This case includes both English and Spanish versions.

A rural explosion, multiple penetrating wounds, and a 50-minute transfer to definitive care. By the time this young patient reaches the trauma centre, the clock is already running.

This interactive case follows a 25-year-old man with multiple thoracoabdominal gunshot wounds, omental evisceration, haemoperitoneum, and suspected thoracic and pericardial involvement. From his arrival in the trauma bay, the reader must make critical decisions regarding initial assessment, interpretation of EFAST findings, haemostatic resuscitation, vascular access, massive transfusion, and operative prioritisation.

Designed for surgeons, residents, fellows, emergency physicians, and trauma teams seeking to strengthen decision-making in complex penetrating trauma, especially when limited prehospital resources, prolonged transport, and multiple potential bleeding sources converge in the same patient.

Estimated duration: 60–90 minutes

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