Management of Hemodynamically Stable Trauma Patient with Positive FAST

Rationale for CT With IV Contrast

• The American College of Radiology recommends CT abdomen and pelvis with IV contrast as the definitive next step in hemodynamically stable trauma patients with positive FAST to characterize injuries, identify the source of bleeding, and determine whether operative or non-operative management is appropriate 1, 2
• Contrast enhancement is critical for accurately characterizing liver, spleen, and kidney injuries, which directly impacts management decisions, as stated by the American College of Radiology 1, 3
• Contrast-enhanced CT can detect pseudoaneurysms, vascular occlusions, and intimal tears that may require angioembolization rather than surgery, according to the American College of Radiology 1, 2

Clinical Algorithm for This Patient

• The American College of Radiology and Anaesthesia guideline society recommend proceeding directly to CT abdomen/pelvis with IV contrast in hemodynamically stable patients, without delaying with pelvic X-ray 1, 2, 7
• CT findings will guide management, with active arterial extravasation indicating angioembolization, solid organ injury without active bleeding indicating non-operative management, hollow viscus injury or peritonitis indicating surgical exploration, and venous bleeding indicating supportive care, as recommended by the American College of Radiology 1, 2, 3, 4, 5

Important Caveats

• If the patient becomes hemodynamically unstable while awaiting or during CT, immediate abortion of imaging and proceeding to the operating room based on FAST findings is recommended by Anaesthesia and Praxis Medical Insights guideline societies 7, 8
• The American College of Radiology states that every 10-minute delay from admission to laparotomy in unstable patients increases mortality, highlighting the importance of prompt intervention 8
• A positive FAST indicates free fluid but does not specify the source or severity, making contrast-enhanced CT essential to characterize the injury and plan appropriate intervention, as recommended by the American College of Radiology and Anaesthesia 1, 7