Motor Vehicle Collision EvaluationAPPROACH

TRAUMA AND WOUNDS · 19 SECTIONS

⚲

617 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/hx82

Event context

›Scene and timeline

›Time since collision

›Found location and position

›Extrication duration

›Prehospital interventions

Onset

›Symptom onset

›Immediate after impact

›Delayed after collision

›Progressive since collision

Provocation/Palliation

›Modifiers

›Worse with movement

›Worse with deep inspiration

›Worse with weight bearing

›Relief with immobilization

›Relief with analgesics

Quality

›Symptom quality

›Sharp pain

›Dull pain

›Burning pain

›Pressure

›Numbness

Region/Radiation

›Symptom location pattern

›Head and face

›Neck

›Chest

›Abdomen

›Back

›Pelvis and groin

›Upper extremity

›Lower extremity

›Radiation to arm

›Radiation to leg

Severity

›Severity and functional impact

›Pain score

›Unable to ambulate

›Unable to use limb

›Dyspnea at rest

›Inability to tolerate oral intake

Timing

›Temporal pattern

›Constant

›Intermittent

›Worsening trajectory

›Improving trajectory

Mechanism of injury

›Crash characteristics

›Estimated speed

›Rollover

›Vehicle intrusion

›Airbag deployment

›Seatbelt use

›Ejection or partial ejection

›Death in same compartment

›Multiple impacts

›Pedestrian struck

›Motorcycle collision

Occupant factors

›Position and biomechanics

›Driver

›Front passenger

›Rear passenger

›Child car seat use

›Headrest position

›Steering wheel deformity

Symptoms after collision

›Associated symptoms

›Loss of consciousness

›Amnesia

›Headache

›Vomiting

›Seizure

›Neck pain

›Weakness

›Numbness

›Vision change

›Chest pain

›Dyspnea

›Abdominal pain

›Back pain

›Hematuria

Baseline status and prior episodes

›Preinjury baseline

›Baseline mobility and assist devices

›Prior spine disease

›Prior joint disease

›Prior concussion or TBI

›Prior bleeding events

02Alarm Features/alarm46

Immediate life threats

›Resuscitation triggers

›Airway compromise

›Respiratory failure

›Suspected tension pneumothorax

›Suspected cardiac tamponade

›Hemorrhagic shock

›Altered mental status with trauma

›Seizure after trauma

Vital sign danger thresholds

›High risk physiology

›SBP under 90 mmHg or age adjusted hypotension

›HR over 120

›RR under 10

›RR over 30

›SpO2 under 90 percent on room air

›Temperature under 35 C

High risk neuro features

›Central nervous system red flags

›GCS under 13

›Focal neurologic deficit

›Repeated vomiting

›Worsening headache

›Anticoagulation or bleeding diathesis with head trauma

High risk spine features

›Unstable spine risk

›Midline cervical tenderness

›Neurologic symptoms

›High energy mechanism

›Distracting injury

›Intoxication

High risk chest features

›Thoracic red flags

›Severe dyspnea

›New hypoxia

›Chest wall crepitus

›Significant chest wall deformity

›Massive hemoptysis

High risk abdominal and pelvic features

›Hemorrhage and hollow viscus risk

›Peritonitis

›Seatbelt sign with pain or tenderness

›Unstable pelvis

›Gross hematuria

›High energy deceleration with hypotension

High risk extremity features

›Limb threat

›Absent distal pulses

›Expanding hematoma

›Severe pain out of proportion

›Compartment syndrome concern

›Open fracture

›Traumatic amputation

03Medications/meds20

Current medications

›Medication reconciliation

›Anticoagulants

›Antiplatelets

›Insulin and diabetes agents

›Antihypertensives

›Opioids

›Benzodiazepines

›Antiseizure medications

Recent exposures

›Substances affecting exam and bleeding

›Alcohol

›Cannabis

›Stimulants

›Sedatives

High risk interactions for ED care

›Therapy constraints

›Opioid tolerance

›QT prolonging agents

›Nephrotoxic combinations

Time since last dose

›Antithrombotic timing

›Last anticoagulant dose time

›Last antiplatelet dose time

