The revised guidelines of JATEC (Japan Advanced Trauma Evaluation and Care) include a focus on CT imaging and introduce the novel concept of three-step evaluation of whole-body CT scan. The first step, called FACT (Focused Assessment with CT for Trauma), focuses on assessment of pre-selected areas and injuries to develop a rapid treatment strategy in a few minutes, in which massive intracranial hematoma, aortic injury, pulmonary contusion, pneumothorax, hemothorax, pericardial hematoma, hemoperitoneum, pelvic and spinal fractures, and abdominal organ injuries are evaluated. The second step should be performed right after FACT and it includes evaluation of active bleeding, which needs to be treated immediately, as well as injuries that are not recognized in FACT. The third step is detailed evaluation of any trivial findings to reduce misses. It is recommended to evaluate CT findings with important clinical factors to start adequate treatment without delay. The important clinical factors include age of the patient, number of bleeding sites and their tightness, coagulation status, medication and past history related to coagulation, time passed since the event, the form of organ injury, mechanism of injury and vital signs.
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