A trauma patient with cirrhosis is at increased risk for complications and death. Wahlstrom et al recommended a number of interventions to increase survival in those patients requiring emergency laparotomy. The authors are from the University of Minnesota and Hennepin County Medical Center in Minneapolis.


Patient selection: Trauma patients with cirrhosis who required emergency laparotomy for intra-abdominal injuries.


Basic principle: The patients need to be closely and aggressively managed since there is no margin for error. Serious problems may occur in patients with seemingly minor injuries.


Management suggestions:

(1) transport to a major trauma center for treatment

(2) promptly diagnose injuries

(3) definitively treat injuries

(4) early and aggressive management of coagulation disorders (vitamin K, FFP, etc.)

(5) avoid hypothermia

(6) avoid unnecessary blood transfusions

(7) early nutritional support as appropriate, especially in patients with hypoalbuminemia


NOTE: These principles should apply to any trauma patient with cirrhosis.


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