[Penetrating trauma of the trunk]

Trauma has been described as a "disease of bleeding" [45]. Recognition of acute blood loss after injury, and restoration of homeostasis is the cornerstone of the initial care of the badly injured patient. Hypovolaemia remains the most common cause of death among those killed in action during military conflicts [46] and, in the civilian arena, increasing numbers of patients are being encountered with penetrating injuries, even in societies where blunt injury have previously been the norm. Increased use of higher calibre weapons or with altered ammunition means some patients will present with exsanguinations and critical physiological instability. Successful outcomes after the treatment of patients with penetrating trauma depend on the integration of many agencies, from prehospital care, initial reception, assessment and resuscitation through the operating room, intensive care and post-injury rehabilitation. Recognition of the importance of time and adherence to sound trauma management principles with conservative management when appropriate should see further improvements in our treatment of this important group of patients. Reducing the incidence of these injuries is the responsibility of us all and must be the focus of all governmental initiatives.