Nonoperative management is the norm in children, but not necessarily in adults.
ATLS algorithm for severe trauma
Vascular access
Consider blood transfusion (and massive transfusion protocol) + TXA
Surgery consult (surgery vs. IR)
polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy
isolated bleed for angioembolization
Vascular access
Consider blood transfusion (and massive transfusion protocol) + TXA
Surgery consult (surgery vs. IR)
polytrauma, hypotension, free intraperitoneal fluid - immediate exploratory laparotomy
isolated bleed for angioembolization
Blunt
Anterior<unk>  injury with hypotension<unk>  wall disruption
Peritonitis
Free air under diaphragm on chest radiograph
Positive FAST or DPL in hemodynamically unstable patient
CT-diagnosed injury requiring surgery (i.e., pancreatic transection, duodenal rupture, diaphragm injury)
Penetrating
Injury to abdomen, back, and flank with hypotension<unk>  tenderness
GI evisceration
High suspicion for transabdominal trajectory after gunshot wound
CT-diagnosed injury requiring surgery (i.e., ureter or pancreas)
Anterior<unk>  injury with hypotension<unk>  wall disruption
Peritonitis
Free air under diaphragm on chest radiograph
Positive FAST or DPL in hemodynamically unstable patient
CT-diagnosed injury requiring surgery (i.e., pancreatic transection, duodenal rupture, diaphragm injury)
Injury to abdomen, back, and flank with hypotension<unk>  tenderness
GI evisceration
High suspicion for transabdominal trajectory after gunshot wound
CT-diagnosed injury requiring surgery (i.e., ureter or pancreas)
Abdominal trauma
Diaphragmatic trauma
Splenic trauma
Liver trauma
G-tube complications
Bladder trauma
Pelvic fractures
Genitourinary trauma