Perform a thorough fluid volume assessment on at least an hourly basis until the patient is stabilized. This assessment includes hemodynamic, urinary, and central nervous system parameters. Notify the physician of overt bleeding and of any early indications that hemorrhage is continuing; this includes delayed capillary refill, tachycardia, urinary output less than 0.5 mL/kg per hour, and alterations in mental status, including restlessness, agitation, and confusion, as well as decreases in alertness. Body weights are helpful in indicating fluid volume status; note that many of the critical care beds have incorporated bed scales.

PSYCHOSOCIAL. The violent and often unexplained nature of this type of trauma can lead to ineffective coping for both the patient and the family. Determine if the patient is at risk from herself or himself or others by questioning the patient, significant others, or police. If the patient is on police hold, determine the patient's and family's response to the pending legal charges.

Diagnostic Highlights

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