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Suspected traumatic intra-abdominal haemorrhage — MRCEM SBA MCQ

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EasyTraumaSuspected traumatic intra-abdominal haemorrhageMRCEM SBA

A 40-year-old construction worker is brought to a major trauma centre after being crushed across the abdomen by a reversing vehicle. He is pale, with a heart rate of 132 beats/min and blood pressure of 78/46 mmHg. His abdomen is distended and tender, and there is no significant external bleeding. After one unit of emergency red blood cells, his blood pressure remains 82/48 mmHg. Red blood cells and plasma are immediately available, and the trauma team is arranging definitive haemorrhage control. What is the most appropriate ongoing fluid replacement strategy?

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Correct answer: C — Give red blood cells and plasma in a 1:1 unit ratio.

The mechanism, abdominal findings and persistent hypotension despite an initial red-cell unit indicate suspected ongoing major internal haemorrhage. Definitive haemorrhage control is being arranged, but resuscitation must continue in parallel. NICE recommends activating a major haemorrhage protocol using an initial fixed ratio of blood components; for adults, fluid replacement uses one unit of plasma per unit of red blood cells. Treatment should become guided by laboratory coagulation results as soon as these are available. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/recommendations)) A is inappropriate because NICE advises against crystalloids for patients with active bleeding in hospital. B supplies oxygen-carrying capacity but omits the plasma required in the initial fixed-ratio approach; laboratory results should refine treatment, not delay it. D substitutes platelets for plasma, whereas the specified initial ratio is plasma to red blood cells. Platelets may subsequently be indicated as part of laboratory-guided treatment. E includes both relevant components but gives less plasma than the recommended initial 1:1 ratio. The single red-cell unit already administered does not justify continuing a red-cell-heavy strategy. ([nice.org.uk](https://www.nice.org.uk/guidance/ng39/chapter/recommendations))

Reference: NICE NG39: Major trauma: assessment and initial management — recommendations 1.5.23–1.5.27 (17 February 2016) — https://www.nice.org.uk/guidance/ng39/chapter/recommendations