04Diet/diet8

Oral intake status

›Aspiration and operative planning

›Last oral intake time

›Nausea or vomiting

›Risk of aspiration

Hydration and exertional context

›Volume status context

›Poor intake prior to crash

›Heat exposure

›Prolonged entrapment

05Review of Systems/ros27

Neurologic

›Neuro symptoms

›Headache

›Dizziness

›Confusion

›Weakness

›Numbness

›Vision change

›Speech change

Cardiopulmonary

›Chest symptoms

›Chest pain

›Dyspnea

›Palpitations

›Syncope

›Hemoptysis

Abdominal and genitourinary

›Abdomen and GU symptoms

›Abdominal pain

›Nausea

›Vomiting

›Hematuria

›Flank pain

Musculoskeletal and skin

›MSK and integument

›Neck pain

›Back pain

›Joint pain

›Lacerations

›Swelling

›Bruising

06Collateral History and Family History/chafh13

Prehospital report

›EMS collateral

›Initial vitals and trends

›GCS and mental status trends

›Analgesia and sedatives given

›Immobilization and hemorrhage control

Witness and scene collateral

›External sources

›Police report elements

›Bystander observations

›Vehicle damage description

Family history relevant to risk

›Inherited and premature disease

›Early coronary disease

›Inherited bleeding disorders

›Sudden cardiac death history

07Risk Factors/rf23

Patient factors increasing injury risk

›Vulnerable populations

›Age 65 and older

›Pregnancy

›Anticoagulation

›Bleeding diathesis

›Osteoporosis

›Chronic kidney disease

›Alcohol use disorder

Mechanism risk factors

›High energy indicators

›Rollover

›Ejection

›High speed collision

›Intrusion into passenger compartment

›Pedestrian or cyclist struck

Thrombosis and bleeding context

›Coagulation risk

›Liver disease

›Platelet disorder

›Recent surgery

›Recent VTE

Occupational and environmental

›Exposure context

›Commercial driver

›Prolonged extrication

›Cold exposure

08Differential Diagnosis/ddx76

Life threatening

›Cannot miss injuries

›Intracranial hemorrhage

›Declining GCS

›Focal deficit

›Cervical spine fracture or dislocation

›Midline tenderness

›Neuro deficit

›Blunt thoracic aortic injury

›High speed deceleration

›Chest back pain

›Tension pneumothorax

›Hypoxia with hypotension

›Unilateral decreased breath sounds

›Massive hemothorax

›Shock

›Dullness to percussion

›Cardiac tamponade

›Hypotension

›JVD

›Blunt cardiac injury

›Arrhythmia

›Sternal fracture

›Solid organ hemorrhage

›Abdominal tenderness

›Hypotension

›Hollow viscus injury

›Seatbelt sign

›Peritonitis

›Pelvic fracture with hemorrhage

›Pelvic instability

›Shock

›Major extremity vascular injury

›Pulse deficit

›Expanding hematoma

Common

›Frequent diagnoses

›Concussion (S06.0X0)

›Headache

›Dizziness

›Cervical strain

›Paraspinal tenderness

›No neuro deficit

›Rib fracture

›Focal chest wall tenderness

›Pain with inspiration

›Pulmonary contusion

›Hypoxia

›Chest imaging opacities

›Musculoskeletal contusion and sprain

›Local tenderness

›Preserved neurovascular status

Less common

›Important less frequent injuries

›Blunt cerebrovascular injury

›Cervical seatbelt sign

›Neuro symptoms

›Traumatic diaphragmatic injury

›Dyspnea

›Abnormal chest imaging

›Spinal epidural hematoma

›Anticoagulation

›Progressive neuro deficit

›Compartment syndrome

›Pain out of proportion

›Pain with passive stretch

Mimics and pitfalls

›Nontraumatic causes uncovered by collision

›ACS (I21.9)

›Chest pain features

›ECG changes

›Aortic dissection (I71.0)

›Tearing pain

›Pulse deficit

›Seizure as precipitant

›Tongue bite

›Postictal state

›Syncope as precipitant

›Prodrome

›Exertional collapse

09Past Medical History/pmh16

Major comorbidities

›Conditions affecting risk and management

›CAD (I25.10)

›Heart failure (I50.9)

›COPD (J44.9)

›Diabetes (E11.9)

›Epilepsy (G40.909)

›Chronic pain and opioid use disorder (F11.9)

