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Liver trauma is one of the most serious injuries, although its incidence is not high, with an excess mortality ratio of 12.3. Liver trauma usually presents as one injury among various injuries involving multiple organs. One should therefore be cautious to focus on the victim itself, and not on the liver, when managing a victim with liver trauma. The principle of decision-making and emergency management for liver trauma is based on the same guideline for multiple trauma victims?Advanced Trauma Life Support (ATLS). ATLS has two stages, a primary survey and a secondary survey. The primary survey is composed of five components: (1) airway management with cervical spine immobilization; (2) breathing and ventilation support; (3) circulation support with hemorrhage control; (4) neurological evaluation; and (5) exposure. The primary survey should include providing immediate interventions for critical conditions such as an airway obstruction, a tension pneumothorax, a flail chest, an open pneumothorax, a massive hemorrhage, and cardiac tamponade. During the primary survey, one can use a non-invasive evaluation method, the Focused Abdominal Sonographic Examination for Trauma (FAST) to screen for hidden blood loss. After the primary survey, one should evaluate all kinds of combined injuries in-detail from head to toe during a secondary survey. By the use of the primary and secondary survey, one can make a decision about further specific management such as to perform or not perform surgery.
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