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FIGURE 103.1 Initial evaluation and treatment of the child with abdominal trauma. FAST,
focused abdominal sonography for trauma.

The American College of Surgeons currently recommends that aggressive fluid
resuscitation should be pursued. Although there is some suggestion that less
rigorous (hypotensive) fluid resuscitation may improve survival by limiting
hemorrhage into the peritoneal space, pursuing this strategy in the management of
children is still controversial and not part of the approach to the injured child with
hypotension.
As the initial evaluation proceeds, the priorities of management depend on the
extent of multisystem injuries and the condition of the patient ( Fig. 103.2 ).
Patients who are unstable as a result of ongoing blood loss or an expanding
intracranial hemorrhage require operative intervention early in the evaluation
phase.