A 32-year-old male arrives at the trauma bay 20 minutes after a high-speed motor vehicle collision. He is alert but restless, with a blood pressure of 94/62 mmHg, heart rate 128/min, respiratory rate 24/min, and capillary refill >2 seconds. Physical examination reveals a distended abdomen with bruising over the left flank. Two large-bore IV lines have been established. What is the most appropriate immediate next step in management?

Clinical Context: Hemorrhagic Shock Class III — Blunt Abdominal Trauma

This patient presents with Class III hemorrhagic shock:

Why Option B is Correct: Activate MTP + Emergency Laparotomy

In a hemodynamically unstable patient with blunt abdominal trauma and clinical signs of intra-abdominal hemorrhage, the ATLS 10th Edition algorithm mandates:

The key distinction: Option C (FAST + permissive hypotension) is appropriate when the source of bleeding is uncertain. Here, the clinical picture (distended abdomen, flank bruising, mechanism) already localizes the source to the abdomen. FAST adds confirmatory value but is not the most appropriate immediate next step — activating MTP and preparing for laparotomy is.

Comparison of Options

High-Yield Facts (ATLS 10th Edition)

Clinical Pearl:

Damage Control Resuscitation (DCR) = MTP activation + permissive hypotension + rapid source control (OR). In a patient with an obviously injured abdomen and shock, the most appropriate immediate next step is activating MTP and proceeding to emergency laparotomy — not performing FAST first. FAST is most valuable when the bleeding source is unknown.

ATLS 10th Edition, Chapter 3 — Shock; Chapter 5 — Abdominal and Pelvic Trauma