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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
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