Examkin

Soru

Zorluk: OrtaTrauma and Burns

A 37-year-old male is brought to the emergency department by ambulance after falling approximately 20 feet (6 meters) from scaffolding. He is immobilized on a backboard with a cervical collar. Upon arrival, his temperature is 36.1∘C36.1^{\circ}\text{C} (97.0∘F97.0^{\circ}\text{F}), blood pressure is 78/45 mmHg78/45\text{ mmHg}, heart rate is 138 /min138\text{ /min}, and respiratory rate is 26 /min26\text{ /min}. Oxygen saturation is 97%97\% on room air. Two large-bore intravenous lines are established, and aggressive crystalloid fluid resuscitation is initiated. The airway is patent, and breath sounds are present and equal bilaterally. The abdomen is distended and diffusely tender. The pelvis is stable to anteroposterior compression. Focused assessment with sonography for trauma (FAST) reveals a significant anechoic fluid collection in the splenorenal recess. His blood pressure remains 80/48 mmHg80/48\text{ mmHg} after 1 L1\text{ L} of crystalloid infusion. Which of the following is the most appropriate next step in management?

  1. Exploratory laparotomyCevap
  2. B
    Computed tomography of the abdomen and pelvis
  3. C
    Diagnostic peritoneal lavage
  4. D
    Pelvic angiography with embolization
  5. E
    Administration of intravenous norepinephrine

Cevap

Exploratory laparotomy
The correct next step is immediate exploratory laparotomy. According to advanced trauma life support (ATLS) protocols, a patient presenting with blunt abdominal trauma who exhibits hemodynamic instability (e.g., persistent hypotension and tachycardia despite initial crystalloid resuscitation) must undergo rapid evaluation for the source of bleeding. A positive Focused Assessment with Sonography for Trauma (FAST) scan confirms the presence of intraperitoneal hemorrhage. In the setting of shock and a positive FAST, the patient is actively bleeding into the abdominal cavity and requires immediate surgical exploration (laparotomy) to achieve source control. Any delay for further diagnostic testing significantly increases mortality.

Adım Adım Çözüm

1
Evaluate the patient's hemodynamic status and response to initial resuscitation.
The patient presents in hypovolemic shock (hypotension, tachycardia) and remains unstable after an initial 1 L crystalloid bolus.
Hemodynamic status dictates the diagnostic and therapeutic algorithm in blunt trauma.
2
Analyze the primary survey and bedside imaging findings.
Airway and breathing are intact. The FAST scan is positive, demonstrating anechoic fluid (blood) in the splenorenal recess.
A positive FAST localizes the source of hemorrhagic shock to the peritoneal cavity.
3
Determine the definitive treatment based on the ATLS algorithm for blunt abdominal trauma.
Immediate exploratory laparotomy is required.
The combination of hemodynamic instability and a positive FAST scan indicates life-threatening intra-abdominal hemorrhage requiring emergent surgical source control.

Anahtar Kavram

In patients with blunt abdominal trauma, the combination of hemodynamic instability and a positive FAST scan is an absolute indication for immediate exploratory laparotomy.
Bu soruyu puanla

Konular

Trauma and Burns

Bu konudan daha fazla soru