In the setting of abdominal trauma, how should one prioritize imaging in an unstable patient?

In the context of managing an unstable patient with abdominal trauma, using ultrasound for rapid evaluation is a critical first step. This approach is recommended for several reasons.

Firstly, an ultrasound, particularly focused assessments like the Focused Assessment with Sonography for Trauma (FAST), can be performed quickly at the bedside. This rapid screening tool is instrumental in identifying free fluid or blood in the abdominal cavity, which can indicate internal bleeding and help prioritize surgical intervention if needed.

Secondly, ultrasound is non-invasive and does not expose the patient to ionizing radiation, making it safer for unstable patients who may already be at significant risk. It allows for immediate decision-making and can provide actionable information without requiring transport to an imaging suite, which can be time-consuming and hazardous for an unstable patient.

In scenarios where time is critical — as in the case of unstable trauma patients — prioritizing modalities that deliver rapid information that can guide immediate treatment is crucial. While computed tomography (CT) is very effective for detailed organ assessment, it requires patient stabilization and transport, which can delay life-saving interventions. Therefore, the use of bedside ultrasound aligns with the ATLS principles of optimizing patient outcomes in emergency scenarios.