Pathway for Blunt Abdominal Solid Organ Injury

Inpatient Management

Study Grade I Grade II Grade III Grade IV/V
Hospital LOS 1-2 days 2 days 3 days 3 - 4 days
Admit to Floor Floor (unless clinically unstable) ICU x 24 hours then floor if stable
Activity Bed rest x 24 hours
Bed rest x 48 hours
Then OOB to toilet only; Can gradually increase activity if remains clinically stable.
Should be ambulating at least 12 hours prior to discharge.
Vital Signs Every 4 hours until discharge Every 4 hours until discharge Every hour while in PICU
Then every 4 hours until discharge
Monitoring Continuous CR Monitor, Pulse Oximetry for 24 hours
Strict I/O
Serial Abdominal Examinations
Lab Tests
After Admission
CBC
Every 12 hours x 2

UA
Repeat if kidney injury or previously abnormal

Repeat if initially abnormal:
  • Hepatic function panel
  • Amylase
  • Lipase
CBC
Every 8 hours x 3 and 48 hours post injury
Post-activity: 4 - 8 hours after ambulating

UA
Repeat if kidney injury or previously abnormal

Repeat if initially abnormal:
  • Hepatic function panel
  • Amylase
  • Lipase
Treatment & Procedures Incentive Spirometry
SCD (if age appropriate)
No foley
Incentive Spirometry
SCD (if age appropriate)
Foley (if renal injury with urology recommendations)
NGT as indicated
Pain
    Assess Pain
  • Mild:   Acetaminophen (PO, PR)
  • Moderate:  Oxycodone (PO)
  • Severe:   Morphine (IV)
IVF Maintenance IVF while NPO then saline lock with good PO intake.
Nutrition NPO x 12 hours
Then clears
Then ADAT
NPO x 24 hours
Clears x 8 hours
Then ADAT
Consults Grade 3 and above renal injuries require a formal Urology consult with recommendations
Other consults as clinically indicated