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Splenic rupture — ACEM Fellowship MCQ

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HardTraumaSplenic ruptureACEM Fellowship

A 24-year-old farm worker presents to a rural ED, triage category 1, after a quad-bike rollover. BP 82/48 after 1 L crystalloid, HR 132. FAST is positive in the left upper quadrant and pelvis. Haemoglobin is 86 g/L and the nearest trauma laparotomy service is 90 minutes away by road. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Activate retrieval and transfer for damage-control laparotomy

Persistent shock with positive FAST after blunt trauma needs damage-control surgery; rural teams should activate retrieval early.

Reference: ACEM trauma curriculum; Australian trauma retrieval principles