›CT abdomen pelvis with IV contrast when concern persists
›Observation with serial exams when low risk and reliable exam
›Unreliable exam pathway
›CT favored when stable
›FAST plus CT complementary when indicated
Analgesia and supportive care
›Analgesia and supportive care
›Pain control principles
›Avoid masking peritonitis concern via reassessment loop
›Reassess exam after analgesia
›Adult dose examples
›Fentanyl IV 25 to 50 micrograms
›Repeat every 5 to 10 minutes to effect
›Caution in hypoventilation risk
›Hydromorphone IV 0.2 to 0.5 mg
›Repeat every 10 to 15 minutes to effect
›Reduce dose in older adults
›Acetaminophen PO 1000 mg
›Maximum 4000 mg per day
›Lower maximum in chronic liver disease
›Antiemetic adult dose examples
›Ondansetron IV 4 mg
›Repeat once if needed
›QT prolongation risk
Reassessment loop
›Reassessment loop
›Timing
›Every 15 minutes in unstable or borderline
›Every 30 to 60 minutes in stable observation
›What to repeat
›Vitals and shock index
›Abdominal exam
›Mental status
›Urine output when catheterized
›Escalation triggers
›New peritonitis
›Rising lactate
›Increasing transfusion requirement
›Worsening pain despite stable imaging
17Disposition/dispo25
ICU and operative criteria
›ICU and operative criteria
›Immediate OR criteria
›Hemodynamic instability with positive FAST
›Peritonitis
›Evisceration
›ICU criteria
›Ongoing vasopressor need
›Ongoing transfusion requirement
›Severe solid organ injury with high grade bleeding risk
›Severe traumatic brain injury with concurrent abdominal injury
Admission and observation criteria
›Admission and observation criteria
›Inpatient admission criteria
›Solid organ injury requiring monitoring
›Concern for delayed hollow viscus injury
›Significant comorbid bleeding risk
›Observation pathway criteria
›Stable vitals
›Reliable serial exam capability
›Pain controlled
›Discharge criteria
›Hemodynamically stable
›Reliable exam
›No concerning imaging findings
›Ambulation acceptable
›Reliable return precautions and supervision
18Discharge Instructions/di26
Copy discharge instructions
›Copy discharge instructions
›Summary
›You were evaluated after a blow to the abdomen
›Your tests today did not show a dangerous internal injury
›Medications
›Use acetaminophen as directed on the label unless told otherwise
›Avoid alcohol if using pain medicines that cause drowsiness
›Avoid NSAIDs if you were told you have bleeding risk or are on blood thinners
›Activity
›Rest for 24 hours
›No contact sports until cleared by a clinician if you had any organ injury concern
›Follow up
›Primary care or clinic follow up within 24 to 72 hours
›Earlier follow up if pain is worsening
›Return to the emergency department now for
›Fainting
›New or worsening shortness of breath
›New or worsening abdominal pain
›Vomiting that does not stop
›Blood in vomit
›Black stools
›Red blood in stool
›Blood in urine
›New confusion
›Weakness
›Fever
19References/r7
Guidelines and key sources
›Guidelines and key sources
›Project instructions source
›American College of Surgeons Committee on Trauma ATLS program information 2025
›EAST Practice Management Guidelines Blunt Abdominal Trauma Evaluation 2001 archived
›WSES Splenic trauma classification and guidelines 2017
›AAST Organ Injury Scale spleen liver kidney revision 2018
›AAST Organ Injury Scale renal trauma revision 2025
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.