Browse categories and answer follow-up questions to refine your symptom profile.
History
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
Alarm Features
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
Medications
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
Diet
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
Review of Systems
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
Collateral History and Family History
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
Risk Factors
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
Differential Diagnosis
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
Past Medical History
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
Physical Exam
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
Lab Studies
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
Imaging
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
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
Special Tests
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
ECG
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
Assessment
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
Plan
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
Disposition
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
Discharge Instructions
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
References
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
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.