Blunt major trauma with suspected multiple injuries after response to resuscitation — MRCEM SBA MCQ

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HardTraumaBlunt major trauma with suspected multiple injuries after response to resuscitationMRCEM SBA

A 24-year-old man arrives at a major trauma centre after falling 7 metres. His initial blood pressure is 84/52 mmHg. After blood-component resuscitation it rises to 116/74 mmHg and remains stable without further transfusion. He is alert, with left-sided chest wall bruising, abdominal tenderness and a splinted thigh deformity. A FAST scan performed during the initial assessment is negative. His airway and ventilation are adequate, and he has no severe respiratory compromise. Which imaging strategy is most appropriate now?

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Correct answer: B — Proceed directly to whole-body CT

This patient has blunt major trauma with suspected injuries in several body regions. Crucially, he has responded to resuscitation and remains haemodynamically stable, so immediate CT is appropriate rather than limiting imaging to tests needed to direct an urgent intervention. NICE recommends whole-body CT for adults with blunt major trauma and suspected multiple injuries. A negative FAST does not exclude intra-abdominal or retroperitoneal haemorrhage and must not be used to decide whether CT is needed. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/Recommendations)) A repeat FAST (A) might help direct an immediate intervention in a patient who remains unstable despite resuscitation; it would not resolve this patient’s need for CT. Abdominopelvic CT alone (C) is too restricted when thoracic and other injuries are also suspected. Chest and pelvic radiographs (D) can help direct intervention in an unstable non-responder, but should not delay immediate CT here. Serial examination without CT (E) risks missing injuries after a high-energy mechanism and an episode of hypotension. Continued resuscitation and monitoring remain necessary during the imaging pathway.

Reference: Major trauma: assessment and initial management (NG39), recommendations 1.5.29–1.5.31 (17 February 2016) — https://www.nice.org.uk/guidance/ng39/chapter/Recommendations Major trauma: assessment and initial management (NG39), recommendations 1.5.32–1.5.34 (17 February 2016) — https://www.nice.org.uk/guidance/ng39/chapter/Recommendations