SAQ 154 – Trauma – splenic injury and hybrid resuscitation

Question 6. splenic injury and hybrid resuscitation.

a. CT findings

• Hypodense anterior half of spleen consistent with reduced perfusion / laceration.
• No free fluid.
• Liver intact.
• Kidneys intact.

b. Predisposing conditions

• Infectious mononucleosis.
• CMV.
• Acute hepatitis.
• SLE.
• Acromegaly.
• Lymphoma.

c. Hybrid resuscitation

• A form of hypotensive resuscitation.
• Theory is to allow more stable clots to form and resist breakdown with later aggressive resuscitation.
• Used when time to definitive care is too long to allow permissive hypotension alone.
• Indications are as for hypotensive resuscitation, such as uncontrolled penetrating or blunt trauma without serious end-organ hypoperfusion when bleeding control is possible.
• Initial permissive hypotension phase, around 1 hour, with duration depending on time to definitive treatment.
• Emphasis on restoring normal coagulation rather than normotension.
• Gentle re-establishment of circulating blood volume after the hypotensive phase.