What is the initial management for suspected hepatic injury with hemodynamic instability?

• A. Initiate rapid resuscitation with blood products and activate surgical team for potential damage-control surgery.
• B. Proceed with CT scan before resuscitation.
• C. Only give antibiotics.
• D. Observe and wait for stabilization.

Answer: (A)

In a patient with suspected hepatic injury who is hemodynamically unstable, the priority is rapid hemorrhage control and resuscitation. Initiating a massive transfusion protocol with balanced blood products restores circulating volume and supports coagulation, while prompt activation of the surgical team for damage-control surgery targets the source of bleeding quickly. Imaging like CT is not appropriate while the patient is unstable because delays can be fatal; antibiotics or observation do not address ongoing hemorrhage. The goal is to reverse the lethal triad (hypothermia, acidosis, coagulopathy) through swift blood-based resuscitation and immediate operative control of bleeding, with definitive repair pursued after stabilization.