Question

A patient presents following a Road Traffic Accident (RTA) with absent air entry on the left side and tenderness in the left lower chest wall. What is the next step in Emergency Management (EMR)?

• A. X-ray
• B. CT
• C. FAST
• D. DPL

Hint:

Think of the point-of-care bedside investigation used first in trauma for detecting haemoperitoneum.

Answer 1

The Correct Option is C

Step 1: Identify the clinical scenario.
The patient has sustained a road traffic accident and presents with absent air entry on the left side along with tenderness in the left lower chest wall. This raises concern for haemothorax, pneumothorax, or intra-abdominal injury with haemoperitoneum.

Step 2: Apply ATLS trauma principles.
In emergency management of a trauma patient, rapid assessment of life-threatening injuries is paramount using the ABC (Airway, Breathing, Circulation) approach.

Step 3: Select the appropriate investigation.
Focused Assessment with Sonography for Trauma (FAST) is the point-of-care ultrasound examination of choice in the initial assessment. It is performed rapidly at the bedside without moving the patient, does not involve radiation, and directly identifies free intraperitoneal fluid (haemoperitoneum) and pericardial effusion. Extended FAST (eFAST) also assesses for pleural fluid and pneumothorax.

Step 4: Why not the other options?
X-ray is useful but slower and less sensitive for haemoperitoneum. CT is highly detailed but time-consuming and requires patient transport to the scanner -- not the first step. DPL (Diagnostic Peritoneal Lavage) is invasive and largely replaced by FAST.

Conclusion: FAST is the immediate next step in emergency management of this trauma patient.