Prior procedures and devices

›Implanted or prior surgery

›Cervical spine surgery

›Joint replacement

›Pacemaker or ICD

›Ventriculoperitoneal shunt

Baseline function

›Functional baseline

›Baseline ambulation

›Baseline cognition

›Baseline oxygen requirement

10Physical Exam/exam55

Primary survey

›ABCDE

›Airway patency and protection

›Breathing symmetry and work of breathing

›Circulation perfusion and external bleeding

›Disability GCS and pupils

›Exposure hypothermia prevention

Vital signs interpretation

›Pattern recognition

›Shock index

›Orthostasis when appropriate

›Trend with analgesia and fluids

Head and face

›Craniofacial exam

›Scalp lacerations and hematoma

›Battle sign or raccoon eyes

›Midface instability

›Dental trauma

Neck and spine

›Spine exam

›Midline cervical tenderness

›Step off deformity

›Paraspinal tenderness

›Neuro symptoms with neck movement

Chest

›Thoracic exam

›Chest wall tenderness

›Crepitus

›Flail segment

›Breath sounds symmetry

›Heart sounds and muffling

Abdomen

›Abdominal exam

›Tenderness and guarding

›Distension

›Seatbelt sign

›Rebound

Pelvis and perineum

›Pelvic stability and bleeding

›Pelvic pain

›Pelvic instability

›Perineal ecchymosis

›Urethral bleeding

Extremities

›Limb exam

›Deformity

›Open wounds

›Range of motion limitation

›Distal pulses

›Capillary refill

›Sensation and motor function

Neurologic

›Neuro exam

›GCS components

›Pupils size and reactivity

›Cranial nerves screen

›Motor strength by limb

›Sensory level

›Coordination when appropriate

Skin and temperature

›Skin findings

›Lacerations

›Abrasions

›Bruising patterns

›Hypothermia signs

11Lab Studies/labs25

Core trauma labs

›Baseline and hemorrhage assessment

›CBC

›Electrolytes and creatinine

›Liver enzymes

›INR and aPTT

›Type and screen

Shock and perfusion

›Metabolic markers

›Lactate

›VBG or ABG

›Base deficit

Pregnancy testing

›Reproductive status

›Urine pregnancy test

›Serum beta hCG when needed

Cardiac injury evaluation

›Blunt cardiac injury workup

›Troponin

›Serial troponin when abnormal or symptomatic

Renal and GU injury markers

›Urinary findings

›Urinalysis

›Microscopic hematuria context

Toxicology when relevant

›Impairment assessment

›Blood alcohol level local protocol dependent

›Urine drug screen selective use

Pitfalls and limitations

›Timing limitations

›Early hemoglobin may be normal in acute hemorrhage

›Normal lactate does not exclude significant injury

12Imaging/img53

Scoring Systems

›Decision rules for imaging selection

›Canadian C Spine Rule

›Use in alert stable adults with trauma

›Not for penetrating trauma

›Not for known vertebral disease with instability concern

›NEXUS C Spine criteria

›Not low risk if midline tenderness

›Not low risk if intoxication

›Not low risk if altered alertness

›Not low risk if focal neuro deficit

›Not low risk if distracting injury

›Canadian CT Head Rule

›Use in minor head injury adults with GCS 13 to 15 and LOC amnesia or confusion

›Not for patients under 16

›Not for anticoagulation without local protocol integration

›PECARN pediatric head trauma

›Age under 2 pathway

›Age 2 and older pathway

›NEXUS Chest decision instrument

›Screening chest imaging selection in blunt trauma

›Local protocol dependent validation use

MRI

›MRI indications in blunt trauma

›Suspected ligamentous spine injury with normal CT and persistent neuro deficit

›Suspected spinal cord injury

›Suspected occult hip fracture with negative radiographs

›MRI constraints

›Hemodynamic instability

›MRI incompatible devices

›Time sensitivity favors CT in unstable patients

›CT head and cervical spine

›If GCS under 13 immediate CT head

›Anticoagulation with head strike local protocol dependent

›CT cervical spine preferred over radiographs in high risk adults

›CT chest abdomen pelvis

›Hemodynamic stability prerequisite

›High energy mechanism with concerning exam

›Contrast allergy risk stratification

›Renal function context

›CTA neck for blunt cerebrovascular injury

›Cervical seatbelt sign with neuro symptoms

›Cervical spine fracture patterns high risk

›High energy with basilar skull fracture

›CT pitfalls

›Early hollow viscus injury may be subtle

›Radiation risk higher in pregnancy and pediatrics

Ultrasound

›eFAST and POCUS

›Free fluid assessment in shock

›Pericardial effusion assessment

›Pneumothorax assessment

›Hemothorax assessment

›Ultrasound pitfalls

›Negative FAST does not exclude solid organ injury in stable patients

›Obesity and subcutaneous emphysema reduce sensitivity

13Special Tests/spec17

Bedside trauma adjuncts

›Point of care procedures and measures

›eFAST interpretation with hemodynamics

›Pelvic binder placement when unstable pelvis suspected

›Tourniquet use for life threatening extremity hemorrhage

Extremity vascular assessment

›Vascular injury evaluation

›ABI for extremity trauma

›Hard signs prompt immediate surgical consult

›Soft signs prompt imaging and observation

Blunt cardiac injury evaluation

›Screening strategy

›ECG abnormalities trigger monitoring

›Normal ECG and troponin reduce likelihood of significant injury

Spine clearance approach

›Clinical clearance conditions

›Alert and cooperative

›No intoxication

›No distracting injury

›No neuro deficit

›No midline tenderness

14ECG/ecg16

Indications in MVC

›When ECG adds value

›Chest pain

›Dyspnea

›Syncope or suspected precipitating event

›Significant anterior chest impact

›Sternal fracture concern

High risk ECG patterns

›Red flags

›New ST elevation or depression

›New bundle branch block

›Ventricular dysrhythmia

›High grade AV block

›Frequent PVCs with symptoms

Serial ECG logic

›Repeats when indicated

›Ongoing chest pain

›Abnormal initial ECG

›Troponin elevation

15Assessment/ax29

Trauma severity stratification

›Level of activation framing

›Physiologic criteria

›Anatomic injury criteria

›Mechanism criteria

›Special population criteria

Working problem list

›Injury based assessment

›Head injury concern

›GCS trend

›Anticoagulation status

›Cervical spine injury concern

›Midline tenderness

›Neuro findings

›Thoracic injury concern

›Hypoxia

›Chest wall findings

›Abdominal injury concern

›Tenderness or peritonitis

›Seatbelt sign

›Pelvic injury concern

›Pelvic pain

›Instability

›Extremity injury concern

›Deformity

›Neurovascular status

Complications to exclude

›High consequence exclusions

›Occult hemorrhage

›Blunt cerebrovascular injury

›Compartment syndrome

›Missed open fracture or tendon injury

16Plan/plan41

First 5 minutes

›Time critical workflow

›Trauma team activation per local protocol

›Monitors and continuous pulse oximetry

›Two large bore IV or IO if needed

›Oxygen if SpO2 under 94 percent

›Cervical spine precautions until cleared

›Immediate hemorrhage control

›Warming measures

Resuscitation and hemorrhage

›Shock management

›Balanced transfusion strategy if hemorrhagic shock suspected local protocol dependent

