Browse categories and answer follow-up questions to refine your symptom profile.
History
Mechanism and scene
Mechanism and scene
Time since injury
Number of wounds
Weapon type
Stab wound
Gunshot wound
Impalement
Range
Contact
Close range
Unknown
Caliber and projectile characteristics
Knife length estimate
Suspected trajectory
Clothing and intermediate targets
Prehospital hemorrhage control
Tourniquet
Hemostatic dressing
Direct pressure
Prehospital interventions
Needle decompression
Airway interventions
IV or IO access
Prehospital vitals trend
Prehospital fluids or blood products
Symptoms and functional impact
Symptoms and function
Dyspnea
Chest pain
Hoarseness
Dysphagia
Hematemesis
Hemoptysis
Abdominal pain
Nausea
Vomiting
Hematuria
Rectal bleeding
Limb pain
Paresthesia
Weakness
Cold limb
Loss of function distal to wound
Bleeding history and prior baseline
Bleeding and baseline
Witnessed pulsatile bleeding
Syncope or near syncope
Baseline neurologic function
Baseline ambulatory status
Prior vascular disease symptoms
Prior thoracic or abdominal surgery
Prior episodes and context
Prior episodes and context
Prior trauma to same region
Prior vascular repair
Prior tracheostomy or neck surgery
Alarm Features
Immediate resuscitation triggers
Immediate resuscitation triggers
Hemodynamic instability
SBP less than 90 mmHg adult
Age adjusted hypotension pediatrics
Altered mental status not explained
Respiratory failure
Active uncontrolled hemorrhage
Expanding hematoma
Airway compromise
Hard signs of vascular injury
Hard signs of vascular injury
Pulsatile bleeding
Expanding hematoma
Bruit or thrill over wound
Distal ischemia
Absent distal pulses
Pale cool limb
Paralysis
Severe pain out of proportion
High risk regional red flags
High risk regional red flags
Neck
Stridor
Hoarseness
Air bubbling from wound
Massive hemoptysis
Massive hematemesis
Neurologic deficit
Chest
Cardiac tamponade physiology
Persistent hypotension with thoracic injury
Massive hemothorax
Persistent air leak
Abdomen
Peritonitis
Evisceration
Impalement with fixed object
Extremity
Compartment syndrome features
Open fracture with hemorrhage
Progressive neurologic deficit
Medications
Antithrombotic and bleeding relevant medications
Bleeding relevant medications
Anticoagulants
Warfarin
Direct oral anticoagulants
Low molecular weight heparin
Unfractionated heparin
Antiplatelets
Aspirin
P2Y12 inhibitors
NSAIDs
Allergies and perioperative considerations
Allergies and perioperative considerations
Antibiotic allergies
Contrast reactions
Prior anesthesia complications
Recent medication changes and adherence
Recent changes and adherence
Missed doses
Recent initiation of anticoagulant
Recent dose increase
Diet
Recent intake relevant to aspiration and surgery
Recent intake
Time of last oral intake
Alcohol ingestion
Recreational substances
Hydration and metabolic risk
Hydration and metabolic risk
Poor intake
Vomiting
Dehydration symptoms
Review of Systems
Targeted trauma ROS
Targeted trauma ROS
Constitutional
Fever
Chills
Cardiopulmonary
Dyspnea
Chest pain
Palpitations
Gastrointestinal
Abdominal pain
Nausea
Vomiting
Hematemesis
Melena
Hematochezia
Genitourinary
Hematuria
Dysuria
Neurologic
Headache
Weakness
Numbness
Visual changes
Musculoskeletal
Limb pain
Loss of function
Collateral History and Family History
Collateral and reliability
Collateral and reliability
EMS report
Police report
Bystander report
Patient reliability
Family history and inherited bleeding risk
Family history
Bleeding disorders
Early cardiovascular disease
Known connective tissue disorders
Risk Factors
Patient factors increasing severity
Patient factors
Older age
Pregnancy
Anticoagulation
Thrombocytopenia history
Chronic liver disease
Chronic kidney disease
Coronary artery disease
Heart failure
COPD
Diabetes mellitus (E11.9)
Exposure and context risks
Exposure and context
High velocity firearm concern
Multiple wounds
Delayed presentation
Contaminated wound environment
Assault with associated blunt trauma
Device and procedure related risks
Device and procedure related risks
Prior vascular graft
Implanted cardioverter defibrillator
Central venous catheter history
Differential Diagnosis
Life threatening
Life threatening diagnoses
Exsanguinating hemorrhage
Major vascular injury
Junctional hemorrhage
Tension pneumothorax
Massive hemothorax
Cardiac tamponade
Penetrating cardiac injury
Tracheobronchial injury
Esophageal perforation
Major airway injury
Hollow viscus perforation
Solid organ laceration with hemorrhage
Pelvic vascular injury
Spinal cord injury
Acute limb ischemia
Common
Common diagnoses
Soft tissue injury without deep violation
Simple pneumothorax
Pulmonary contusion
Rib fracture
Diaphragm injury
Liver injury
Spleen injury
Kidney injury
Bowel injury
Peripheral nerve injury
Less common and mimics
Less common and mimics
Traumatic aortic injury
