The evaluation of blunt abdominal trauma (BAT) can be difficult because of the subtle manifestations of the injuries and because assessment is hampered by altered neurologic status. Short of laparotomy, CT and diagnostic peritoneal lavage provided the best means of accurately diagnosing intra-abdominal injury. Ultrasound (US) has recently been introduced into trauma centers in the United States as a quick, cheap, and safe method to make the diagnosis of BAT. After theoretical and practical training, one attending surgeon and one chief resident began performing trauma ultrasounds at a rural, Level 1 trauma center. The US was performed concurrent with initial resuscitation and prior to other studies. The US was then correlated with the other tests. Of the 82 tests performed, 79 correlated with other methods of diagnosis. Overall, US was 88 per cent sensitive, 98 per cent specific, and 96 per cent accurate in diagnosing intra-abdominal injuries. There were no operative sequelae to patients whose injury was missed by US. We conclude that: 1) US can be used as the initial method of diagnosis of BAT and 2) surgeons are able to perform the examination accurately.