Western Trauma Association
Management of Adult Blunt Hepatic Trauma
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
