Approach to the Critical Patient

Immediate stabilization

Hemorrhagic shock recognition

Airway and access

Operative vs nonoperative decision

Critical branching decision

Team activation and monitoring

Consult triggers

Monitoring targets

History

Mechanism and event

Blunt trauma mechanisms

Penetrating trauma

Symptoms

Abdominal complaints

Hemorrhage symptoms

Relevant history

Medications affecting hemorrhage

Pre-existing liver conditions

Surgical history

Last oral intake: relevant for operative planning

Risk factors for NOM failure

Predictors of nonoperative management failure

Physical Exam

Vital signs and hemodynamic status

Hemodynamic assessment

Abdominal exam

Inspection

Palpation

Percussion and auscultation

Secondary survey

Right lower chest

Pelvic instability: alternative source of massive hemorrhage

Rectal exam: melena suggests delayed hemobilia

Serial abdominal exams

Differential Diagnosis

Life-threatening hemorrhagic causes

Solid organ injuries

Vascular injuries

Hollow viscus and other injury

Hollow viscus injury

Chest injuries mimicking abdominal source

Delayed complications of liver injury

Laboratory Tests

Hemorrhage and resuscitation labs

Complete blood count

Type and screen/crossmatch

Coagulation panel

Organ function and shock markers

Hepatic transaminases

Metabolic and perfusion markers

Renal and electrolyte function

Additional panels

Diagnostic Tests

Scoring Systems

AAST Organ Injury Scale (universally accepted grading system)

WSES Classification (World Society of Emergency Surgery)

Assessment of Blood Consumption (ABC) Score

MRI

MRI role in liver laceration

CT

CT abdomen/pelvis with IV contrast

CT chest

Follow-up CT imaging

Ultrasound

E-FAST (Extended Focused Assessment with Sonography for Trauma)

Follow-up ultrasound

Disposition

Operative and interventional pathway

Immediate operative indications

Angioembolization pathway

Nonoperative management disposition

ICU admission indications

Ward admission criteria

Discharge criteria

Safe discharge from NOM

Activity restriction guidance

Follow-up planning

Treatment

Resuscitation and hemorrhage control

Damage control resuscitation

Anticoagulant reversal

Nonoperative management

NOM protocol for blunt liver injury

Angioembolization

Hepatic angioembolization indications

Embolization technique

Operative management

Damage control laparotomy

Definitive hepatic repair

Complication management

Biloma

Hemobilia

Hepatic abscess

Pain management

Special Populations

Pregnancy

Pregnancy-specific considerations

Geriatric

Older adult considerations

Pediatrics

Pediatric-specific approach

Background

Epidemiology

Incidence and burden

Pathophysiology

Injury mechanisms

Hepatic vascular anatomy and hemorrhage

Coagulopathy in hepatic trauma

Therapeutic Considerations

NOM evidence base

Angioembolization evidence

Damage control philosophy

Biliary complication management

Patient Discharge Instructions

copy discharge instructions

Liver laceration home care instructions

Return to emergency department immediately if you experience

Follow-up appointments

Important reminders

References

Guidelines and key sources

Trauma society guidelines

Key studies and evidence

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.