›Massive transfusion protocol activation criteria local protocol dependent

›TXA within 3 hours for severe hemorrhage or high risk of hemorrhage local protocol dependent

Analgesia and sedation

›Pain control options

›Acetaminophen PO or IV 1000 mg once then 1000 mg every 6 hours maximum 4000 mg per day

›Ibuprofen PO 400 mg every 6 hours as needed

›Ketorolac IV 15 mg once then 15 mg every 6 hours as needed maximum 60 mg per day

›Fentanyl IV 25 mcg increments every 5 minutes to effect

›Hydromorphone IV 0.2 mg increments every 5 to 10 minutes to effect

›Analgesia cautions

›Avoid NSAIDs in significant bleeding risk

›Avoid oversedation obscuring neuro exam

Imaging and testing sequence

›Diagnostic pathway

›CXR and pelvis radiograph in unstable patients

›eFAST in shock

›CT pan scan selection based on stability and exam local protocol dependent

Wound and fracture care

›Soft tissue and bone care

›Tetanus update per immunization status

›Open fracture antibiotics local protocol dependent

›Splinting and immobilization

›Compartment syndrome monitoring

Reassessment loop

›Iterative checks

›Repeat vitals every 15 to 30 minutes until stable

›Repeat neuro exam after analgesia and imaging

›Repeat abdominal exam at 2 to 4 hours when observation chosen

›Escalation if new hypotension hypoxia or mental status change

Consultation

›Specialty involvement

›Trauma surgery

›Neurosurgery for intracranial hemorrhage or unstable spine

›Orthopedics for fractures and dislocations

›Vascular surgery for suspected vascular injury

›OB for pregnancy trauma local protocol dependent

17Disposition/dispo27

ICU criteria

›Critical care indications

›Ongoing vasopressor or transfusion requirement

›Respiratory failure or impending airway compromise

›Severe TBI

›Unstable spine injury with neuro compromise

Inpatient admission criteria

›Admission indications

›Intracranial hemorrhage or concerning CT findings

›Unstable fractures

›Solid organ injury

›Persistent hypoxia

›Blunt cardiac injury with abnormal ECG or troponin

Observation pathway

›Observation candidates

›Mild TBI with persistent symptoms and normal imaging

›Abdominal pain with negative CT but ongoing tenderness

›Serial exams needed due to intoxication or distracting injuries

Transfer criteria

›Trauma center transfer triggers

›Need for surgery not available

›Polytrauma with high resource needs

›Severe TBI

›Unstable pelvic fracture

Discharge criteria

›Safe discharge requirements

›Hemodynamically stable

›Pain controlled with oral meds

›Ambulation safe or baseline mobility confirmed

›Normal neuro exam or stable mild concussion plan

›Reliable supervision and return access

›Clear follow up plan

18Discharge Instructions/di30

Copy discharge instructions

›Summary

›You were evaluated after a motor vehicle collision

›Your exam and tests today did not show a dangerous injury that needs admission

›Expected symptoms

›Muscle soreness and stiffness can worsen over the next 24 to 48 hours

›Bruising may increase over the next few days

›Pain control

›Acetaminophen as directed on the label

›Ibuprofen as directed on the label unless you were told to avoid it

›Avoid alcohol or sedatives if using opioid pain medicine

›Activity

›No driving if you feel dizzy sleepy or are taking sedating medicines

›Gradual return to normal activity as tolerated

›Avoid contact sports until concussion symptoms are gone if you had a head injury

›Wound care

›Keep wounds clean and dry for the first day unless told otherwise

›Return for redness pus fever or worsening pain at a wound site

›Follow up

›Primary care follow up within 2 to 3 days

›Return sooner if symptoms are not improving

›Return to ED now for

›Trouble breathing or chest pain

›Worsening headache repeated vomiting or confusion

›Weakness numbness trouble walking or new vision or speech problems

›Fainting

›Increasing abdominal pain or belly swelling

›Blood in urine or inability to urinate

›New severe back or neck pain

›Increasing limb swelling severe pain or color change

›Fever or chills

19References/r13

Evidence based sources

›Core trauma guidance

›ACS Committee on Trauma ATLS Student Course Manual latest edition local protocol dependent

›Eastern Association for the Surgery of Trauma practice management guidelines

›World Society of Emergency Surgery guidelines for trauma topics local protocol dependent

›Decision rules

›Canadian C Spine Rule derivation and validation

›NEXUS C Spine criteria derivation and validation

›Canadian CT Head Rule derivation and validation

›PECARN pediatric head trauma rule derivation and validation

›NEXUS Chest decision instrument studies

›Hemorrhage and TXA

›CRASH 2 trial tranexamic acid in trauma 2010

›CRASH 3 trial tranexamic acid in traumatic brain injury 2019

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.

