A 29-year-old man is brought to the emergency department by paramedics following a high-speed motorcycle collision. On arrival, he is confused and diaphoretic. His temperature is 36.5°C (97.7°F), blood pressure is 82/50 mm Hg, pulse is 128/min, and respiratory rate is 24/min. Physical examination reveals a distended and diffusely tender abdomen with overlying ecchymosis. Breath sounds are equal bilaterally. The pelvis is mechanically stable to manual compression. Intravenous fluid resuscitation is initiated through two large-bore peripheral catheters. Which of the following is the most appropriate initial imaging study for this patient?
- Bedside focused assessment with sonography for trauma (FAST)Answer
- BComputed tomography (CT) of the abdomen and pelvis with intravenous contrast
- CAnteroposterior radiograph of the abdomen
- DBedside plain radiograph of the pelvis
- EMagnetic resonance imaging (MRI) of the abdomen
Answer
Bedside focused assessment with sonography for trauma (FAST)
The correct answer is a bedside focused assessment with sonography for trauma (FAST). This patient is presenting with hemorrhagic shock (hypotension, tachycardia, altered mental status) following blunt abdominal trauma, as evidenced by a distended, ecchymotic abdomen. According to Advanced Trauma Life Support (ATLS) protocols, the initial diagnostic test of choice for a hemodynamically unstable patient with suspected intra-abdominal hemorrhage is a bedside FAST exam. It is rapid, non-invasive, and highly sensitive for detecting intraperitoneal free fluid (blood). A positive FAST exam in this unstable patient would be an immediate indication for an emergency exploratory laparotomy.
Step-by-Step Solution
Key Concept
In hemodynamically unstable patients with blunt abdominal trauma, a bedside focused assessment with sonography for trauma (FAST) is the most appropriate initial imaging study to rapidly identify intraperitoneal hemorrhage.