When liver packing is needed (step 9), hepatic mobilization is not recommended since this maneuver increases the risk of hepatic vein damage and aggravates the initial liver injury.
Major hepatic lesions are usually caused by a deceleration trauma leading to a liver fracture at the level of the right triangular ligament along the right hepatic vein. This location is often difficult to access. To stop the bleeding, the fracture should be closed by placing the assistant's hand beyond the fracture, while traction should be avoided.
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