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Haemorrhagic Shock — FRCA Final MCQ

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ModerateTrauma & Emergency AnaesthesiaHaemorrhagic ShockFRCA Final

A 22-year-old man is brought to the emergency department after a high-speed motorcycle collision. His airway is patent with cervical spine protection. He has equal bilateral breath sounds, a respiratory rate of 32 breaths min−1, heart rate 130 beats min−1, blood pressure 85/55 mmHg and cold peripheries. His GCS is 15. There is no external haemorrhage and no clinical suspicion of a pelvic fracture. FAST demonstrates free intraperitoneal fluid in Morison's pouch. Tranexamic acid has been given and restricted haemostatic resuscitation commenced, but his blood pressure remains 82/50 mmHg. What is the next priority?

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Correct answer: B — Activate the major haemorrhage protocol and proceed directly to emergency laparotomy

This patient has ongoing haemorrhagic shock with a positive FAST localising likely bleeding to the peritoneal cavity. He is haemodynamically unstable despite initial resuscitation, so the priorities are simultaneous major haemorrhage protocol activation and immediate operative haemorrhage control by damage-control laparotomy. NICE recommends physiological criteria and response to resuscitation for protocol activation, minimal imaging in unstable non-responders, and damage-control surgery. CT would delay source control and is reserved for patients who are haemodynamically normal or responding to resuscitation. Laparotomy without haemorrhage-protocol support neglects essential balanced blood-component resuscitation. A pelvic binder is appropriate when pelvic bleeding is suspected, which the stem excludes. Additional radiographs must not delay definitive control of identified life-threatening intra-abdominal haemorrhage.

Reference: National Institute for Health and Care Excellence. Major trauma: assessment and initial management (NG39), recommendations 1.5.13, 1.5.20, 1.5.23–1.5.31 and 1.5.37. 2016. https://www.nice.org.uk/guidance/ng39/chapter/Recommendations