A 28-year-old man sustains blunt abdominal trauma. FAST (Focused Assessment with Sonography in Trauma) reveals free fluid in the pelvis. His BP is 80/50 mmHg and HR is 130/min despite 2L crystalloid. What is the MOST appropriate next step?
- A Emergency laparotomy (damage control surgery) ✓
- B CT abdomen with contrast to identify the source of bleeding
- C Diagnostic peritoneal lavage to confirm haemoperitoneum
- D Angiographic embolization as first-line treatment
Correct answer: A. Emergency laparotomy (damage control surgery)
Explanation
A haemodynamically unstable trauma patient with positive FAST (free intraperitoneal fluid) indicating haemoperitoneum requires immediate surgical intervention — damage control laparotomy. CT is contraindicated in haemodynamically unstable patients as it delays definitive treatment. DPL has been largely supplanted by FAST. Angioembolisation can be considered in pelvic fractures with retroperitoneal haemorrhage, but not as first-line for intraperitoneal bleeding in an unstable patient.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.