This case includes both English and Spanish versions.

A street assault, a penetrating gunshot wound, and a patient arriving in profound hemorrhagic shock. From the moment he reaches the trauma centre, every decision has immediate consequences.

This interactive case follows a 47-year-old man with a gunshot wound to the right inguinal region and an exit wound through the right gluteal region. On arrival, he is pale, diaphoretic, tachypneic, and severely hypotensive, with a blood pressure of 60/30 mmHg and clear signs of compromised tissue perfusion.

From his initial assessment in the trauma bay, the reader must make critical decisions regarding haemorrhage control, hemostatic resuscitation, vascular access, identification of major vascular injury, operative prioritisation, and damage-control strategy in an unstable patient with penetrating pelvic and groin trauma.

Designed for surgeons, residents, fellows, emergency physicians, and trauma teams seeking to strengthen decision-making in high-acuity penetrating trauma, particularly when profound shock, suspected vascular injury, and the need for immediate operative intervention converge in the same patient.

Estimated duration: 60–90 minutes
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