Motor Vehicle Collision EvaluationAPPROACH

TRAUMA AND WOUNDS · 19 SECTIONS

⚲

617 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/hx82

Event context

›Scene and timeline

›Time since collision

›Found location and position

›Extrication duration

›Prehospital interventions

Onset

›Symptom onset

›Immediate after impact

›Delayed after collision

›Progressive since collision

Provocation/Palliation

›Modifiers

›Worse with movement

›Worse with deep inspiration

›Worse with weight bearing

›Relief with immobilization

›Relief with analgesics

Quality

›Symptom quality

›Sharp pain

›Dull pain

›Burning pain

›Pressure

›Numbness

Region/Radiation

›Symptom location pattern

›Head and face

›Neck

›Chest

›Abdomen

›Back

›Pelvis and groin

›Upper extremity

›Lower extremity

›Radiation to arm

›Radiation to leg

Severity

›Severity and functional impact

›Pain score

›Unable to ambulate

›Unable to use limb

›Dyspnea at rest

›Inability to tolerate oral intake

Timing

›Temporal pattern

›Constant

›Intermittent

›Worsening trajectory

›Improving trajectory

Mechanism of injury

›Crash characteristics

›Estimated speed

›Rollover

›Vehicle intrusion

›Airbag deployment

›Seatbelt use

›Ejection or partial ejection

›Death in same compartment

›Multiple impacts

›Pedestrian struck

›Motorcycle collision

Occupant factors

›Position and biomechanics

›Driver

›Front passenger

›Rear passenger

›Child car seat use

›Headrest position

›Steering wheel deformity

Symptoms after collision

›Associated symptoms

›Loss of consciousness

›Amnesia

›Headache

›Vomiting

›Seizure

›Neck pain

›Weakness

›Numbness

›Vision change

›Chest pain

›Dyspnea

›Abdominal pain

›Back pain

›Hematuria

Baseline status and prior episodes

›Preinjury baseline

›Baseline mobility and assist devices

›Prior spine disease

›Prior joint disease

›Prior concussion or TBI

›Prior bleeding events

02Alarm Features/alarm46

Immediate life threats

›Resuscitation triggers

›Airway compromise

›Respiratory failure

›Suspected tension pneumothorax

›Suspected cardiac tamponade

›Hemorrhagic shock

›Altered mental status with trauma

›Seizure after trauma

Vital sign danger thresholds

›High risk physiology

›SBP under 90 mmHg or age adjusted hypotension

›HR over 120

›RR under 10

›RR over 30

›SpO2 under 90 percent on room air

›Temperature under 35 C

High risk neuro features

›Central nervous system red flags

›GCS under 13

›Focal neurologic deficit

›Repeated vomiting

›Worsening headache

›Anticoagulation or bleeding diathesis with head trauma

High risk spine features

›Unstable spine risk

›Midline cervical tenderness

›Neurologic symptoms

›High energy mechanism

›Distracting injury

›Intoxication

High risk chest features

›Thoracic red flags

›Severe dyspnea

›New hypoxia

›Chest wall crepitus

›Significant chest wall deformity

›Massive hemoptysis

High risk abdominal and pelvic features

›Hemorrhage and hollow viscus risk

›Peritonitis

›Seatbelt sign with pain or tenderness

›Unstable pelvis

›Gross hematuria

›High energy deceleration with hypotension

High risk extremity features

›Limb threat

›Absent distal pulses

›Expanding hematoma

›Severe pain out of proportion

›Compartment syndrome concern

›Open fracture

›Traumatic amputation

03Medications/meds20

Current medications

›Medication reconciliation

›Anticoagulants

›Antiplatelets

›Insulin and diabetes agents

›Antihypertensives

›Opioids

›Benzodiazepines

›Antiseizure medications

Recent exposures

›Substances affecting exam and bleeding

›Alcohol

›Cannabis

›Stimulants

›Sedatives

High risk interactions for ED care

›Therapy constraints

›Opioid tolerance

›QT prolonging agents

›Nephrotoxic combinations

Time since last dose

›Antithrombotic timing

›Last anticoagulant dose time

›Last antiplatelet dose time

