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presence of a hematoma, and the findings will dictate the next steps with regard to evaluation of the abdomen If hemodynamic instability or the need for immediate craniotomy exists and does not allow for CT evaluation of the abdomen ( Fig 103.2 ), a focused abdominal sonography for trauma (FAST examination) should be performed either in the ED or in the operating suite In the presence of a positive FAST examination, laparotomy or laparoscopy and craniotomy proceed simultaneously Finally, if neither thoracotomy nor craniotomy is indicated, emergent laparotomy or laparoscopy is performed when pneumoperitoneum is noted on a plain radiograph or when the patient remains hemodynamically unstable in the face of historical or physical evidence of abdominal trauma With massive hemorrhage, fresh frozen plasma and platelets should be administered along with packed RBCs Initial management of the stable patient Commonly, the injured child can be stabilized in the ED with proper airway and cervical spine management, and with intravenous fluid therapy and blood transfusion A careful secondary survey should then be performed On the basis of history and careful, serial abdominal examinations, CT is indicated when intra-abdominal injuries are suspected ( Table 103.1 ) An abdominal CT scan may be merited based solely on severe force inherent in a particular mechanism of injury, despite an unremarkable physical examination or the absence of abnormal screening laboratory values FAST examination and laboratory studies may help guide the decision making regarding abdominal CT scan Additional management Children with abdominal trauma often need decompression of the stomach; this procedure facilitates examination, may provide information concerning gastric or diaphragmatic injury (bloody aspirate, radiographic evidence of the nasogastric tube in the thoracic cavity), and relieves the discomfort of an ileus Major maxillofacial trauma precludes nasogastric tube placement, but an orogastric tube suffices in these instances Urinary bladder catheterization may provide evidence of genitourinary system injury and is helpful in monitoring urinary output Bladder catheterization is contraindicated when urethral disruption is suspected on the basis of the findings described previously