ABSTRACT
A thorough handoff, including mechanism of injury, initial resuscitation, imaging findings, and injuries should be performed. In the setting of ongoing resuscitation requirements, particular attention must be paid to clues that the abdomen may be the source of decompensation. Evaluation of a patient requiring ongoing resuscitation begins with a thorough tertiary exam. One must consider the mechanism of injury and force trajectory. A direct blow to the epigastrium is most often inflicted by a steering wheel in motor vehicle crashes, or a handlebar in bicycle crash. Pancreatic injuries manifest over time and therefore combined serial measurements of serum amylase and lipase should be considered if there is clinical suspicion. Surprisingly, the increased total dose of vasoconstricting medications does not result in the same degree of peripheral ischemia as seen in other types of shock. Vasopressin, which induces vascular smooth muscle contraction, is indicated as a second agent and may reduce the overall dose of catecholamines.
