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

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

PICU 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 V or Admission Hgb ≤ 7 or Hemodynamically Unstable
Epic Admission Order Set TraumaBluntAbdomen Grade V and/or PICU
Activity
  • Strict bedrest until 24 hrs from injury
  • then
  • Bedrest with bathroom privileges for 24 hrs
  • then
  • Advance activity as tolerated
Nutrition
  • NPO for 24 hrs
  • Advance based on clinical status
Lab Tests
  • CBC q8hr until stable trend
  • and
  • 36 hrs from injury
  • and
  • Consider 4-6 hrs post-ambulation
  •  
  • LFTs, amylase, lipase, UA
    • Repeat if previously abnormal
Vital Signs
  • Every 1 hr while in PICU
  • Then every 4 hrs until discharge
Monitoring Continuous CR monitor and pulse oximetry for 24-48 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)
  • No NSAIDS
Consults ≥ Grade III renal injuries require a formal Urology consult