A 32-year-old man is brought to the emergency department following a high-speed motor vehicle collision. On primary survey, he is alert and oriented, airway patent, breathing at 24/min with bilateral breath sounds, heart rate 118/min, blood pressure 132/88 mmHg, and capillary refill <2 seconds. Abdominal examination reveals mild tenderness in the left upper quadrant without guarding or rigidity. What is the most appropriate next step in management?

Explanation

## Approach to Blunt Abdominal Trauma in Stable Patients **Key Point:** In a haemodynamically stable patient with blunt abdominal trauma, the priority is to complete the primary survey, then proceed systematically through the secondary survey with imaging to identify occult injuries. ### Clinical Context This patient meets criteria for haemodynamic stability: - Systolic BP >90 mmHg - Heart rate <120/min (borderline) - Capillary refill <2 seconds - Alert mental status ### ATLS Protocol for Stable Blunt Trauma | Phase | Action | Rationale | |-------|--------|----------| | **Primary Survey** | A-B-C-D-E assessment | Already completed — patient stable | | **Resuscitation** | Establish IV access, fluid readiness | Ongoing; patient not in shock | | **Secondary Survey** | Systematic head-to-toe examination | **Next step** — identify all injuries | | **Imaging** | FAST ± CT abdomen/pelvis | Localise intra-abdominal injury | | **Definitive Care** | OR only if unstable or imaging positive | Not indicated yet | **High-Yield:** FAST (Focused Assessment with Sonography for Trauma) is the imaging modality of choice in the trauma bay for rapid detection of free fluid (blood) in dependent areas: perihepatic (Morrison's pouch), perisplenic, pelvic, and pericardial. ### Why Secondary Survey Now? The patient has: - Completed primary survey (A-B-C-D-E) - No signs of shock or immediate life threat - Mild LUQ tenderness (possible splenic injury, but stable) Secondary survey allows systematic evaluation of all body regions and identification of non-life-threatening injuries before imaging. **Clinical Pearl:** Mild abdominal tenderness in a stable patient does NOT mandate immediate laparotomy. Imaging and serial examination are the standard of care. [cite:ATLS 10th Edition]