Step II surgery question from UW

[250256]

42 ys woman after motor vehicle collision.

unconscious, BP70/20 pulse 110/m,
low jugular venous pulse distended abdomen with absent bowel sounds and some bruising
after 2L of ringer, BP 80/30

what is next:

A x-ray of abdomen
B CT of head
C exploratory laparotomy
D xray of spine
E chest x ray

the answer is C without doubt.

My question is if there is FAST or DPL, should I choose laparotomy?

In the explanation, they said abdominal distention, absent bowel sounds and abdominal bruising suggest the hemorrhage is most likely intraabdominal.

I personally think we still need FAST or DPL before surgery, but want to check with others.

Thank you!

 

[David Hasselhof]

In real life they'd probably run her through the scanner, but I think a FAST or DPL would be completely reasonable before ex lap.

 

[AndyRSC]

Depending on what options they give you, FAST may or may not be an option. Use this chart from Surgical Recall to guide you step by step.

Note that CT scan is not an option for unstable patients, unless you can't find the source of bleeding.

 

[250256]

thanks to David Hasselhof and AndyRSC.
I did not reply in time because the forum was out of work when I tried to loggin this Friday.