Resuscitation and hemorrhage control
›Hemorrhage and shock management
›Balanced transfusion strategy when indicated
›Packed red blood cells
›Target based on perfusion and bleeding, not a single number
›Ongoing reassessment with lactate in mmol/L
›Plasma and platelets
›Massive transfusion protocol ratios per local protocol
›Coagulopathy correction guided by labs or viscoelastic testing if available
›Tranexamic acid in major trauma bleeding
›1 g IV over 10 minutes
›If within 3 hours of injury, benefit favored in trauma protocols
›Avoid if clear contraindication per local protocol
›1 g IV over 8 hours
›Ongoing hemorrhage concern
›Monitor for thrombosis risk context
›Observation-first strategy in stable renal trauma
›Bed rest and activity restriction in hospital
›Hematuria resolution trend
›Pain control and mobilization plan
›Serial exams and labs
›Hemoglobin trend
›Vital signs trend
›VTE prophylaxis timing coordination
›Mechanical prophylaxis early
›Pharmacologic prophylaxis when bleeding stability confirmed (Class I framework, strong consensus)
Interventional radiology and urologic interventions
›Hemorrhage control without nephrectomy
›Angioembolization indications
›Active arterial extravasation on CT with stability
›Pseudoaneurysm or AV fistula
›Ongoing transfusion need with stable vitals
›Angioembolization targets
›Selective branch embolization preferred
›Renal function preservation priority
›Urinary extravasation management
›Ureteral stent considerations
›Persistent urinary leak from collecting system injury
›Obstruction or UPJ injury concern
›Percutaneous drainage considerations
›Symptomatic urinoma
›Infected collection
Analgesia, renal protection, and adjuncts
›Symptom control and kidney-safe choices
›Analgesia ladder
›Paracetamol 1 g PO or IV q6h
›Maximum 4 g per day
›Lower maximum if liver disease or low body mass
›Opioid for severe pain
›Hydromorphone 0.2 to 0.5 mg IV q10 minutes PRN
›Reassess sedation and respiratory status
›NSAID caution in renal injury
›Avoid in high-grade injury or AKI risk
›If used, shortest duration and lowest effective dose per local protocol
›Antiemetic support
›Ondansetron 4 mg IV or ODT q8h PRN
›QT prolongation risk awareness
›Alternative agent if prolonged QT
Operative management triggers
›Surgery triggers and goals
›Immediate operative indications
›Hemodynamic instability from suspected renal bleeding
›Expanding or pulsatile retroperitoneal hematoma at exploration
›Operative options
›Renorrhaphy when feasible
›Nephrectomy for unsalvageable injury or pedicle avulsion
›Evidence and practice level notes
›Nonoperative management preferred for stable renal trauma, including many high-grade injuries in centers with IR and monitoring (ACEP Level C framework, expert consensus)
›Angioembolization preferred over surgery for stable patients with active contrast extravasation (Class I framework, strong consensus)