A 28-year-old motorcyclist is brought to the emergency department following a high-speed collision. He is GCS 8, BP 90/60 mmHg, HR 130 bpm. FAST (focused assessment with sonography for trauma) shows free fluid in the hepatorenal and splenorenal spaces. After 1L crystalloid, BP is 80/50 mmHg. According to ATLS principles, the IMMEDIATE next step is:

• A CT scan of the abdomen and pelvis to characterise injuries before surgery
• B Give a further 2L crystalloid and reassess
• C Diagnostic peritoneal lavage (DPL) to confirm haemoperitoneum
• D Emergency laparotomy for haemorrhage control ✓

Explanation

This patient has haemodynamic instability (shock) despite initial resuscitation with a positive FAST showing haemoperitoneum — this is a category of 'haemodynamically unstable with peritoneal haemorrhage' requiring immediate emergency laparotomy. Transporting an unstable patient to CT risks death from uncontrolled haemorrhage. Further crystalloid resuscitation without definitive haemorrhage control worsens the lethal triad. DPL has been largely superseded by FAST. The ATLS algorithm mandates damage control surgery (DCS) when FAST is positive and resuscitation fails to restore haemodynamic stability.

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.