Thoracic duct injury
Ureteral injury
Pancreatic injury
Retroperitoneal hematoma
Non traumatic causes of shock
Sepsis
Anaphylaxis
Past Medical History
Comorbidities and baseline function
Comorbidities and baseline
Coronary artery disease (I25.10)
Heart failure (I50.9)
COPD (J44.9)
Chronic kidney disease (N18.9)
Chronic liver disease (K76.9)
Diabetes mellitus (E11.9)
Hypertension (I10)
Bleeding disorder
Prior procedures and devices
Prior procedures and devices
Vascular surgery
Abdominal surgery
Thoracic surgery
Tracheostomy history
Implanted devices
Physical Exam
Primary survey focused exam
Primary survey
Airway
Patency
Blood in airway
Stridor
Voice change
Breathing
Work of breathing
Bilateral breath sounds
Tracheal deviation
Subcutaneous emphysema
Circulation
Active bleeding
Skin perfusion
Central pulses
Distal pulses all extremities
Disability
GCS
Pupils
Focal deficits
Exposure
Full body inspection
Prevent hypothermia
Wound assessment and trajectory
Wound assessment
Location by anatomic zone
Number of wounds
Entry and exit wounds
Bleeding pattern
Air bubbling
Impaled object stability
Regional secondary survey
Regional secondary survey
Head and face
Scalp lacerations
Facial fractures signs
Neck
Platysma violation concern
Hematoma
Crepitus
Tracheal tenderness
Chest
Chest wall wounds
Sucking chest wound
Heart sounds
Abdomen
Tenderness
Guarding
Rigidity
Distension
Pelvis and perineum
Pelvic stability
Perineal wounds
Blood at urethral meatus
Extremities
Motor and sensory exam distal to wounds
Capillary refill
Compartment firmness
Vascular and neurologic limb detail
Limb vascular and neurologic detail
Pulse exam
Palpable
Doppler only
Absent
Signs of ischemia
Pain
Pallor
Pulselessness
Paresthesia
Paralysis
Poikilothermia
Lab Studies
Resuscitation and hemorrhage labs
Resuscitation labs
CBC
Type and screen
Type and crossmatch
INR
aPTT
Fibrinogen
Basic metabolic panel
VBG
Lactate
Blood alcohol level when relevant
Point of care and hemostasis guidance
Point of care and hemostasis
Glucose
TEG or ROTEM local protocol dependent
Calcium during massive transfusion
Special population labs
Special population labs
Pregnancy test for reproductive potential
Anti Xa level when relevant local protocol dependent
Drug screen when it changes management local protocol dependent
Imaging
Scoring Systems
Scoring systems and structured risk
Shock Index
HR divided by SBP
Greater than 0.9 higher risk adult
Revised Trauma Score local protocol dependent
Mangled Extremity Severity Score local protocol dependent
MRI
MRI limited role
Spinal cord injury evaluation when stable
Soft tissue and ligamentous injury when CT nondiagnostic
CT
CT and CTA strategy
CTA neck for penetrating neck without hard signs
Detects vascular injury
Guides selective operative management
CT chest with IV contrast for stable penetrating thorax
Hemothorax
Great vessel injury
CT abdomen and pelvis with IV contrast for stable penetrating abdomen
Solid organ injury
Free fluid
Trajectory assessment
CT cystography when bladder injury suspected
Contrast cautions
Severe renal impairment risk
Prior anaphylactoid reaction
Ultrasound
Ultrasound and POCUS
eFAST
Pericardial effusion
Intraperitoneal free fluid
Pneumothorax
Hemothorax
Vascular ultrasound adjunct
Duplex for zone II arterial injury screening when available
DVT evaluation when indicated
Special Tests
Bedside vascular evaluation
Bedside vascular evaluation
ABI or API for extremity penetrating trauma without hard signs
Handheld Doppler signals
Serial pulse exams
Aerodigestive tract evaluation
Aerodigestive tract evaluation
Flexible nasopharyngolaryngoscopy when stable
Contrast esophagram when esophageal injury suspected
Esophagoscopy local protocol dependent
Bronchoscopy local protocol dependent
Abdominal and pelvic adjuncts
Abdominal and pelvic adjuncts
Local wound exploration for stab wounds local protocol dependent
Diagnostic peritoneal aspiration or lavage local protocol dependent
Rigid proctoscopy or sigmoidoscopy when rectal injury suspected
Retrograde urethrogram when urethral injury suspected
ECG
Indications and high risk patterns
ECG indications and patterns
Penetrating chest trauma near heart
Hypotension of unclear source
Suspected tamponade physiology
Dysrhythmia on monitor
Ischemia patterns when shock and anemia
Serial ECG logic
Serial ECG logic
Repeat with recurrent chest pain
Repeat after resuscitation if initial nondiagnostic
Assessment
Problem representation and stability
Problem representation
Penetrating trauma with region classification
Neck
Thorax
Abdomen
Pelvis
Extremity
Physiologic status
Unstable
Transient responder
Stable
Key complications to rule out
Key complications to rule out
Major vascular injury
Airway injury
Tension pneumothorax
Cardiac tamponade
Hollow viscus injury
Compartment syndrome
Diagnostic uncertainty and alternate paths
