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Suspected multiple injuries after blunt major trauma — MRCEM SBA MCQ

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EasyTraumaSuspected multiple injuries after blunt major traumaMRCEM SBA

A 38-year-old driver is brought to a major trauma centre after a high-speed collision. He is alert, with a blood pressure of 124/78 mmHg and no respiratory compromise. He has left-sided chest wall tenderness and marked right upper-quadrant abdominal tenderness. A FAST scan performed during the initial assessment shows no free fluid. He remains haemodynamically stable, and CT is immediately available. What is the most appropriate imaging strategy?

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Correct answer: E — Obtain immediate whole-body CT.

This is an adult with blunt major trauma and suspected injuries in more than one body region: chest wall tenderness raises concern for thoracic injury, while focal abdominal tenderness raises concern for intra-abdominal injury. His normal haemodynamic status permits immediate CT. The negative FAST scan does not exclude intraperitoneal or retroperitoneal haemorrhage and must not determine whether CT is needed. NICE recommends whole-body CT for adults with blunt major trauma and suspected multiple injuries. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/Recommendations)) A is inadequate because the mechanism and persistent tenderness warrant investigation now, rather than observation alone. B is tempting because FAST can help direct urgent intervention in a patient with suspected haemorrhage who is unstable and not responding to resuscitation; it is not a screening test for CT in this stable patient. C similarly substitutes limited imaging used to direct intervention in an unstable patient for CT that is available now. D addresses the abdominal findings but fails to assess the suspected thoracic injury and is less appropriate than whole-body CT when multiple injuries are suspected. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/Recommendations))

Reference: NICE NG39: Major trauma: assessment and initial management — haemorrhage imaging and whole-body CT (17 February 2016) — https://www.nice.org.uk/guidance/ng39/chapter/Recommendations