Hypotension and Blunt Abdominal Trauma

Abstract

Hypotension associated with intra-abdominal injury is most commonly the result of a solid organ injury (liver, spleen, kidney) but may be due to vascular injury or injuries to the visceral mesentery. Hypotension in the face of blunt abdominal trauma requires rapid, systematic evaluation and intervention to optimize survival.

One must employ advanced trauma life support (ATLS) protocol as the backbone of this rapid assessment. During the initial assessment, the establishment of adequate intravenous access and initiation of fluids and blood products early are paramount to restore intravascular volume. Adjuncts to the primary survey such as chest x-ray, focused assessment with sonography for trauma (FAST), and diagnostic peritoneal lavage or aspiration (DPL/A) are also extremely useful to triage the various cavities to identify the source of hemorrhage. Once intra-abdominal hemorrhage has been confirmed by either FAST or DPL/A, the patient must move expeditiously to the operating room for an exploratory laparotomy for definitive hemorrhage control.

One must utilize a standardized algorithm as a framework from which to assess and treat the hemodynamically unstable patient. However, good clinical judgment must be utilized with a low threshold for surgical exploration should an obvious source of bleeding not be identified with the standard adjuncts to the primary survey (CXR, FAST, etc.) especially in the persistently hypotensive or hemodynamically unstable patient who sustained blunt force trauma.