A patient involved in a road traffic accident undergoes FAST (Focused Assessment with Sonography for Trauma). Free fluid is visualised in the hepatorenal space (Morison's pouch) and the patient is haemodynamically unstable despite 2L crystalloid. The correct immediate management is:
- A CT scan of the abdomen and pelvis
- B Immediate exploratory laparotomy ✓
- C Diagnostic peritoneal lavage
- D Repeat FAST scan in 30 minutes
Correct answer: B. Immediate exploratory laparotomy
Explanation
A positive FAST (free intraperitoneal fluid indicating haemoperitoneum) in a haemodynamically unstable trauma patient mandates immediate exploratory laparotomy without further imaging. CT scan requires haemodynamic stability and is contraindicated in ongoing shock. DPL has been largely replaced by FAST. Delay for repeat imaging in an unstable patient risks fatal exsanguination.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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