A young woman is wheeled into the trauma bay. She’d been crossing a busy intersection at night, clad entirely in black, and was hit by a sport utility vehicle moving at full tilt through the crosswalk. Smears of blood streak her face like war paint, and her arms are bent at unnatural angles. Her body lies exposed, her clothing in snipped tatters about her small frame as we do an initial physical assessment.

These are the final moments of her life, but no one knows that yet. She remains unresponsive, and given the number of blunt injuries she has most likely sustained, we decide to intubate. Intravenous access is established. Our FAST exam [focused assessment with sonography in trauma] is positive for massive abdominal bleeding. We speak in low staccato to one another, poised for what will happen next, willing her body to...

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