Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm

Annotation for Point B

 Although there is no well-accepted definition of hemodynamic instability, the traditionally accepted value is 90 mm Hg. However, recent studies demonstrate that patients are at risk for hemorrhage and death with a blood pressure 110 mm Hg and a base deficit of 4.13,14 To assist in early triage decisions, a hemodynamic instability score has been proposed for patients with blunt splenic trauma.2 Initial evaluation should also include an assessment of admission coagulopathy. The early use of a massive transfusion protocol, rather than the excessive use of crystalloids, is encouraged for patients with ongoing transfusion needs and has been shown to reduce mortality.15 Recent data also support the early use of plasma to packed red blood cells in a ratio approaching 1:1, although a prospective randomized trial has not yet been performed.16,17 The association between plasma- and transfusion-related acute lung injury suggests the need for further investigation into this practice.18