A 25-year-old man presents after blunt abdominal trauma with haemodynamic instability. FAST ultrasound shows free fluid in the right upper quadrant. After 2 L of crystalloid, BP remains 80/50 mmHg. The MOST appropriate next step is:

• A Urgent CT scan of abdomen and pelvis with IV contrast to characterise the injury
• B Transfusion of 4 units packed red blood cells before deciding on surgery
• C Angioembolisation as first-line treatment for all blunt liver injuries
• D Immediate exploratory laparotomy for haemorrhage control ✓

Explanation

In haemodynamically unstable trauma patients with positive FAST (free intraperitoneal fluid), the correct management is immediate exploratory laparotomy for haemorrhage control — CT is contraindicated in the unstable patient because of the time delay. The ATLS principle is: unstable + positive FAST = operating room, not the scanner. Angioembolisation is a useful adjunct in haemodynamically stable or marginally unstable patients with solid organ injuries but not first-line when the patient cannot be stabilised. Ongoing transfusion without surgical source control perpetuates haemorrhage.

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

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Written and medically reviewed by the StethoPrep medical team.