Prichayudh et al identified predictors for surgery in a patient with hepatic trauma. These patients require more aggressive management. The authors are from Chulalongkorn University in Bangkok.
Patient selection: liver trauma
Predictors for undergoing surgery:
(1) Glasgow coma score <= 12
(2) penetrating mechanism
(3) heart rate > 100 beats per minute (tachycardia)
(4) systolic blood pressure <= 90 mm Hg
Predictors for damage control surgery (perihepatic packing and temporary abdominal closure):
(1) Grade 4 or 5 hepatic trauma, including injuries to the juxtahepatic inferior vena cava
(2) heart rate > 100 beats per minute (tachycardia)
(3) blunt mechanism
Indications for damage control surgery:
(1) hemodynamic instability with failure to control bleeding by simpler methods
(2) hypothermia
(3) acidosis
(4) coagulopathy
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