A 28-year-old motorcyclist sustains high-speed trauma. FAST ultrasound reveals free fluid in Morrison's pouch. Which of the following is the most appropriate next step in a haemodynamically unstable patient?
- A CT scan of abdomen and pelvis with contrast
- B Immediate exploratory laparotomy ✓
- C Diagnostic peritoneal lavage
- D Repeat FAST in 30 minutes
Correct answer: B. Immediate exploratory laparotomy
Explanation
In a haemodynamically unstable patient with positive FAST (free fluid in Morrison's pouch), the source of bleeding is intra-abdominal and the patient should proceed directly to exploratory laparotomy without CT. CT is reserved for haemodynamically stable patients to characterize injuries. DPL has largely been replaced by FAST but is also not the next step when laparotomy is already indicated. Repeat FAST wastes precious 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.