injuries poisoning
Hepatic Injury
Treatment of Hepatic Injury
Observation Sometimes embolization or surgical repair Hemodynamically stable patients who have no other indications for laparotomy (eg, hollow viscus perforation) can be observed with monitoring of vital signs and serial hematocrit (Hct) levels. Patients with significant ongoing hemorrhage (ie, those with hypotension and Shock , significant ongoing transfusion requirements, or declining Hct) require intervention. Patients whose vital signs are stable but who require ongoing transfusion may be candidates for angiography with selective embolization of bleeding vessels. Unstable patients should undergo laparotomy. Success rates for nonoperative management are about 92% for grade 1 and 2 injuries, 80% for grade 3 injuries, 72% for grade 4 injuries, and 62% for grade 5 injuries. Following nonoperative management, there is no consensus in the literature regarding length of intensive care unit (ICU) stay, hospital stay, resumption of diet, duration of bedrest, or limitation of activity once discharged ( Treatment reference ). However, the more severe the injury, the more care should be taken before permitting resumption of activities that may involve heavy lifting, contact sports, or torso trauma. When surgery is done, small lacerations can typically be sutured or treated with hemostatic agents (eg, oxidized cellulose, fibrin glue, mixtures ofthrombinand powdered gelatin). Surgical management of deeper and more complex injuries can be complicated. Hepatectomy and even partial resection are rarely done Stassen NA, Bhullar I, Cheng JD: Nonoperative management of blunt hepatic injury: An Eastern Association for the Surgery of Trauma practice management guideline.J Trauma Acute Care Surg73:S288-S293, 2012. doi: 10.1097/TA.0b013e318270160d 