Abdominal trauma with signs of shock and peritonitis – Surgery MCQ

A patient presents to the emergency department with an abdominal trauma with signs of shock and peritonitis. Airway and breathing were checked. 2 large bore cannulas were inserted to secure IV access. What is the next step in the management of this patient?

A. Immediate exploratory laparotomy with general anaesthesia
B. Focused Assessment with Sonography in Trauma (FAST)
C. Laparoscopic visualisation of the injury
D. Watch and wait

Correct answer : A. Immediate exploratory laparotomy with general anaesthesia

Management of a case of abdominal trauma

• Maintenance of airway, breathing and circulation is the first priority
• The patient should be intubated in case of airway block
• If the breathing is compromised, the patient should be ventilated with a high fraction of inspired oxygen
• Large bore IV cannulas should be inserted and IV fluids should be administered
• In case of external bleeding, direct pressure should be applied to control it
• Spinal immobilisation should be done in cases with suspected spinal cord injury

Indications for laparotomy in blunt trauma abdomen

• Hemodynamically unstable patients with shock
• Signs of peritonitis
• Progressive deterioration of the patient’s status
• Identification of hemoperitoneum after Focused Assessment with Sonography in Trauma (FAST) or Diagnostic Peritoneal Lavage (DPL)

Non surgical management

• If the patent is hemodynamically stable, further investigations like CT scan can be done to visualise the site of injury