## Clinical Context This patient presents with **Class III hemorrhagic shock** (BP 94/58, HR 128, altered perfusion) with evidence of intra-abdominal bleeding (FAST positive, distended abdomen, flank bruising). The mechanism (high-speed MVC) and hemodynamic instability indicate life-threatening hemorrhage requiring immediate surgical intervention. ## Rationale for Correct Answer **Key Point:** In unstable trauma patients with confirmed or highly suspected intra-abdominal hemorrhage, **immediate blood product resuscitation and surgical control of bleeding takes priority over diagnostic imaging or crystalloid-only resuscitation**. **High-Yield:** The ATLS approach to Class III/IV shock with positive FAST is: 1. Activate massive transfusion protocol (MTP) 2. Type O-negative blood immediately (do not wait for cross-match) 3. Prepare for emergency laparotomy (definitive hemorrhage control) 4. Avoid prolonged resuscitation in the ED ("scoop and run" principle) **Clinical Pearl:** Crystalloid-only resuscitation in Class III hemorrhagic shock with ongoing bleeding is associated with worse outcomes (dilutional coagulopathy, hypothermia, acidosis). Early blood product use and surgical hemostasis are cornerstones of **damage control resuscitation** (DCR). ## Why This Approach - FAST-positive with hemodynamic instability = presumed intra-abdominal hemorrhage until proven otherwise - Hemoglobin 9.2 g/dL in acute trauma suggests significant blood loss - Continued crystalloid without blood products worsens the "lethal triad" (hypothermia, coagulopathy, acidosis) - Time to OR is critical; imaging delays mortality in unstable patients [cite:ATLS 10th Edition, Chapter 3: Shock]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.