Theatre vs CT — the trauma team leader's decision

The theatre-versus-CT decision is the critical decision the trauma team leader makes after the primary survey, and it rests on the physiological stability and the identification of the source of the bleeding.^[1] The patient who is unstable — hypotensive despite the initial resuscitation with the blood products, or with a positive FAST and the ongoing bleeding — goes to the operating theatre for the damage-control surgery, not the scanner. The rationale is that the bleeding source is identified (the abdomen, the chest, the pelvis) and the time spent in the CT is time spent bleeding, with the lethal triad worsening and the coagulopathy developing.^[1] The patient who is stable — the blood pressure responds to the resuscitation, the FAST is negative or equivocal, and the bleeding is controlled — goes to the whole-body CT for the definitive imaging, and returns for the targeted management.^[1] The leader considers the mechanism (the penetrating abdominal trauma goes to the theatre; the blunt trauma with the negative FAST may go to the CT), the response to the resuscitation (the transient responder is borderline and may benefit from the CT if time-critical and closely monitored), and the institutional resources (the availability of the angioembolisation for the pelvic bleeding, the interventional radiology for the aortic injury).^[1]