Diagnostic uncertainty and alternate paths
Occult trajectory injuries with small skin wounds
Multiple cavities involved
Concomitant blunt injury
Plan
First 5 minutes and hemorrhage control
First 5 minutes priorities
Resuscitation bay criteria
Hypotension
Altered mental status
Active hemorrhage
Monitoring
Continuous pulse oximetry
Cardiac monitor
Noninvasive BP frequent cycling
Access
Two large bore IV
IO if IV delay
Airway strategy
Anticipated difficult airway with neck trauma
Awake approach local protocol dependent
Hemorrhage control
Direct pressure
Tourniquet for extremity life threatening hemorrhage
Junctional hemostatic packing for groin or axilla local protocol dependent
Massive transfusion protocol activation local protocol dependent
Calcium repletion during massive transfusion local protocol dependent
TXA for suspected major hemorrhage within 3 hours local protocol dependent
Adult dose 1 g IV over 10 minutes
Then 1 g IV over 8 hours
Regional management pathways
Regional management pathways
Neck penetrating injury with platysma violation
Hard signs
Immediate operative management
No hard signs
CTA neck
Aerodigestive evaluation based on symptoms and trajectory
Thoracic penetrating injury
Tension physiology
Immediate decompression
Large hemothorax
Tube thoracostomy
Surgical escalation thresholds local protocol dependent
Abdominal penetrating injury
Unstable or peritonitis
Immediate laparotomy
Stable without peritonitis
CT strategy based on mechanism and location
Serial abdominal exams
Extremity penetrating injury
Hard signs
Immediate vascular surgery involvement
No hard signs
ABI or API
CTA extremity if abnormal ABI or concerning trajectory
Antibiotics and tetanus
Infection prevention
Tetanus prophylaxis per immunization status
Antibiotics by wound type local protocol dependent
Contaminated wounds
Open fractures
Hollow viscus injury concern
Analgesia and sedation
Analgesia and sedation
Multimodal analgesia
Procedural sedation considerations in shock
Avoid hypotension worsening agents when unstable
Reassessment loop
Reassessment loop
Repeat vitals every 5 to 15 minutes when unstable
Repeat airway and breathing exam after interventions
Repeat pulse checks after splinting or tourniquet changes
Repeat hemoglobin and lactate trending local protocol dependent
Disposition
Level of care criteria
Level of care criteria
OR immediate
Hemodynamic instability with suspected internal bleeding
Peritonitis
Hard signs vascular injury
Cardiac tamponade concern
ICU
Ongoing transfusion requirement
Vasopressor requirement
Mechanical ventilation
High grade solid organ injury with instability risk
Inpatient admission
Penetrating injury with cavity violation
Chest tube management
Vascular injury managed nonoperatively
Observation pathway
Stable with negative initial imaging but trajectory risk
Serial exams required
Discharge
Superficial soft tissue injury only
Normal neurovascular exam
Reliable follow up and return precautions
Transfer criteria
Transfer criteria
Need for trauma center resources
Need for vascular surgery
Need for cardiothoracic surgery
Pediatric trauma resources
REBOA capability local protocol dependent
Discharge Instructions
Copy discharge instructions
Copy discharge instructions
You were treated for a penetrating injury and your evaluation did not show a dangerous internal injury today
Wound care
Keep the wound clean and dry for the first 24 hours
After 24 hours gentle soap and water daily
Apply a thin layer of ointment if recommended
Keep dressing in place as instructed
Pain control
Use acetaminophen as directed on the label
Avoid NSAIDs if you were told you have increased bleeding risk
Avoid alcohol and driving if taking sedating pain medicine
Activity
Avoid strenuous activity and heavy lifting until cleared
Protect the injured area from impact
Follow up
Follow up with your primary care clinician or wound clinic within 24 to 72 hours
Return for suture or staple removal as instructed
Return to the emergency department now for
Worsening bleeding
New swelling or rapidly enlarging bruising
New numbness or weakness
Cold pale or painful limb
Trouble breathing
Chest pain
Fainting
Severe or worsening abdominal pain
Vomiting blood
Black or bloody stools
Fever
Redness spreading from the wound
Pus drainage
References
Guidelines and landmark evidence
Core references
American College of Surgeons Committee on Trauma Advanced Trauma Life Support ATLS 11
Eastern Association for the Surgery of Trauma Practice Management Guideline Selective Nonoperative Management of Penetrating Abdominal Trauma 2010
Eastern Association for the Surgery of Trauma Practice Management Guideline Neck Trauma Penetrating Zone II 2008
Western Trauma Association Critical Decisions in Trauma Penetrating Neck Trauma 2013
CRASH 2 trial Tranexamic Acid in Trauma 2010
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.