Management of Blunt Hepatic Trauma

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Slide 1

Western Trauma Association Critical Decisions in Trauma: Nonoperative Management of Adult Blunt Hepatic Trauma Volume 67(6), December 2009, pp 1144-1149 summarized and animated by sun yai-cheng http://decode-medicine.blogspot.com/

Slide 2

86.3% of hepatic injuries are managed without operative intervention

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Subcapsular, nonexpanding, <10% surface area Capsular tear, nonbleeding, <1 cm parenchymal depth Subcapsular, nonexpanding, 10–50% surface area; intraparenchymal, nonexpanding, <10 cm in diameter Capsular tear, active bleeding; 1–3 cm parenchymal depth, <10 cm in length Subcapsular, >50% surface area or expanding; ruptured subcapsular hematoma with active bleeding; intraparenchymal hematoma, >10 cm or expanding >3 cm parenchymal depth Ruptured intraparenchymal hematoma with active bleeding Parenchymal disruption involving 25–75% of hepatic lobe or 1–3 Couinaud's segments within a single lobe Parenchymal disruption involving >75% of hepatic lobe or >3 Couinaud's segments within a single lobe Juxtahepatic venous injuries, i.e., retrohepatic vena cava/central major hepatic veins Hepatic avulsion Grade Injury Description American Association for the Surgery of Trauma Liver Injury Scale I. Hematoma Laceration II. Hematoma Laceration III. Hematoma Laceration IV. Hematoma Laceration V. Laceration Vascular VI. Vascular

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Massive Transfusion Protocol 1:1 ratio of pRBC to FFP and a pharesis platelet pack per 5-10 units pRBC as a starting point (+) Initial Assessment of BAT ATLS Abdominal exam Response to resuscitation Stable Unstable FAST CT Scan Liver Injury Unstable Blush? Other causes of instability? (-) DPL (+) Operating Room Observation TAE Unstable (-) (+) Algorithm for management of blunt hepatic trauma Severe pelvic fracture Massive hemothorax Tension pneumothorax Cardiac tamponade Myocardial contusion Neurogenic shock

Summary: Western Trauma Association Critical Decisions in Trauma: Nonoperative Management of Adult Blunt Hepatic Trauma J. Trauma Volume 67(6), December 2009, pp 1144-1149

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