A 30-year-old motorcyclist is brought to the Emergency Department after a high-speed collision. Primary survey reveals GCS 14, BP 80/50 mmHg, HR 130/min, distended abdomen, and dullness on percussion. FAST shows free intraperitoneal fluid. Despite 1 L crystalloid bolus, the patient remains haemodynamically unstable. What is the next management step?
- A Urgent CT scan of abdomen and pelvis to identify the source of bleeding
- B Angioembolisation under interventional radiology
- C Emergency laparotomy for haemorrhage control ✓
- D Further resuscitation with 2 L crystalloid followed by reassessment
Explanation
A haemodynamically unstable patient with positive FAST indicating haemoperitoneum requires immediate emergency laparotomy; CT scan is only appropriate for haemodynamically stable patients. ATLS principles dictate that in blunt abdominal trauma with positive FAST and haemodynamic instability unresponsive to initial resuscitation, operative intervention cannot be delayed for imaging. Damage control laparotomy (DCL) with initial haemostasis, temporary abdominal closure, and ICU resuscitation before definitive repair is the paradigm. Further fluid resuscitation without source control perpetuates the lethal triad.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.