Question
A 30-year-old male presents after sustaining a contusion to the left hypochondrium. On examination, he is hypotensive with a systolic blood pressure of 70 mm Hg and has a pulse rate of 110 beats per minute. What is the next best step in management?
| A. |
FAST |
| B. |
CECT Abdomen |
| C. |
DPL |
| D. |
Abdomen X-ray |
|
Correct Answer » A Explanation |
 |
Clinical Reasoning for the Correct Answer:
– The patient has blunt abdominal trauma and is hemodynamically unstable (SBP 70 mm Hg, tachycardia).
– In unstable trauma patients, rapid identification of intra-abdominal bleeding is critical for decision-making.
– The Focused Assessment with Sonography for Trauma (FAST) is non-invasive, rapid, and can be performed at the bedside to detect free intra-abdominal fluid (blood).
– FAST can quickly confirm intra-abdominal hemorrhage, prompting emergent surgical intervention.
Why Option A is Correct:
– FAST is the first-line investigation in a hemodynamically unstable patient with blunt abdominal trauma.
– It can be rapidly performed even in shock, without moving the patient.
– Positive FAST → direct to emergency surgery or laparotomy; negative FAST → search for alternate sources or DPL.
Why Option B (CECT Abdomen) is Incorrect:
– Contrast-Enhanced CT is best for stable patients.
– Requires the patient to be hemodynamically stable and transferred to the radiology suite.
– Risk of rapid deterioration and death if unstable patient is moved or delays occur.
Why Option C (DPL) is Incorrect:
– Diagnostic Peritoneal Lavage is invasive and mostly replaced by FAST.
– Indicated if FAST is equivocal or unavailable.
– Not first-line when FAST is available and operator is skilled.
Why Option D (Abdomen X-ray) is Incorrect:
– Plain X-ray has poor sensitivity for acute hemoperitoneum.
– Does not reliably demonstrate free fluid or assess organ injury.
– Not useful as an initial diagnostic or decision-making tool in this scenario.
High‑Yield Synopsis:
Blunt Abdominal Trauma – Initial Assessment
– Hemodynamic Instability
– Defined as SBP < 90 mm Hg, tachycardia, poor peripheral perfusion.
– Assess for ongoing hemorrhage.
– First Investigation
– FAST is rapid and bedside-accessible.
– Detects free intraperitoneal fluid (usually blood).
– Differential Investigations
– CECT Abdomen: Best for stable patients, detects solid organ injury, retroperitoneal bleeding.
– DPL: Invasive, detects intraperitoneal bleeding; reserved for equivocal/negative FAST.
– Abdominal X-ray: Rarely used for acute trauma diagnosis; may detect free air (perforation), not bleeding.
– Management Algorithm
– Unstable + positive FAST → emergent laparotomy.
– Unstable + negative/equivocal FAST → DPL or search for extra-abdominal source.
– Stable → CECT for further evaluation.
– Key Decision Point
– Hemodynamic stability determines the investigation and definitive management pathway.
