# Splenic Injury — GCMD Library living collection

Everything in the library about splenic injury — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 57 cited statements

## Episodes
### Evidence & Research
- [History Of Non Operative Management for Splenic Injury with Dr. Wesson](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472) — podcast · 15:17 · [machine version](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472.md)

### Case-Based Learning
- [Solid Organ Injury Rapid Fire Session: Update Course 2015](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877) — video · 10:11 · [machine version](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877.md)

### In-Depth Reviews
- [Trauma Abdominal Cerrado con el Dr. Raphael Parrado](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222) — podcast · 18:34 · [machine version](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=0) Case Presentation and Hemodynamic-Based Management (Ep 1)
- [4:54](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=294) Post-Discharge Activity Restrictions and Future Directions (Ep 1)
- [7:40](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=460) Management of Incidental Pseudoaneurysms (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=0) Modern non-operative management and historical context (Ep 2)
- [2:52](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=172) Early 1900s through 1960s: the secret practice at Sick Kids (Ep 2)
- [4:48](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=288) 1968-1989: Dr. Simpson and Dr. Wesson's published series (Ep 2)
- [7:35](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=455) Acceptance and paradigm shift in pediatric surgery (Ep 2)
- [11:22](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=682) Return to clinical assessment and current APSA guidelines (Ep 2)
- [0:09](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=9) Epidemiology and Initial Assessment of Pediatric Blunt Abdominal Trauma (Ep 3)
- [3:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=180) Diagnostic Workup and PECARN Criteria for CT Imaging (Ep 3)
- [7:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=420) Non-Operative Management Protocols for Solid Organ Injuries (Ep 3)
- [10:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=650) Indications for Operative Intervention and Transfusion Thresholds (Ep 3)
- [15:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=900) Surgical Techniques and Damage Control Strategies (Ep 3)
- [17:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1050) Post-Operative Management and Complications (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Blunt abdominal trauma represents 5% of cases in pediatric trauma — Raphael Parrado (epidemiological) [Ep 3 · 0:09](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=9)
- The spleen is the most commonly injured organ in pediatric blunt abdominal trauma, accounting for 40% of cases — Raphael Parrado (epidemiological) [Ep 3 · 0:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=50)
- Other organs injured include pancreas, kidney, and intestines — Raphael Parrado (clinical) [Ep 3 · 1:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=80)
- Seatbelt sign on inspection is an important finding in pediatric blunt abdominal trauma, associated with pelvic fractures and intra-abdominal injuries — Raphael Parrado (clinical) [Ep 3 · 2:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=140)
- FAST ultrasound is the most commonly implemented imaging study to determine presence or absence of free fluid in the abdomen — Raphael Parrado (clinical) [Ep 3 · 3:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=200)
- Laboratory studies for blunt abdominal trauma include renal panel, hematocrit, amylase, and aminotransferase — Raphael Parrado (clinical) [Ep 3 · 4:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=240)
- Amylase greater than 200 or elevated aminotransferase indicates need for CT imaging — Raphael Parrado (clinical) [Ep 3 · 4:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=270)
- PECARN (Pediatric Emergency Care Applied Research Network) criteria for CT imaging include Glasgow Coma Scale, abdominal examination findings, seatbelt sign, and thoracic trauma — Raphael Parrado (guideline) [Ep 3 · 4:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=290)
- For patients with minor injuries, observation in the emergency department or discharge home with follow-up may be appropriate in absence of other injuries — Raphael Parrado (clinical) [Ep 3 · 6:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=380)
- Non-operative management protocol includes crystalloid fluid limit, serial hemoglobin checks to determine transfusion need — Raphael Parrado (clinical) [Ep 3 · 7:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=450)
- Renal injuries with hematuria can be observed, with monitoring for worsening hematuria as indication for intervention — Raphael Parrado (clinical) [Ep 3 · 8:40](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=520)
- Grade 3, 4, and 5 solid organ injuries can be observed in many institutions if patient remains hemodynamically stable — Raphael Parrado (clinical) [Ep 3 · 9:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=560)
- Indications for operative intervention include peritonitis, free air, and hemodynamic instability — Raphael Parrado (clinical) [Ep 3 · 10:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=650)
- Transfusion threshold for operative consideration is 40 mL/kg of crystalloid or 40 mL/kg of packed red blood cells — Raphael Parrado (clinical) [Ep 3 · 11:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=680)
- Laparotomy incision extends from inferior border of pubis to xiphoid process — Raphael Parrado (clinical) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=780)
- Most common injury grades requiring surgery are grades 4 and 5, though grade 3 may also require intervention — Raphael Parrado (clinical) [Ep 3 · 13:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=810)
- Initial surgical steps include packing anterior and posterior abdomen for hemorrhage control — Raphael Parrado (clinical) [Ep 3 · 14:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=840)
- Hemostatic techniques include use of non-permanent coagulation sutures and large figure-of-eight sutures — Raphael Parrado (clinical) [Ep 3 · 14:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=870)
- Anatomic resection is preferred when patient is hemodynamically stable; non-anatomic resection with stapler may be used for ongoing hemorrhage — Raphael Parrado (clinical) [Ep 3 · 15:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=900)
