Operative management of hepatic injury

Algorithm for operative management of blunt liver trauma.
(A) Minor bleeding most often from grade I or grade II injuries.
(B) Manual compression, fluid therapy, correct coagulopathy, acidosis, hypothermia.
(C) Subset of patients who would benefit from angiography is unknown.
(D) Placement of clamp across the porta hepatis.
(E) Finger fracture as needed to ligate bleeding vessels and injured bile ducts, viable omentum used to fill deadspace.
(F) Risk of liver necrosis.
(G) Rates of survivial improved with combination of packing and/or shunting compared with direct repair alone.
(H) Timing of interval laparotomy not well defined, formal resection rarely required.