In case you didn’t know or were wondering, using TPA in the trauma patient isn’t a good idea. It’s especially bad when the path of the bullet went across to top of the liver. And before you ask, yes there was a vascular injury and yes a vascular surgeon used the TPA. I guess another way to say it is, “Why you should open the patient’s abdomen 3 different times before they leave the OR.” Bottom line: Factor VII is great stuff and we closed the abdomen for the final time about 36 hours later.