- Most common procedures performed are splenectomy and bowel resection — Raphael Parrado (clinical) [Ep 3 · 16:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=960)
- For arterial pulsatile bleeding versus diffuse venous bleeding, surgeon should pack and return for re-exploration at 24 hours — Raphael Parrado (clinical) [Ep 3 · 16:20](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=980)
- Damage control surgery with packing is appropriate when patient is hemodynamically unstable despite resuscitation — Raphael Parrado (clinical) [Ep 3 · 17:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1020)
- Transfusion-related complications include hemodynamic instability and pulmonary edema — Raphael Parrado (clinical) [Ep 3 · 17:30](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1050)
- Patients require monitoring in ICU to ensure adequate fluid removal without complete depletion — Raphael Parrado (clinical) [Ep 3 · 17:50](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1070)
- Important complications include peritonitis, infectious complications, and overwhelming post-splenectomy sepsis (OPSS), which can be fatal — Raphael Parrado (clinical) [Ep 3 · 18:10](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1090)
- Post-splenectomy vaccines are given at 2 weeks after surgery — Raphael Parrado (clinical) [Ep 3 · 18:40](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1120)
- Follow-up includes monitoring for hematoma or fluid collections — Raphael Parrado (clinical) [Ep 3 · 19:00](https://qa.library.globalcastmd.com/watch/trauma-abdominal-cerrado-con-el-dr-raphael-parrado-7222?t=1140)
- In 1909, Dr. Coker wrote that if the spleen is injured it should be removed, and that was the only treatment. — David Wesson (clinical) [Ep 2 · 2:52](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=172)
- In 1968, Dr. Jimmy Simpson published the first series of non-operative management of splenic injuries in what is now the Journal of the American College of Surgeons; it was a case series of only 50 patients with a small percentage managed non-operatively. — David Wesson (clinical) [Ep 2 · 4:48](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=288)
- In the 1960s and 1970s there was no way to prove splenic injury because imaging was not available, so skeptics didn't believe Dr. Simpson's experience and didn't change their practice. — David Wesson (clinical) [Ep 2 · 4:48](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=288)
- In 1980, Dr. Wesson presented a case series titled 'Ruptured Spleen, when to operate' at the American Academy of Pediatrics pediatric surgical section in Detroit, and all patients had diagnostic imaging, the majority being radionuclide spleen scans. — David Wesson (clinical) [Ep 2 · 5:56](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=356)
- Non-believers said the radionuclide scans in Dr. Wesson's 1980 series were congenital anomalies, so Dr. Wesson's team did follow-up radionuclide scans showing healing and resolution of the defect as proof of traumatic injury. — David Wesson (clinical) [Ep 2 · 6:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=410)
- At an American College of Surgeons meeting in Florida, Dr. William Blaisdell told Dr. Wesson that if you believe surgery aggravates bleeding you shouldn't be in surgery, and that adult trauma surgeons have more experience managing kids than any pediatric surgeon will ever see because pediatric surgeons don't see that much. — David Wesson (opinion) [Ep 2 · 6:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=410)
- Adult trauma surgeons thought non-operative management of splenic injuries was complete baloney, but pediatric surgeons were more open-minded to the practice change. — David Wesson (opinion) [Ep 2 · 8:47](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=527)
- After the 1980 presentation, all the talk was about resource utilization and length of stay, and the hook was that these patients would have better outcomes if managed non-operatively, which got the attention of the rest of the surgical world. — David Wesson (opinion) [Ep 2 · 9:52](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=592)
- Non-operative management of the spleen put pediatric surgeons in the limelight, and adult trauma surgeons at adult trauma meetings credit pediatric surgeons for starting this trend that is now the norm. — David Wesson (opinion) [Ep 2 · 9:52](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=592)
- APSA made standardized guidelines so institutions could manage splenic injuries in a similar way and group outcomes across the country to assess results. — David Wesson (guideline) [Ep 2 · 10:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=650)
- CT scans became more prevalent, leading to a grading system for splenic injuries and a treatment algorithm based on CT gradings, but in the last 10 years the approach has flipped to prioritize clinical assessment over CT grade. — David Wesson (clinical) [Ep 2 · 10:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=650)
- The patient was a 15-year-old involved in a collision during a baseball game, with the right fielder's knee impacting the left upper quadrant. — Kenneth Azarow (clinical) [Ep 1 · 0:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=0)
- The CT scan showed a complete crush injury of the spleen involving down to the hilum with a blush and blood around the liver. — Kenneth Azarow (clinical) [Ep 1 · 0:40](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=40)
- The patient had vital signs of 125/80 blood pressure and pulse of 85, which was considered stable despite the grade 5 injury. — Kenneth Azarow (clinical) [Ep 1 · 0:40](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=40)
- Current management trend is to treat based on hemodynamics rather than injury grade, allowing patients to be discharged much quicker than traditional protocols. — Kenneth Azarow (clinical) [Ep 1 · 1:43](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=103)
- The patient with grade 5 splenic injury was discharged within 48 hours using the hemodynamic-based protocol. — Kenneth Azarow (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=180)
- Patients with less severe injuries are being discharged in less than 24 hours at the speaker's institution. — Kenneth Azarow (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=180)
- Tachycardia must be evaluated to determine if it is due to pain, overlying broken rib, blood in abdomen, or low hematocrit before determining ICU vs ward placement. — Kenneth Azarow (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=180)
