Unstable  OR  splenectomy

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Presentation transcript:

Unstable  OR  splenectomy Rule out: • Airway causes • B causes (tension pneumo) • C causes (cardiac ??, pelvic fx) Confirm: FAST/DPL/neurotrauma Blunt ICU Serel leds Serel exams F/U CT (24 h) Angio OR? No active extrav or pseudoaneurysm Active extrav or Pseudoaneurysm (contrast pooling) Hilar injury? Stable  secondary survey  CT Suspect: Abdominal tenderness L lower thoracic trauma Macroscopic hematuris + FAST Mechanism ∆ MS SPLENIC TRAUMA Long-term: • F/U CT scan?? • Return to work • Activity / contact sports (children) Splenectomy Splenorrhaphy if hemodynamics OK Acute hemorrhage No active hemorrhage Penetrating  Explore Splenorrhaphy if hemodynamics OK * Rational for nonperative management Threshold for operation: • Adult = once Tx PRBC survival benefit from avoiding OPSS is negated by risk of transfusion of blood borne pathogens • Children =  OPSS  OR after TX of 25% of (20cc/kg) blood volume in 24 hours