BLUNT SPLEEN MANAGEMENT PROTOCOL. 2011. A. NOTS Blunt Spleen Management Protocol B. All adult patients with an identified blunt spleen injury (> 14 years of age) C. Prehospitital Recommendations: Follow NOTS triage protocols. D. E.D. Recommendations. Ensure 2 good working IVS
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Initial Mangement of a Hemodymically Stable Patient with a Blunt Spleen Injury
CT scan with IV contrast
Blush, Extravisation, or Psuedoaneurysm
Grade I & II can admit to Floor
Angio-Embolization (within 1-2 hours)
No or Small hemoperitoneum
Floor patients: should be mobilized, diet advance and daily HCTs until stable for two days.
Grade 1 and 2: minimum of 1 floor day
Grade 3-5: minimum of 3 hospital days
Splenectomy patients require immunizations
ICU/Step-down unit* - q 4- 6 hr HCTs until stable X 3
Stable HCTs for 24 hours
Dropping HCTs for 24 hours, or need to transfuse blood
Consider the following options:
OR, angio, Repeat CT scan
Can mobilize patient, transfer to floor, and give diet pending other injuries
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