Blunt Thoracic Aortic injury article Flashcards
What percentage of subjects survive long enough following blunt thoracic injury
20%
The majority of blunt injuries to the thoracic aorta occur where
Aortic Isthmus
Blunt aortic injury may be a result of a “water hammer” effect, explain.
It is a sudden compression of the abdomen due to a sudden impact occluding the aorta, leading to rupture of the proximal, intrinsically weak isthmus
In what order of the aortic layes do aortic rupture occur?
intimal, medial, and then the adventitia
What you look for on a plain film for aortic trauma
wide mediastinum
obscure, indistinct or enlargedaortic knob or arch
Left apical cap or bld in the L apicies of the lung
displacement of the L mainstem bronchi
right ward deviation of the trachea
What is the diagnostic test of choice for Blunt aortic injury detection
CT
What you may see on CT
Aortic contour abnormality
pseudoaneurysm
contained rupture
vessel wall disruption
intimal flap
luminal filling defect
active extravasation
Aortic Grading 1-4
I. Intimal tear
II. Intramural hematoma
III. Pseudoaneurysm
IV. Rupture
Type I Injury managment
nonopertively
medically therapy with Beta blockers
serial imaging
Type II, III, IV treatment
under go repair
Unless comorbidities perclude repair
Delay is an option for hemodynamically stable patients providing there are no signs of rupture, aortic thrombus, massive pneumothorax, luminal encroachment or pseudoaneurysm
Heart rate control while awating repair is what?
Esmolol at less than 100
BP should be maintained with what? At what? while awaiting surgery
SBP at 100
Nitroglycerin or Nipride
Overall survival of a traumatic blunt aortic injury is what
10-20%
