A 28-year-old man arrives after a high-speed MVA. On FAST examination, anechoic fluid is seen in the hepatorenal recess (Morison's pouch) and in the pelvis. His BP is 80/50 mmHg. According to ATLS principles, the next IMMEDIATE step is:

• A Contrast-enhanced CT abdomen and pelvis
• B Diagnostic peritoneal lavage (DPL)
• C Repeat FAST after IV fluid resuscitation
• D Emergency exploratory laparotomy ✓

Explanation

A haemodynamically unstable patient with a positive FAST (free intraperitoneal fluid) should proceed directly to emergency laparotomy without CT. CT is reserved for haemodynamically stable patients. DPL is largely replaced by FAST; repeating FAST wastes time in an unstable patient.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.