Abdominal trauma - resuscitation and early management
Abdominal trauma can be life‑threatening and frequently occult. Management is centred on a rapid primary survey (ABCDE), early haemorrhage control, focused bedside imaging in the unstable patient, and prompt escalation to definitive haemorrhage control (operating theatre or interventional radiology) rather than prolonged ED stabilisation when bleeding is uncontrolled (NICE NG39, RCEM).
Key principles up front
- Prioritise catastrophic haemorrhage control and the ABCDE primary survey and make early destination decisions (major trauma centre vs trauma unit) per local trauma network protocols (NICE NG39).
- Use bedside ultrasound (eFAST) in unstable patients if it will not delay definitive care; a positive eFAST in an unstable patient supports urgent laparotomy (RCEM, NICE).
- In haemodynamically stable patients the investigation of choice is contrast‑enhanced CT abdomen/pelvis (IV contrast; CT angiography if arterial bleeding suspected) (RCEM, NICE).
- Adopt a restrictive/titrated fluid strategy for suspected uncontrolled haemorrhage and give tranexamic acid early when major bleeding is suspected (NICE NG39).
- Notify surgical, vascular and interventional radiology teams early and activate massive transfusion protocols (MTP) where indicated.
Mechanisms and typical injury patterns
- Blunt trauma: compression, deceleration or crush injuries (road traffic collisions, falls, sports). Commonly injured organs are the spleen (most common solid organ), liver and kidneys; hollow viscus and retroperitoneal injuries (pancreas, duodenum, aorta) may be occult or delayed.
- Penetrating trauma: stab...
Ready to master this topic for the FRCEM?