Retrohepatic inferior vena caval injuries resulting from blunt or penetrating abdominal trauma are rare but devastating events that remain formidable challenges to even the most experienced Level I trauma center team members. Prepackaged atrial caval shunts have improved emergency medical treatments, and prior planning and coordination by perioperative nurses allow for rapid response by surgical team members. These efforts provide an optimal level of care required to increase patient survival. This article provides a general overview of abdominal trauma and retrohepatic inferior vena caval injuries and a proactive plan to meet the needs of patients with these injuries.