Document resource
A teenaged male sustained a direct blunt injury to his epigastrium from the handlebar of a standing scooter. On presentation, the primary survey was unremarkable, and the patient was hemodynamically normal (blood pressure: 113/75 mm Hg, heart rate: 96 beats per minute). Chest and pelvis radiographs were within normal limits. Focused Assessment with Sonography for Trauma revealed the presence of free fluid in all abdominal views. On secondary survey, the patient was alert, but diaphoretic and anxious. Physical examination revealed a mid-epigastric hematoma and signs of peritonitis. A repeat blood pressure measurement, taken approximately 5 minutes after arrival, was 79/54 mm Hg. In light of the clinical evidence of hemorrhagic shock and peritonitis, resuscitation with low-titer group O whole blood (LTOWB) was initiated, the massive transfusion protocol was activated, and the patient was transferred emergently to the operating room (OR).