The aim of this study is to evaluate correlation between the collapsibility indices of the FV or IJV to IVC-CI among polytrauma patients presenting to the ED by sonographic evaluation before and after resuscitation.

Polytrauma patients often present with hemodynamic instability where rapid and accurate assessment of intravascular volume is crucial. Central venous pressure monitoring, though considered a standard, is invasive and not always feasible in emergency settings. Point-of-care ultrasound (POCUS) provides a non-invasive alternative through assessment of venous collapsibility indices.

The inferior vena cava (IVC) collapsibility index is commonly used, but its evaluation may be limited in cases of abdominal trauma, obesity, or technical difficulties. The internal jugular vein (IJV) and femoral vein (FV) are superficial, easily accessible, and may provide reliable alternatives.

This study aims to compare the collapsibility indices of the IVC, IJV, and FV in polytrauma patients before and after resuscitation using sonographic evaluation. The objective is to determine their relative accuracy and feasibility as non-invasive markers of intravascular volume status to guide resuscitation in emergency settings.

Inclusion Criteria:

• Adult patients aged ≥ 18years. ( Patients presented by hypovolemic shock

Exclusion Criteria:

• Patient refusal Body Mass Index > 40 kg/m2. Cardiac patients or cardiac tamponade Aortic injury or for cardio-thoracic emergent operation Patients with abdominal mass or other pathology as abdominal collection. Any patient needs emergent surgical intervention History of pulmonary artery hypertension. Femoral vein occlusion. Pregnancy. Pulmonary oedema. Patients will need mechanical ventilation.

The study population will include adult patients aged 18-65 years presenting with shock to the emergency department and requiring volume status assessment through both IVC,FV and IJV collabsibility indecis by ultrasound.