04Diet/diet8

Oral intake status

›Aspiration and operative planning

›Last oral intake time

›Nausea or vomiting

›Risk of aspiration

Hydration and exertional context

›Volume status context

›Poor intake prior to crash

›Heat exposure

›Prolonged entrapment

05Review of Systems/ros27

Neurologic

›Neuro symptoms

›Headache

›Dizziness

›Confusion

›Weakness

›Numbness

›Vision change

›Speech change

Cardiopulmonary

›Chest symptoms

›Chest pain

›Dyspnea

›Palpitations

›Syncope

›Hemoptysis

Abdominal and genitourinary

›Abdomen and GU symptoms

›Abdominal pain

›Nausea

›Vomiting

›Hematuria

›Flank pain

Musculoskeletal and skin

›MSK and integument

›Neck pain

›Back pain

›Joint pain

›Lacerations

›Swelling

›Bruising

06Collateral History and Family History/chafh13

Prehospital report

›EMS collateral

›Initial vitals and trends

›GCS and mental status trends

›Analgesia and sedatives given

›Immobilization and hemorrhage control

Witness and scene collateral

›External sources

›Police report elements

›Bystander observations

›Vehicle damage description

Family history relevant to risk

›Inherited and premature disease

›Early coronary disease

›Inherited bleeding disorders

›Sudden cardiac death history

07Risk Factors/rf23

Patient factors increasing injury risk

›Vulnerable populations

›Age 65 and older

›Pregnancy

›Anticoagulation

›Bleeding diathesis

›Osteoporosis

›Chronic kidney disease

›Alcohol use disorder

Mechanism risk factors

›High energy indicators

›Rollover

›Ejection

›High speed collision

›Intrusion into passenger compartment

›Pedestrian or cyclist struck

Thrombosis and bleeding context

›Coagulation risk

›Liver disease

›Platelet disorder

›Recent surgery

›Recent VTE

Occupational and environmental

›Exposure context

›Commercial driver

›Prolonged extrication

›Cold exposure

08Differential Diagnosis/ddx76

Life threatening

›Cannot miss injuries

›Intracranial hemorrhage

›Declining GCS

›Focal deficit

›Cervical spine fracture or dislocation

›Midline tenderness

›Neuro deficit

›Blunt thoracic aortic injury

›High speed deceleration

›Chest back pain

›Tension pneumothorax

›Hypoxia with hypotension

›Unilateral decreased breath sounds

›Massive hemothorax

›Shock

›Dullness to percussion

›Cardiac tamponade

›Hypotension

›JVD

›Blunt cardiac injury

›Arrhythmia

›Sternal fracture

›Solid organ hemorrhage

›Abdominal tenderness

›Hypotension

›Hollow viscus injury

›Seatbelt sign

›Peritonitis

›Pelvic fracture with hemorrhage

›Pelvic instability

›Shock

›Major extremity vascular injury

›Pulse deficit

›Expanding hematoma

Common

›Frequent diagnoses

›Concussion (S06.0X0)

›Headache

›Dizziness

›Cervical strain

›Paraspinal tenderness

›No neuro deficit

›Rib fracture

›Focal chest wall tenderness

›Pain with inspiration

›Pulmonary contusion

›Hypoxia

›Chest imaging opacities

›Musculoskeletal contusion and sprain

›Local tenderness

›Preserved neurovascular status

Less common

›Important less frequent injuries

›Blunt cerebrovascular injury

›Cervical seatbelt sign

›Neuro symptoms

›Traumatic diaphragmatic injury

›Dyspnea

›Abnormal chest imaging

›Spinal epidural hematoma

›Anticoagulation

›Progressive neuro deficit

›Compartment syndrome

›Pain out of proportion

›Pain with passive stretch

Mimics and pitfalls

›Nontraumatic causes uncovered by collision

›ACS (I21.9)

›Chest pain features

›ECG changes

›Aortic dissection (I71.0)

›Tearing pain

›Pulse deficit

›Seizure as precipitant

›Tongue bite

›Postictal state

›Syncope as precipitant

›Prodrome

›Exertional collapse

09Past Medical History/pmh16

Major comorbidities

›Conditions affecting risk and management

›CAD (I25.10)

›Heart failure (I50.9)

›COPD (J44.9)

›Diabetes (E11.9)

›Epilepsy (G40.909)

›Chronic pain and opioid use disorder (F11.9)

