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Western Trauma Association
Management of Adult Blunt Splenic Trauma
Annotation
for Point B
Unstable patients (grade 3-5) should have a FAST
examination done (if available and reliable) after the
initial ABCs. Patients who stabilize with initial volume
loading and require modest ongoing resuscitation (grade
3) may be triaged to the CT scanner if readily
available. Grade 3 patients who are FAST (+) are
presumed to have a hemoperitoneum. This information
should prompt closer monitoring and quicker processing
through the CT scanner. On the other hand, FAST (+)
patients who require vigorous ongoing resuscitation
(grade 4 and 5 instability) should be triaged to the
operating room (OR). In some cases patients with grade 4
instability might be triaged to the CT scanner with
caution. This would be a reasonable option if the CT
scanner is readily available and (a) a plausible
explanation for instability exists (e.g., tension
pneumothorax, pelvic fracture, neurogenic shock), or (b)
the CT scan results will change triage decision making
(e.g., epidural hematoma requiring craniotomy, torn
thoracic aorta requiring thoracotomy, massive brain
injury to declare futility, or vascular blush associated
with a pelvic fracture prompting AE).
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