Primary Survey
What does the “C” in the ABCDE trauma approach stand for?
Circulation with haemorrhage control
What is the purpose of a FAST scan in trauma assessment?
To detect free intraperitoneal or pericardial fluid (usually blood).
A patient has left lower rib fractures after a car crash. Which organ is most likely injured?
Spleen
What is the first priority in managing a penetrating abdominal injury?
Follow ATLS: control external bleeding and assess ABCs
Name one sign of shock you would look for during the primary survey.
Tachycardia, hypotension, pallor, cold/clammy skin, altered consciousness
Name two areas where free fluid can be seen on a FAST scan.
Morrison’s pouch (RUQ), splenorenal recess (LUQ), pelvis, pericardium
What finding on exam indicates peritonitis, suggesting possible hollow viscus perforation?
Rebound tenderness or rigidity
What is the gold standard investigation for a stable patient with a penetrating abdominal wound?
CT abdomen/pelvis with IV contrast
Why is C-spine protection important during airway assessment in blunt trauma?
Because cervical spine injuries can coexist with head/torso trauma — moving the neck could worsen spinal cord injury.
What investigation is the gold standard for assessing blunt abdominal injury in a stable patient?
CT abdomen/pelvis with IV contrast
A patient with blunt abdominal trauma is hypotensive and tachycardic, and the FAST scan shows free fluid. What is the next immediate step in management?
Emergency laparotomy
What are two indications for immediate laparotomy in penetrating abdominal trauma?
Haemodynamic instability, evisceration, peritonitis, or uncontrolled bleeding
During exposure, you notice a seatbelt sign. What underlying abdominal injury should you suspect?
Small bowel or mesenteric tear
Elevated amylase or lipase after blunt trauma suggests injury to which organ?
Pancreas
A stable patient has a splenic laceration seen on CT. What is the preferred management approach?
Non-operative management — close monitoring, serial haemoglobin checks, and repeat imaging if needed.
Why should a penetrating object never be removed in the emergency department?
Because it may be tamponading bleeding vessels or organs — removal can cause massive haemorrhage.