An adult in a road traffic collision has a systolic blood pressure of 70 mmHg, a rigid abdomen and a positive FAST scan. What is the immediate priority?

Answer and explanation

Correct answer: B. Activate the major haemorrhage protocol and transfer for surgical control of bleeding

  1. Step 1: Hypotension with intra-abdominal free fluid means haemorrhage.
  2. Step 2: Early blood products, tranexamic acid and surgical control take priority over large volumes of crystalloid.
Answer
Activate the major haemorrhage protocol and transfer for surgical control of bleeding.
Why not the others: Give oral analgesia and observe for deterioration over the next hour: Observation delays life-saving surgery. Request an MRI abdomen to define the source before treatment: MRI is unsafe and too slow in an unstable patient. Give a 2 litre crystalloid bolus and wait for stabilisation before further tests: Large crystalloid volumes worsen coagulopathy and dilution.

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