Cardiac tamponade — USMLE Step 2 CK MCQ

Correct answer: D — Admit for nonoperative monitoring with serial examinations and hemoglobin measurements

A hemodynamically stable patient without peritonitis can undergo a trial of nonoperative management for an isolated blunt splenic injury; injury grade alone does not mandate laparotomy. He should be admitted where serial vital signs, abdominal examinations, and hemoglobin or hematocrit measurements can be performed and urgent surgery is available if bleeding develops. Immediate discharge is unsafe because delayed hemorrhage can occur. Diagnostic peritoneal lavage adds no useful information after a diagnostic contrast CT in this stable patient. Angiography or embolization is considered for higher-risk features such as active contrast extravasation, pseudoaneurysm, ongoing bleeding, substantial hemoperitoneum, or higher-grade injury, but it is not automatically required for this uncomplicated grade III injury. Hemodynamic instability or diffuse peritonitis would instead require urgent operative management. Worsening pain, falling hemoglobin, or inflammatory deterioration should prompt reassessment and possible repeat imaging or intervention.

Reference: Eastern Association for the Surgery of Trauma. Selective Nonoperative Management of Blunt Splenic Injury. https://www.east.org/education-resources/practice-management-guidelines/details/splenic-injury-blunt-selective-nonoperative-management-of