- Pain control is necessary to accurately assess whether tachycardia is due to the injury or other causes. — Kenneth Azarow (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=180)
- The early discharge protocol is applied only to local patients, not those transferred from across the state. — Kenneth Azarow (clinical) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=180)
- The speaker follows activity restrictions of grade plus 2 weeks for solid organ injuries because rebleeds have been observed. — Kenneth Azarow (clinical) [Ep 1 · 6:14](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=374)
- After surgery, the speaker gives no restrictions and tells patients if it hurts, don't do it, but for solid organ injuries, specific time-based restrictions are given. — Kenneth Azarow (clinical) [Ep 1 · 6:14](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=374)
- Once a stable clot forms for about 3 weeks, it is probably more stable than the remaining spleen. — Todd (clinical) [Ep 1 · 6:44](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=404)
- Future practice may move toward getting patients back to some normal activity (though not contact sports) earlier than current restrictions, once early discharge becomes common practice. — Todd (opinion) [Ep 1 · 6:44](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=404)
- For large pseudoaneurysms in splenic vessels, interventional coiling is an appropriate treatment option. (clinical) [Ep 1 · 8:51](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=531)
- Pseudoaneurysms can be managed with stenting, coiling, or observation depending on size and growth. (clinical) [Ep 1 · 8:51](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=531)
- Small pseudoaneurysms can be followed with observation initially, but intervention is needed if they grow. (clinical) [Ep 1 · 9:24](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=564)
- In adults, 2 centimeters is the cutoff for mesenteric vessel pseudoaneurysms at which intervention is typically considered, but the threshold for pediatric patients is unclear. (clinical) [Ep 1 · 9:24](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=564)
- The true denominator of how many pediatric patients develop pseudoaneurysms after splenic injury is unknown because routine follow-up imaging is no longer performed. — Todd (epidemiological) [Ep 1 · 9:55](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=595)
- Hilar vessel injuries can be identified on initial CT scans. (clinical) [Ep 1 · 10:04](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=604)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- ATOMAC guidelines state that grade doesn't matter for splenic injury management; decision-making is based on clinical concern, and if hemodynamically normal and stable, admit to the floor with regular diet and out of bed as tolerated, then discharge after two stable hemoglobins. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 2:05](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=125)
- In 1909 there were no ICUs, no blood available, no way to maintain an IV, no monitored beds, no oxygen delivery, and no imaging, so surgeons only had clinical grounds to work with. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 2:52](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=172)
- In the late 1940s, Tim Wandsworth at Toronto Sick Kids had a patient with an abdominal injury who recovered, went home, then came back with another injury that caused death; at autopsy the spleen was found in two pieces that had healed, giving the notion that the spleen doesn't necessarily need to be removed and the patient won't exsanguinate. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 3:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=230)
- After Wandsworth's observation, in select patients at Sick Kids surgeons wouldn't operate on splenic injuries, and this became practice among general surgeons there throughout the 1950s and 1960s, but they didn't publish or talk about it because it went against common wisdom. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 3:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=230)
- Approximately 70% of patients in Dr. Wesson's 1980 study were managed non-operatively and did well. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 6:50](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=410)
- In 1989, Dr. Wesson published a 5-year follow-up series where almost all patients had CT scans documenting the splenic injury, again showing good outcomes with non-operative management. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 7:45](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=465)
- The 1989 series plus the 1980 series combined made the first treatment algorithm for when to operate and when not to operate on a pediatric splenic injury. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 7:45](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=465)
- In pediatric surgery, acceptance of non-operative splenic injury management wasn't very long at all after the initial presentations. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 9:27](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=567)
- The ATOMAC guidelines boil down to: if hemodynamically stable, go to the floor with diet the next morning and hemoglobin check and go home; if hemodynamically unstable, get fluids and blood and decide whether to go to the OR, using clinical judgment rather than just CT grade. — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 11:58](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=718)
- The updated APSA blunt liver spleen injury guidelines (update from 1990 guidelines) cover: A for admission (ICU vs ward orders), P for procedures (transfusion, angioembolization, OR indications), S for set free (discharge criteria including eating), and A for aftercare (activity restriction and follow-up imaging recommendations). — Em Gootee summarizes what Dr. David Wesson said [Ep 2 · 12:38](https://qa.library.globalcastmd.com/watch/history-of-non-operative-management-for-splenic-injury-with-dr-wesson-5472?t=758)
- Most places around the country have adopted aggressive discharge protocols for solid organ injuries. — Todd summarizing the discussion [Ep 1 · 5:40](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=340)
- The literature is fairly clear that patients with solid organ injuries do not need to be reimaged after discharge. — Todd summarizing the discussion [Ep 1 · 5:40](https://qa.library.globalcastmd.com/watch/solid-organ-injury-rapid-fire-session-update-course-2015-877?t=340)

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