26 year old female has been involved in mva. She has fractures in both upper extremities, facial lacerations, and no other obvious injuries. Chest x-ray is normal. Shortly thereafter she develops hypotension, tachycardia, and dropping hematocrit. Her CVP is low.
Only massive plevic fractures, multiple femur fractures, or intraabdominal bleeding can accommodate enough blood to go into hypovolemic shock. Abdomen is where to look for hidden bleeding.
If hemodynamically stable, CT. If not stable peritoneal lavage or sonogram in ER or OR.