Non-Operative Management of Adult Blunt
Hepatic Trauma Algorithm
Annotation for Point D
Patients with persistent hemodynamic instability and a negative FAST pose a diagnostic dilemma and should not be triaged to the CT scanner, rather resuscitation should continue as the differential diagnosis of refractory shock is pursued. Patients with blunt hepatic injuries are at risk for both associated abdominal and extra-abdominal injuries. 8,20 Extra-abdominal sources of exsanguinating hemorrhage include massive hemothorax and severe pelvic fracture, whereas nonhemorrhagic shock from cardiogenic (tension pneumothorax, cardiac tamponade, and myocardial contusion or infarct) or neurogenic (spinal shock) causes may be present either as the sole source or in addition to hemorrhagic sources of instability. Rather than continuing shock resuscitation in the trauma bay, an alternative is to proceed to the operating room for an exploratory laparotomy in patients at risk for imminent cardiac arrest.