A 28-year-old man arrives following a high-speed motor vehicle collision. He is hypotensive (BP 80/50 mmHg), tachycardic (HR 130 bpm), and CT scan is unavailable as he is too unstable. FAST ultrasound shows free fluid in the right upper quadrant and pelvis. According to current ATLS (10th edition) guidelines, the decision to transfer to theatre versus CT is based on which principle?

• A All trauma patients should have CT before any operative intervention
• B Haemodynamic instability despite initial resuscitation warrants immediate operative intervention without CT ('scoop and run' to theatre) ✓
• C FAST positive findings in an unstable patient indicate splenic injury requiring angioembolisation
• D Patient should receive 2 litres crystalloid and reassess before theatre decision

Explanation

ATLS 10th edition reinforces that haemodynamically unstable patients with suspected abdominal/pelvic injury who do not respond to initial resuscitation (non-responders or transient responders) require immediate operative intervention — damage control surgery to control haemorrhage. CT scanning should NOT delay operative intervention in unstable patients. FAST positive in this context confirms abdominal haemorrhage. The previous recommendation of 2 L crystalloid upfront has been revised to permissive hypotension and balanced resuscitation (1:1:1 packed RBC:FFP:platelets) with early surgical haemorrhage control.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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