not-yet-known not-yet-known not-yet-known unknown Case History/examination A 26-year-old male patient with no history of underlying disease or surgery was sent to the emergency room by ambulance following multiple trauma after a car accident. The time interval between the accident and entering the emergency room was about 30 minutes. At the time of visit, the patient was alert and anxious. He complained of pain in his limbs, pelvis and abdomen. He did not feel nausea. Vital sign at presentation was Pulse Rate: 105; Blood Pressure:95/60; Respiratory Rate:24; Tempreture:36.7°C; Saturated O2: 95%; and Glascow Coma Scale:15. The patient was immediately given basic resuscitation. The airway was normal. The patient was breathing spontaneously. The breathing rate was high, but there was no respiratory distress. There was no evidence of damage to the skull or mouth. The trachea was in the middle line. Chest movements were symmetrical. No sound reduction was heard during lung auscultation. He did not have neck or chest emphysema. There was no evidence of neck hematoma. Jugular venous pressure was normal. There was no evidence of active bleeding in any part of the body. On more detailed examination, there was evidence of a small laceration on the right eyebrow. Heart auscultation had no pathological findings. The abdomen was smooth, there was no distention. It had no guarding or rebounds. There was generalized abdominal tenderness, especially in the epigastrium. There was ecchymosis in the perineum and scrotum. Movement of the patient’s pelvis was painful. The limbs were warm and the pulse was symmetric and normal. The sensation and movement of the limbs was acceptable. He had tenderness in the heel of his right foot.