Western Trauma Association
Management of Adult Blunt Splenic Trauma
Annotation
for Point A
The initial assessment of patients with suspected blunt
abdominal trauma should focus on the abdominal
examination (tenderness and abdominal wall eccymosis),
vital signs, and response to resuscitation. In patients
with evidence of shock or overt serious injury, blood
should be immediately drawn for laboratory testing
including complete blood count, electrolytes, markers of
metabolic stress (base deficit or lactate), coagulation
profile, and blood typing. Adequate intravenous (IV)
access should be obtained for resuscitation and
potential IV contrast administration. There is
considerable variability in the definition of
hemodynamic instability and there is no validated
scoring system. Table 2
depicts a modified hemodynamic instability score.36
Systolic blood pressure <90 mm Hg to define significant
hypotension and heart rate >130 beat per minute to
define serious tachycardia was taken from the recently
published guidelines for shock resuscitation developed
by the National Institutes of Health sponsored Glue
Grant consortium.37
Baseline systolic blood pressure and heart rate, how
they response to initial advanced trauma life support
recommended volume loading and the need for ongoing for
resuscitation are used to grade hemodynamic instability.
We propose that this score be used for early triage
decision making and be validated in prospective studies.
Stable patients (grade 0-2) should be triaged to the CT
scanner.
