Solid Organ Injury Rapid Fire Session: Update Course 2015

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.

The CT scan showed a complete crush injury of the spleen involving down to the hilum with a blush and blood around the liver.

The patient had vital signs of 125/80 blood pressure and pulse of 85, which was considered stable despite the grade 5 injury.

Current management trend is to treat based on hemodynamics rather than injury grade, allowing patients to be discharged much quicker than traditional protocols.

The patient with grade 5 splenic injury was discharged within 48 hours using the hemodynamic-based protocol.

Patients with less severe injuries are being discharged in less than 24 hours at the speaker's institution.

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.

Pain control is necessary to accurately assess whether tachycardia is due to the injury or other causes.

The early discharge protocol is applied only to local patients, not those transferred from across the state.

The speaker follows activity restrictions of grade plus 2 weeks for solid organ injuries because rebleeds have been observed.

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.

Once a stable clot forms for about 3 weeks, it is probably more stable than the remaining spleen.

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.

For large pseudoaneurysms in splenic vessels, interventional coiling is an appropriate treatment option.

Pseudoaneurysms can be managed with stenting, coiling, or observation depending on size and growth.

Small pseudoaneurysms can be followed with observation initially, but intervention is needed if they grow.

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.

The true denominator of how many pediatric patients develop pseudoaneurysms after splenic injury is unknown because routine follow-up imaging is no longer performed.

Hilar vessel injuries can be identified on initial CT scans.