Western Trauma Association
Management of Adult Blunt Hepatic Trauma
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.
