A 19-Year-Old Man Is Brought to the Emergency Department by Ambulance

question 313

Multiple Choice

A 19-year-old man is brought to the emergency department by ambulance after a motor vehicle collision.  The accident occurred 1 hour ago when his vehicle spun out of control and rolled over.  He was wearing his seatbelt and his airbag deployed.  The patient is alert and reports abdominal pain.  Blood pressure is 110/70 mm Hg, pulse is 106/min, and respirations are 16/min.  On examination, lungs are clear to auscultation bilaterally and the chest wall is nontender.  Heart sounds are normal.  The abdomen is nondistended with tenderness to palpation in the left upper quadrant.  There are no gross deformities of the extremities.  A Focused Assessment with Sonography for Trauma (FAST) examination reveals free fluid in the left subphrenic space.  Which of the following is the best next step in management?

• A)CT scan of abdomen and pelvis
• B)Diagnostic peritoneal lavage
• C)Exploratory laparotomy
• D)No additional workup
• E)Serial abdominal examinations

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