Thanks for your response. OBVIOUSLY a needle decompression is the first thing one must do/consider but I was trying to see what people would do in a last ditch effort, some medical personal would be more aggresive and some not; and in the end as long as the patient survives that is all that matters. Anyhow what are your thoughts on this one: I'm interested in your opinions on whether you would have obtained or think mandatory, a double contrast abdominal CT in the following circumstance. This 71 year old woman was dead in ICU when I came on duty this morning. She came to us moribund in the early hours from OT. 48 hours earlier she presented to the emergency department (metropolitan University teaching hospital, not Trauma centre) with little history obtained from Ambulance officers. Pedestrian hit by motor vehicle (no other info). Past medical history: nil relevent. Had been unconcious at scene. Duration? GCS @ scene? In ED: GCS 14, ABC OK (???), soft non tender abdo with no bruising &c, Bilateral nasty femoral #'s, # of right superior pubic ramus pelvis, SI jts and lower lumbar vertabrae NAD. C-spine : old but no #. CXR: NAD, thoracic and upper lumbar vertatabrae well seen and no #'s detected. Head CT: NAD. Who thinks an abdo CT should have been done? Who thinks it would be a waste of time money and resources? Should she be admitted to ICU or an Orthopaedic ward? Remainder of her course and operative findings available to responders.