1. Preparing for trauma surgery:
-2 large bore (18 g) peripheral IVs is better for resuscitation than a central line. In a trauma situation, if you got 2 big peripheral IVs, don't waste time getting in a central line for the purposes of getting in fluids. You don't need it.
-Get an A-line.
-Prep and drape before you induce anesthesia; induction can drop perfusion, and you want to be ready to go immediately if you start losing vital signs.
-For emergency ex-laps in an abdominal trauma situation, prep chin to knees: you may need to enter thorax, you may need to harvest vein grafts from the legs.
2. Emergency surgery on a traumatic abdomen: 
-Get in fast: 3 passes of the knife and in. Don't waste time getting in clean and slow with the bovie.
-Above the umbilicus, the pre-peritoneal fat is really thin, so you can just push your finger through it, and then lift up the peritoneum with your hand and bovie between your fingers.
-As soon as you get in, pull out all the bowels so you can see what's bleeding.
3. How to pack a bleeding liver: pack above, below, and anywhere inside (i.e. if there is an avulsion) where it's bleeding
4. Retroperitoneal bleeding: when to surgically explore vs medically manage
-Zone 1 (central abdomen): explore
-Zone 2 (lateral abdomen): explore if the patient is unstable, the hematoma is expanding, the injury mechanism is penetrating, or there is obvious injury to a vessel or the colon. Otherwise, in blunt trauma, leave it.
-Zone 3 (pelvis): explore if there was penetrating injury. For blunt injury, better go to IR.

5. Pringle Maneuver: clamp across hepaticoduodenal ligament/portal triad, controls liver hemorrhage. Maximum time debated, around 30-45 minutes. 

6. Kocher Maneuver: incise the bloodless plane to the R of the duodenal C-curve, that will allow you to flip the duodenum and head of pancreas to the L and expose the aorta and IVC, SMA/SMV, gonadal and renal vessels. 

7. Mattox Maneuver: incise the white line of toldt lateral to the descending colon, flip up the colon to the opposite side, rotate up the spleen, either leave kidney in place (if its damaged and/or surgical target) or flip kidney out of the surgical field if its intact, you gain access to IVC/aorta and L renal vessel. 

-Pitfalls during mattox maneuver: you can injure the kidney or spleen in your manipulations, or you can injure L lumbar vv (comes off L renal) 

8. Cattell-Braasch Maneuver: similar to Mattox, but on the R side, and slightly more involved. You have to do the Kocher maneuver, then incise the white line of toldt on the right side, then connect the two together. Then, importantly, you have to extend the incision from the bottom of the white line of toldt across the mesentery of the small bowel, diagonally towards the ligament of treitz. Do not cut any mesenteric vessels while you do this. Then you can lift the whole thing over to the L and have exposure to the great vessels. 

-Pitfalls: do not cut R gonadal vein or SMV. 

9. Maneuver to get to thoracic aorta for cross-clamping when all else fails and you can't control the hemorrhage: incise through hepatogastric ligament, along the lesser curve of the stomach to enter lesser sac. Retract the stomach down and lateral, you should now be able to get behind stomach and esophagus and see the aorta coming out of the aortic hiatus, with the diaphragmatic crus on either side. Cut through the crus (they will be soft) to get maximally high on the aorta, and cross-clamp. Note, this is only for massive hemorrhage that is leading to impending crash despite your best efforts at packing. 

10. Retroperitoneal bleeding can track between the fascial planes, around the kidney, down into the pelvis, up into the upper abdomen.