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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