Abdominal Trauma — FAST, Laparotomy Indications

Which of the following is an ABSOLUTE indication for emergency laparotomy in a patient with blunt abdominal trauma?

During trauma resuscitation, two patients with blunt abdominal trauma are being evaluated. Patient A has a positive FAST (free fluid in Morrison's pouch and pelvis) but is haemodynamically stable after 2 litres of IV crystalloid. Patient B has a negative FAST but is haemodynamically unstable (SBP 85 mmHg, HR 128 bpm) despite 3 litres of crystalloid and ongoing transfusion. Which finding best discriminates between these two presentations and determines the need for immediate laparotomy?

A 28-year-old woman is brought to the trauma bay following a stab wound to the right lower abdomen. She is haemodynamically unstable (BP 88/56 mmHg, HR 128/min) despite two units of O-negative blood. On examination, she has severe right-sided abdominal tenderness and guarding. Which is the most appropriate next investigation before proceeding to the operating theatre?

A 32-year-old man is brought to the emergency department following a high-speed motor vehicle collision. Clinical examination reveals abdominal tenderness and distension. FAST examination is performed. Which organ is the most common site of injury in blunt abdominal trauma?

In a haemodynamically unstable patient with blunt abdominal trauma and a positive FAST examination, which of the following is the most appropriate next step according to ATLS guidelines?