Prior procedures and devices

›Implanted or prior surgery

›Cervical spine surgery

›Joint replacement

›Pacemaker or ICD

›Ventriculoperitoneal shunt

Baseline function

›Functional baseline

›Baseline ambulation

›Baseline cognition

›Baseline oxygen requirement

10Physical Exam/exam55

Primary survey

›ABCDE

›Airway patency and protection

›Breathing symmetry and work of breathing

›Circulation perfusion and external bleeding

›Disability GCS and pupils

›Exposure hypothermia prevention

Vital signs interpretation

›Pattern recognition

›Shock index

›Orthostasis when appropriate

›Trend with analgesia and fluids

Head and face

›Craniofacial exam

›Scalp lacerations and hematoma

›Battle sign or raccoon eyes

›Midface instability

›Dental trauma

Neck and spine

›Spine exam

›Midline cervical tenderness

›Step off deformity

›Paraspinal tenderness

›Neuro symptoms with neck movement

Chest

›Thoracic exam

›Chest wall tenderness

›Crepitus

›Flail segment

›Breath sounds symmetry

›Heart sounds and muffling

Abdomen

›Abdominal exam

›Tenderness and guarding

›Distension

›Seatbelt sign

›Rebound

Pelvis and perineum

›Pelvic stability and bleeding

›Pelvic pain

›Pelvic instability

›Perineal ecchymosis

›Urethral bleeding

Extremities

›Limb exam

›Deformity

›Open wounds

›Range of motion limitation

›Distal pulses

›Capillary refill

›Sensation and motor function

Neurologic

›Neuro exam

›GCS components

›Pupils size and reactivity

›Cranial nerves screen

›Motor strength by limb

›Sensory level

›Coordination when appropriate

Skin and temperature

›Skin findings

›Lacerations

›Abrasions

›Bruising patterns

›Hypothermia signs

11Lab Studies/labs25

Core trauma labs

›Baseline and hemorrhage assessment

›CBC

›Electrolytes and creatinine

›Liver enzymes

›INR and aPTT

›Type and screen

Shock and perfusion

›Metabolic markers

›Lactate

›VBG or ABG

›Base deficit

Pregnancy testing

›Reproductive status

›Urine pregnancy test

›Serum beta hCG when needed

Cardiac injury evaluation

›Blunt cardiac injury workup

›Troponin

›Serial troponin when abnormal or symptomatic

Renal and GU injury markers

›Urinary findings

›Urinalysis

›Microscopic hematuria context

Toxicology when relevant

›Impairment assessment

›Blood alcohol level local protocol dependent

›Urine drug screen selective use

Pitfalls and limitations

›Timing limitations

›Early hemoglobin may be normal in acute hemorrhage

›Normal lactate does not exclude significant injury

12Imaging/img53

Scoring Systems

›Decision rules for imaging selection

›Canadian C Spine Rule

›Use in alert stable adults with trauma

›Not for penetrating trauma

›Not for known vertebral disease with instability concern

›NEXUS C Spine criteria

›Not low risk if midline tenderness

›Not low risk if intoxication

›Not low risk if altered alertness

›Not low risk if focal neuro deficit

›Not low risk if distracting injury

›Canadian CT Head Rule

›Use in minor head injury adults with GCS 13 to 15 and LOC amnesia or confusion

›Not for patients under 16

›Not for anticoagulation without local protocol integration

›PECARN pediatric head trauma

›Age under 2 pathway

›Age 2 and older pathway

›NEXUS Chest decision instrument

›Screening chest imaging selection in blunt trauma

›Local protocol dependent validation use

MRI

›MRI indications in blunt trauma

›Suspected ligamentous spine injury with normal CT and persistent neuro deficit

›Suspected spinal cord injury

›Suspected occult hip fracture with negative radiographs

›MRI constraints

›Hemodynamic instability

›MRI incompatible devices

›Time sensitivity favors CT in unstable patients

›CT head and cervical spine

›If GCS under 13 immediate CT head

›Anticoagulation with head strike local protocol dependent

›CT cervical spine preferred over radiographs in high risk adults

›CT chest abdomen pelvis

›Hemodynamic stability prerequisite

›High energy mechanism with concerning exam

›Contrast allergy risk stratification

›Renal function context

›CTA neck for blunt cerebrovascular injury

›Cervical seatbelt sign with neuro symptoms

›Cervical spine fracture patterns high risk

›High energy with basilar skull fracture

›CT pitfalls

›Early hollow viscus injury may be subtle

›Radiation risk higher in pregnancy and pediatrics

Ultrasound

›eFAST and POCUS

›Free fluid assessment in shock

›Pericardial effusion assessment

›Pneumothorax assessment

›Hemothorax assessment

›Ultrasound pitfalls

›Negative FAST does not exclude solid organ injury in stable patients

›Obesity and subcutaneous emphysema reduce sensitivity

13Special Tests/spec17

Bedside trauma adjuncts

›Point of care procedures and measures

›eFAST interpretation with hemodynamics

›Pelvic binder placement when unstable pelvis suspected

›Tourniquet use for life threatening extremity hemorrhage

Extremity vascular assessment

›Vascular injury evaluation

›ABI for extremity trauma

›Hard signs prompt immediate surgical consult

›Soft signs prompt imaging and observation

Blunt cardiac injury evaluation

›Screening strategy

›ECG abnormalities trigger monitoring

›Normal ECG and troponin reduce likelihood of significant injury

Spine clearance approach

›Clinical clearance conditions

›Alert and cooperative

›No intoxication

›No distracting injury

›No neuro deficit

›No midline tenderness

14ECG/ecg16

Indications in MVC

›When ECG adds value

›Chest pain

›Dyspnea

›Syncope or suspected precipitating event

›Significant anterior chest impact

›Sternal fracture concern

High risk ECG patterns

›Red flags

›New ST elevation or depression

›New bundle branch block

›Ventricular dysrhythmia

›High grade AV block

›Frequent PVCs with symptoms

Serial ECG logic

›Repeats when indicated

›Ongoing chest pain

›Abnormal initial ECG

›Troponin elevation

15Assessment/ax29

Trauma severity stratification

›Level of activation framing

›Physiologic criteria

›Anatomic injury criteria

›Mechanism criteria

›Special population criteria

Working problem list

›Injury based assessment

›Head injury concern

›GCS trend

›Anticoagulation status

›Cervical spine injury concern

›Midline tenderness

›Neuro findings

›Thoracic injury concern

›Hypoxia

›Chest wall findings

›Abdominal injury concern

›Tenderness or peritonitis

›Seatbelt sign

›Pelvic injury concern

›Pelvic pain

›Instability

›Extremity injury concern

›Deformity

›Neurovascular status

Complications to exclude

›High consequence exclusions

›Occult hemorrhage

›Blunt cerebrovascular injury

›Compartment syndrome

›Missed open fracture or tendon injury

16Plan/plan41

First 5 minutes

›Time critical workflow

›Trauma team activation per local protocol

›Monitors and continuous pulse oximetry

›Two large bore IV or IO if needed

›Oxygen if SpO2 under 94 percent

›Cervical spine precautions until cleared

›Immediate hemorrhage control

›Warming measures

Resuscitation and hemorrhage

›Shock management

›Balanced transfusion strategy if hemorrhagic shock suspected local protocol dependent

