Packing liver

place rolled packs in subphrenic and subhepatic space
avoid IVC compression
effective packing is a wrap not a sandwich
pack early (packing relies on clot formation)

if still bleeding despite packing:
technical error
packs do not control arterial bleeding:
inflow occlusion needed (in trauma usually venous)
if bleeding looks arterial despite inflow occlusion the hepatic artery may have an anomalous origin (left hepatic from left gastric in 15% Right hepatic can arise from SMA. Supra coeliac cross clamp will help)
if dark blood gushes from behind the liver: dealing with retrohepatic venous injury: divide falciform and push liver posteriorly to compress
Do not mobilise when there is a suspicion of a retrohepatic venous injury: you will lose control

If packs dont fully control bleeding: send to angio for embolisation