Table 1 Protocol of nonoperative management in AAST-OIS grade IV blunt hepatic trauma.
From: Nonoperative management for patients with grade IV blunt hepatic trauma
Protocol of nonoperative management in AAST-OIS grade IV blunt hepatic trauma - Division of Trauma Surgery - University of Campinas |
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Criteria for patient selection: 1- Abdominal blunt trauma 2- Hemodynamic stability after initial resuscitation with no need for blood: a. Systemic blood pressure > 90 mmHg b. Initial hemoglobin level > 8 3- Evaluation by Computed Tomography with: a. Absence of associated injuries on hollow viscus and pneumoperitonium b. Absence of contrast blush (evidence of active arterial bleeding is indication for angiography and embolization) 4- Clinical evaluation with no signs of peritonitis |
Monitorization of patients undergoing nonoperative management: 1- Hemoglobin/ Hematocrit measurement every 6 hours or more frequently if any clinical deterioration 2- ABG measurements every 6 hours or more frequently if any clinical deterioration 3- ICU (Intensive Care Unit) |
Criteria for failure of nonoperative management: 1- Need for surgical intervention determined by: a. Hemodynamic instability b. Failure of angioembolization to control active bleeding c. Progressive fall of hemoglobin/ hematocrit levels with recurrent blood transfusion d. Clinical signs of peritonitis |