## Clinical Context This patient presents with blunt abdominal trauma and haemodynamic stability. FAST has detected free intra-abdominal fluid, but the patient remains haemodynamically stable with no peritoneal signs. ## Rationale for CT Imaging **Key Point:** In a haemodynamically stable patient with positive FAST, CT scan with IV contrast is the gold standard for further characterization of intra-abdominal injuries and determination of solid organ injury grade. **High-Yield:** The FAST examination is sensitive for detecting free fluid but does not identify the source or severity of injury. CT provides organ-specific diagnosis, injury grading, and helps guide non-operative management decisions in stable patients. ## Management Algorithm ```mermaid flowchart TD A[Blunt abdominal trauma]:::outcome --> B{Haemodynamically stable?}:::decision B -->|No| C[Immediate laparotomy]:::urgent B -->|Yes| D{FAST positive?}:::decision D -->|No| E[Observation + serial exam]:::action D -->|Yes| F[CT abdomen/pelvis with IV contrast]:::action F --> G{Solid organ injury?}:::decision G -->|Yes, low grade| H[Non-operative management]:::action G -->|High grade or hollow viscus| I[Laparotomy]:::action ``` **Clinical Pearl:** Splenic injuries (common in left upper quadrant trauma) are increasingly managed non-operatively in stable patients if imaging shows Grade I–III injury without active bleeding. **Key Point:** Serial FAST examinations without change in a stable patient do not mandate laparotomy; they support the need for detailed imaging to guide conservative vs. operative management. 
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