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, with a patent airway and normal breathing. Pulse is 118/min, BP 94/60 mmHg, and capillary refill is 3 seconds. Abdominal examination reveals tenderness in the left upper quadrant with guarding. What is the most appropriate immediate next step in management?

Question

Accepted Answer

D. Obtain a FAST (Focused Assessment with Sonography for Trauma) examination. ## Clinical Context
This patient presents with signs of hemorrhagic shock (tachycardia, hypotension, delayed capillary refill) and a mechanism suggesting intra-abdominal injury (high-speed MVC with left upper quadrant tenderness and guarding).

## Primary Survey Assessment
**Key Point:** The primary survey (ABCDE) has been completed — airway patent, breathing adequate, circulation compromised (Class II hemorrhagic shock). The patient is now in the secondary survey phase.

## FAST Examination Rationale
**High-Yield:** FAST is the gold standard rapid imaging modality in ATLS protocol for detecting free fluid (blood) in the peritoneal cavity in trauma patients. It is:
  - Non-invasive and can be performed at the bedside
  - Rapid (takes 2–3 minutes)
  - Highly sensitive for detecting hemoperitoneum
  - Does not delay resuscitation
  - Guides decision for operative intervention

**Clinical Pearl:** A positive FAST in a hemodynamically unstable patient with abdominal trauma is an indication for immediate operative exploration — no further imaging is needed.

## Sequence in ATLS
1. Complete primary survey (ABCDE)
2. Initiate resuscitation (IV access, fluid/blood)
3. Perform secondary survey with FAST for blunt abdominal trauma
4. Decide operative vs. non-operative management based on FAST + hemodynamic response

**Mnemonic:** **FAST** = Focused Assessment with Sonography for Trauma. Evaluates four views:
  - **F**ree fluid in Morrison's pouch (RUQ)
  - **A**bdominal free fluid in pelvis
  - **S**plenorenal view (LUQ)
  - **T**horax (pericardial view for hemopericardium)

Answer

A. Proceed directly to the operating theatre for exploratory laparotomy

Answer

B. Perform a diagnostic peritoneal lavage

Answer

C. Administer 2 units of O-negative blood immediately

Explanation

Clinical Context

Primary Survey Assessment

FAST Examination Rationale

Sequence in ATLS

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