›Massive transfusion protocol activation criteria local protocol dependent

›TXA within 3 hours for severe hemorrhage or high risk of hemorrhage local protocol dependent

Analgesia and sedation

›Pain control options

›Acetaminophen PO or IV 1000 mg once then 1000 mg every 6 hours maximum 4000 mg per day

›Ibuprofen PO 400 mg every 6 hours as needed

›Ketorolac IV 15 mg once then 15 mg every 6 hours as needed maximum 60 mg per day

›Fentanyl IV 25 mcg increments every 5 minutes to effect

›Hydromorphone IV 0.2 mg increments every 5 to 10 minutes to effect

›Analgesia cautions

›Avoid NSAIDs in significant bleeding risk

›Avoid oversedation obscuring neuro exam

Imaging and testing sequence

›Diagnostic pathway

›CXR and pelvis radiograph in unstable patients

›eFAST in shock

›CT pan scan selection based on stability and exam local protocol dependent

Wound and fracture care

›Soft tissue and bone care

›Tetanus update per immunization status

›Open fracture antibiotics local protocol dependent

›Splinting and immobilization

›Compartment syndrome monitoring

Reassessment loop

›Iterative checks

›Repeat vitals every 15 to 30 minutes until stable

›Repeat neuro exam after analgesia and imaging

›Repeat abdominal exam at 2 to 4 hours when observation chosen

›Escalation if new hypotension hypoxia or mental status change

Consultation

›Specialty involvement

›Trauma surgery

›Neurosurgery for intracranial hemorrhage or unstable spine

›Orthopedics for fractures and dislocations

›Vascular surgery for suspected vascular injury

›OB for pregnancy trauma local protocol dependent

17Disposition/dispo27

ICU criteria

›Critical care indications

›Ongoing vasopressor or transfusion requirement

›Respiratory failure or impending airway compromise

›Severe TBI

›Unstable spine injury with neuro compromise

Inpatient admission criteria

›Admission indications

›Intracranial hemorrhage or concerning CT findings

›Unstable fractures

›Solid organ injury

›Persistent hypoxia

›Blunt cardiac injury with abnormal ECG or troponin

Observation pathway

›Observation candidates

›Mild TBI with persistent symptoms and normal imaging

›Abdominal pain with negative CT but ongoing tenderness

›Serial exams needed due to intoxication or distracting injuries

Transfer criteria

›Trauma center transfer triggers

›Need for surgery not available

›Polytrauma with high resource needs

›Severe TBI

›Unstable pelvic fracture

Discharge criteria

›Safe discharge requirements

›Hemodynamically stable

›Pain controlled with oral meds

›Ambulation safe or baseline mobility confirmed

›Normal neuro exam or stable mild concussion plan

›Reliable supervision and return access

›Clear follow up plan

18Discharge Instructions/di30

Copy discharge instructions

›Summary

›You were evaluated after a motor vehicle collision

›Your exam and tests today did not show a dangerous injury that needs admission

›Expected symptoms

›Muscle soreness and stiffness can worsen over the next 24 to 48 hours

›Bruising may increase over the next few days

›Pain control

›Acetaminophen as directed on the label

›Ibuprofen as directed on the label unless you were told to avoid it

›Avoid alcohol or sedatives if using opioid pain medicine

›Activity

›No driving if you feel dizzy sleepy or are taking sedating medicines

›Gradual return to normal activity as tolerated

›Avoid contact sports until concussion symptoms are gone if you had a head injury

›Wound care

›Keep wounds clean and dry for the first day unless told otherwise

›Return for redness pus fever or worsening pain at a wound site

›Follow up

›Primary care follow up within 2 to 3 days

›Return sooner if symptoms are not improving

›Return to ED now for

›Trouble breathing or chest pain

›Worsening headache repeated vomiting or confusion

›Weakness numbness trouble walking or new vision or speech problems

›Fainting

›Increasing abdominal pain or belly swelling

›Blood in urine or inability to urinate

›New severe back or neck pain

›Increasing limb swelling severe pain or color change

›Fever or chills

19References/r13

Evidence based sources

›Core trauma guidance

›ACS Committee on Trauma ATLS Student Course Manual latest edition local protocol dependent

›Eastern Association for the Surgery of Trauma practice management guidelines

›World Society of Emergency Surgery guidelines for trauma topics local protocol dependent

›Decision rules

›Canadian C Spine Rule derivation and validation

›NEXUS C Spine criteria derivation and validation

›Canadian CT Head Rule derivation and validation

›PECARN pediatric head trauma rule derivation and validation

›NEXUS Chest decision instrument studies

›Hemorrhage and TXA

›CRASH 2 trial tranexamic acid in trauma 2010

›CRASH 3 trial tranexamic acid in traumatic brain injury 2019

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.