Abdominal Injury — Inpatient Unit — Clinical Pathway: Emergency Department, Inpatient, and ICU

Blunt Abdominal Solid Organ Injury Clinical Pathway – Emergency Department, Inpatient and ICU

Inpatient Unit Admission Guidelines

  • Failure of nonoperative management is uncommon (< 5 %) and is significantly associated with injury severity, pancreatic injury, and multiple organ system involvement
  • The need for operative intervention is typically determined within 12 hrs of the injury
  Grade I-II Grades III-IV
Epic Admission Order Set TraumaBluntAbdomen Grade I-II FLOOR TraumaBluntAbdomen Grade III-IV FLOOR
Activity Ad Lib
  • Bedrest with bathroom privileges until 24 hrs from injury
  • then
  • Advance activity as tolerated
Nutrition Regular diet
Lab Tests CBC q8hr until stable trend
  • CBC q8hr until stable trend
  • and
  • Consider 4-6 hrs post-ambulation
  • LFTs, amylase, lipase, UA
  • Repeat if previously abnormal
Vital Signs Every 4 hrs
Monitoring As needed Continuous CR monitor and pulse oximetry
for 24 hrs (Minimum)
Treatment and Procedures
  • Incentive spirometry
  • Sequential compression device (if age appropriate)
Pain Management
  • Mild: acetaminophen (PO, PR)
  • Moderate: oxycodone (PO)
  • Severe: morphine (IV)
  • NSAIDs may be utilized as second line for management of pain in hemodynamically stable children with Grade I-IV spleen and liver injuries, and Grade I-III kidney injuries without large or expanding hematoma
Consults
  • ≥ Grade III and above renal injuries require a formal Urology consult
  • Other consults as clinically indicated