• Injuries are generally classified based on mechanism as either blunt or penetrating. Each has a different method of evaluation and treatment.

• In blunt injuries, solid organs are commonly injured with acceleration/deceleration injuries (i.e., motor vehicle collisions [MVC], falls from height) and crush injuries. Blunt injuries are associated with greater mortality than penetrating ones. The spleen is the most commonly injured solid organ, followed by the liver.

• A stab wound, one such penetrating injury, is less likely to cause intra-abdominal injury and penetrate the peritoneum requiring surgical intervention when compared with projectile wounds.

• Severe pelvic fractures are a major cause of morbidity and mortality in trauma patients. As hemorrhage is the main cause of mortality in pelvic trauma, it is critical to assess hemodynamic stability and identify ongoing bleeding in the chest, abdomen and long bones. If no clear source of hemorrhage is identified and a patient remains unstable, suspicion for primary pelvic hemorrhage should be high. Suspect pelvic fracture in all cases of serious or multisystem trauma patients.

• In pelvic trauma, there is a high incidence of associated injuries; therefore, special attention should be paid to the rectal and urogenital examinations. The most commonly used classification system for pelvic fractures is the Young–Burgess system. This system categorizes injuries on the basis of mechanism of injury and can be used to predict the risk of blood loss.

• Optimal initial management of the trauma patient during the first several hours after injury offers the best chance of a good outcome. Patient management consists of rapid primary survey, resuscitation of vital functions, a more detailed secondary assessment, diagnostic tests to ascertain the extent of traumatic injury and finally, the initiation of definitive care.

Abdominal ultrasonography is an extremely valuable diagnostic tool for all perioperative physicians. While the FAST exam was designed for use in patients with blunt abdominal trauma, its principles are applicable in a wide variety of perioperative settings and can be used to narrow the differential diagnosis in unstable patients. Aortic ultrasound is easy to perform and rapidly confirms or rules out the presence of abdominal aortic aneurysm or dissection. Other uses include gallbladder imaging and evaluation for free intra-peritoneal air. Perioperative and intensive care unit patients will benefit from point-of-care ultrasound, including detailed examination of the abdominal cavity.