1. 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