns and actions

›STEMI patterns

›Immediate reperfusion pathway

›Coordinate with trauma priorities

›Wide complex tachycardia

›Unstable cardioversion pathway

›Electrolyte causes evaluation

›Bradycardia with hypotension

›High grade AV block

›Pacing pathway local protocol dependent

15Assessment/ax24

Problem representation and severity

›Problem representation and severity

›Blunt abdominal trauma with suspected intraabdominal injury (S39.91XA)

›Hemodynamic status classification

›Exam reliability classification

›Hemorrhage risk stratification

›Unstable

›Transient responder

›Stable

›Complications to exclude

›Ongoing hemorrhage

›Hollow viscus injury

›Retroperitoneal bleed

›Abdominal compartment syndrome

Working diagnoses with supporting features

›Working diagnoses with supporting features

›Solid organ injury suspected

›LUQ or RUQ tenderness

›FAST positive

›Hollow viscus injury suspected

›Seatbelt sign

›Peritonitis

›Free fluid without solid organ injury on CT

›Genitourinary injury suspected

›Hematuria

›Pelvic fracture

16Plan/plan69

Approach to the critical patient

›Approach to the critical patient

›First 5 minutes workflow

›Resuscitation bay criteria

›Hypotension

›Altered mental status

›Respiratory distress

›Monitoring

›Cardiac monitor

›Continuous pulse oximetry

›Noninvasive blood pressure cycling

›IV access

›Two large bore peripheral IV

›Intraosseous if IV access delayed

›Labs and blood

›Type and screen

›Crossmatch if unstable

›Imaging priority

›FAST early

›CT only if stable

›Hemorrhage control and transfusion

›Massive transfusion protocol activation local protocol dependent

›Balanced blood products local protocol dependent

›Calcium replacement during large volume transfusion local protocol dependent

›TXA consideration

›Suspected major hemorrhage within 3 hours

›Contraindications local protocol dependent

Diagnostic sequencing

›Diagnostic sequencing

›Hemodynamically unstable pathway

›FAST first line

›Immediate surgical consultation

›OR if positive FAST with instability

›Hemodynamically stable pathway

›CT abdomen pelvis with IV contrast when concern persists

›Observation with serial exams when low risk and reliable exam

›Unreliable exam pathway

›CT favored when stable

›FAST plus CT complementary when indicated

Analgesia and supportive care

›Analgesia and supportive care

›Pain control principles

›Avoid masking peritonitis concern via reassessment loop

›Reassess exam after analgesia

›Adult dose examples

›Fentanyl IV 25 to 50 micrograms

›Repeat every 5 to 10 minutes to effect

›Caution in hypoventilation risk

›Hydromorphone IV 0.2 to 0.5 mg

›Repeat every 10 to 15 minutes to effect

›Reduce dose in older adults

›Acetaminophen PO 1000 mg

›Maximum 4000 mg per day

›Lower maximum in chronic liver disease

›Antiemetic adult dose examples

›Ondansetron IV 4 mg

›Repeat once if needed

›QT prolongation risk

Reassessment loop

›Reassessment loop

›Timing

›Every 15 minutes in unstable or borderline

›Every 30 to 60 minutes in stable observation

›What to repeat

›Vitals and shock index

›Abdominal exam

›Mental status

›Urine output when catheterized

›Escalation triggers

›New peritonitis

›Rising lactate

›Increasing transfusion requirement

›Worsening pain despite stable imaging

17Disposition/dispo25

ICU and operative criteria

›ICU and operative criteria

›Immediate OR criteria

›Hemodynamic instability with positive FAST

›Peritonitis

›Evisceration

›ICU criteria

›Ongoing vasopressor need

›Ongoing transfusion requirement

›Severe solid organ injury with high grade bleeding risk

›Severe traumatic brain injury with concurrent abdominal injury

Admission and observation criteria

›Admission and observation criteria

›Inpatient admission criteria

›Solid organ injury requiring monitoring

›Concern for delayed hollow viscus injury

›Significant comorbid bleeding risk

›Observation pathway criteria

›Stable vitals

›Reliable serial exam capability

›Pain controlled

›Discharge criteria

›Hemodynamically stable

›Reliable exam

›No concerning imaging findings

›Ambulation acceptable

›Reliable return precautions and supervision

18Discharge Instructions/di26

Copy discharge instructions

›Copy discharge instructions

›Summary

›You were evaluated after a blow to the abdomen

›Your tests today did not show a dangerous internal injury

›Medications

›Use acetaminophen as directed on the label unless told otherwise

›Avoid alcohol if using pain medicines that cause drowsiness

›Avoid NSAIDs if you were told you have bleeding risk or are on blood thinners

›Activity

›Rest for 24 hours

›No contact sports until cleared by a clinician if you had any organ injury concern

›Follow up

›Primary care or clinic follow up within 24 to 72 hours

›Earlier follow up if pain is worsening

›Return to the emergency department now for

›Fainting

›New or worsening shortness of breath

›New or worsening abdominal pain

›Vomiting that does not stop

›Blood in vomit

›Black stools

›Red blood in stool

›Blood in urine

›New confusion

›Weakness

›Fever

19References/r7

Guidelines and key sources

›Guidelines and key sources

›Project instructions source

›American College of Surgeons Committee on Trauma ATLS program information 2025

›EAST Practice Management Guidelines Blunt Abdominal Trauma Evaluation 2001 archived

›WSES Splenic trauma classification and guidelines 2017

›AAST Organ Injury Scale spleen liver kidney revision 2018

›AAST Organ Injury Scale renal trauma revision 2025

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.