This allows an abdominal incision to be extended into the chest, or T-ed off laterally. Access to the groins is important if major vascular injuries are encountered. Both arms should be out, to maximize access for resuscitation. The room should be warmed and precautions taken to maintain normothermia. Laparotomy is performed through a midline incision.
Blood is scooped out and all four quadrants of the abdomen sequentially explored and packed.
Hemostasis is obtained by pressure unless an obvious bleeder is seen. Resuscitation should continue during laparotomy. Constant communication between surgical and anesthesia teams concerning blood loss, ongoing bleeding, and hemodynamic status must be ongoing. An autotransfusion device may be used if major vascular injury is suspected. Spleen - Isolated splenic injuries due to blunt trauma may be managed nonoperatively, if bleeding has stopped and the surgeon is confident that no hollow viscus injury exists.