When a wound penetrates the abdomen or thorax the presence of internal visceral injury must be assumed. On the other hand, "closed" visceral injuries of the abdomen and thorax constitute special problems because the clinical manifestations may be unimpressive early in the postinjury period, as has been emphasized by Simeone.1 Later, when symptoms develop, a severe physiological derangement may already exist and may compromise the results of therapy.
It is the purpose of this presentation (1) to emphasize the importance of precise physiological assessment in preparation of the patient before major surgery required as a result of trauma, (2) to define the frequency of this clinical problem in a general hospital, and (3) to cite specific cases as illustrations of principles in management.
Initial Therapy and Assessment
In a military evacuation system this function is carried out continuously in a triage area. Blood volume replacement is initially started with