Hemodynamically unstable patients, not responsive to resuscitation, should go directly from the trauma bay to the operating room for laparotomy. In addition, patients with peritoneal signs should go to the operating room. Patients that fail non-operative therapy must undergo laparotomy. Damage control laparotomy principles should be followed in the unstable patient undergoing laparotomy. This includes first controlling hemorrhage, then controlling gastrointestinal (GI) contamination. The abdomen should be packed in all 4 quadrants, allowing for injuries to be localized and the anesthesia team to resuscitate the patient. The “lethal triad” of coagulopathy, acidosis, and hypothermia should trigger a damage control approachIn blunt liver trauma, nonoperative management is a standard of care in hemodynamically stable patients. It is not the grade of the injury, but rather the hemodynamic parameters of the patient which dictate the conservative versus operative management decision. The patient’s positive response to an initial fluid bolus or maintenance of a stable hemodynamic state allows for a CT scan of abdomen and pelvis. If extravasation is identified, angiogram and angioembolization should be considered. Failures of these steps then mandate operative intervention. The most common reasons for failure are advanced age, delayed bleeding, hypotension and active extravasation of contrast not controlled by angioembolization.There is an overall survival benefit and 23% reduction of mortality for conservative approach in blunt liver injury