When blunt abdominal trauma is present but there are no peritoneal signs and the patient is hypotensive, what should be done next?

• A. CT abdomen
• B. Observational care
• C. FAST exam
• D. Explorative laparotomy

Answer: (C)

In the scenario of blunt abdominal trauma accompanied by hypotension yet lacking peritoneal signs, the most appropriate next step is to perform a FAST (Focused Assessment with Sonography for Trauma) exam. This bedside ultrasound is a rapid and non-invasive method used to assess for free fluid (such as blood) in the abdominal cavity, which could indicate significant internal injury.

The presence of hypotension is a critical factor, as it may suggest internal bleeding or hypovolemic shock, necessitating further evaluation to identify the source of bleeding urgently. The FAST exam allows for quick assessment and can guide further management decisions. If free fluid is identified, it typically indicates a need for immediate surgical intervention, while a negative FAST might allow for a more conservative approach or further imaging.

Other options, while they could be considered in different contexts, may delay necessary care. For instance, although a CT abdomen can provide detailed images of abdominal organs and potential injuries, it is time-consuming and may not be suitable when rapid stabilization is needed in a hypotensive patient. Observational care would not be appropriate given the instability presented by the hypotension. An exploratory laparotomy may be indicated eventually if the FAST or other evaluations suggest significant injury, but it would be premature to proceed directly