Question:
A patient presents with a left hypochondrium contusion with systolic blood pressure of 70 mmHg and pulse rate of 110 per minute. What should be done next?
A patient presents with a left hypochondrium contusion with systolic blood pressure of 70 mmHg and pulse rate of 110 per minute. What should be done next?
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In a haemodynamically unstable trauma patient, the bedside investigation of choice is rapid sonographic assessment of the abdomen.
Updated On: Jun 23, 2026
- FAST (Focused Assessment with Sonography in Trauma)
- CECT abdomen
- DPL (Diagnostic Peritoneal Lavage)
- Abdominal X-ray
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The Correct Option is A
Solution and Explanation
Step 1: Assess the clinical scenario.
The patient has sustained trauma to the left hypochondrium (left upper quadrant). The vital signs show:
- Systolic BP: 70 mmHg (severely hypotensive)
- Pulse rate: 110/min (tachycardia)
This clinical picture is consistent with haemodynamic instability (shock), likely due to intra-abdominal haemorrhage (e.g., splenic laceration, which is the most common solid organ injured in left hypochondrium trauma).
Step 2: Identify the most appropriate next step in a haemodynamically unstable trauma patient.
In trauma management, the investigation of choice for a haemodynamically unstable patient is FAST (Focused Assessment with Sonography in Trauma).
- FAST is a rapid bedside ultrasound protocol that takes less than 5 minutes.
- It detects haemoperitoneum and haemopericardium at the bedside without exposing the patient to radiation or contrast.
- A positive FAST (free fluid = blood) in an unstable patient is a direct indication for emergency exploratory laparotomy.
- FAST reduces time to surgical intervention and patient length of stay.
Step 3: Why not the other options?
- CECT: Contraindicated in haemodynamically unstable patients -- the patient cannot be sent to the CT scanner.
- DPL: Diagnostic Peritoneal Lavage is invasive and has been largely replaced by FAST. It is used when FAST is unavailable or indeterminate.
- Abdominal X-ray: Not useful for detecting intra-abdominal haemorrhage; too slow and non-specific.
Conclusion: FAST is the next best step in a haemodynamically unstable trauma patient with suspected intra-abdominal injury.
The patient has sustained trauma to the left hypochondrium (left upper quadrant). The vital signs show:
- Systolic BP: 70 mmHg (severely hypotensive)
- Pulse rate: 110/min (tachycardia)
This clinical picture is consistent with haemodynamic instability (shock), likely due to intra-abdominal haemorrhage (e.g., splenic laceration, which is the most common solid organ injured in left hypochondrium trauma).
Step 2: Identify the most appropriate next step in a haemodynamically unstable trauma patient.
In trauma management, the investigation of choice for a haemodynamically unstable patient is FAST (Focused Assessment with Sonography in Trauma).
- FAST is a rapid bedside ultrasound protocol that takes less than 5 minutes.
- It detects haemoperitoneum and haemopericardium at the bedside without exposing the patient to radiation or contrast.
- A positive FAST (free fluid = blood) in an unstable patient is a direct indication for emergency exploratory laparotomy.
- FAST reduces time to surgical intervention and patient length of stay.
Step 3: Why not the other options?
- CECT: Contraindicated in haemodynamically unstable patients -- the patient cannot be sent to the CT scanner.
- DPL: Diagnostic Peritoneal Lavage is invasive and has been largely replaced by FAST. It is used when FAST is unavailable or indeterminate.
- Abdominal X-ray: Not useful for detecting intra-abdominal haemorrhage; too slow and non-specific.
Conclusion: FAST is the next best step in a haemodynamically unstable trauma patient with suspected intra-abdominal injury.
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