- Grade 3 central, Grade IV and Grade V
- treat all as severe liver injuries
- Biliary stent can be used to manage a bilious fistula injury
- Tolerate permissive hypotension and decreased pRBC transfusion if suspect a liver injury
- increased blood pressure can aggravate liver bleeding
- CT very helpful in mapping hepatic injury
Perform pringle early!
- pack and don't keep looking at the liver
- Packing can be used to control even retrohepatic injuries
- EEM also uses veno-veno bypass with a femoral/SMV line feeding into a subclavian line
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