A 30-year-old motorcyclist is brought in after a road traffic accident. BP is 80/50 mmHg, HR 128/min. FAST ultrasound shows free fluid in Morrison's pouch. Two large-bore IV lines are placed and 1 L of crystalloid is given rapidly with no improvement. He remains haemodynamically unstable. Per ATLS protocol, the next step is:
- A CT abdomen and pelvis for grading of injury
- B Repeat FAST examination
- C Emergency laparotomy (damage control) ✓
- D Diagnostic peritoneal lavage for confirmation
Correct answer: C. Emergency laparotomy (damage control)
Explanation
A haemodynamically unstable patient with a positive FAST showing intraperitoneal free fluid after trauma requires immediate emergency laparotomy for haemorrhage control. ATLS mandates that CT imaging is contraindicated in haemodynamically unstable abdominal trauma patients — CT is only for stable patients. Damage control surgery (DCS) principles apply: haemorrhage control, contamination control, packing, and planned relook at 24–48 hours.
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.