Chap 155-160 Vascular Trauma Flashcards
What is the equation for impact kinetic energy?
IKE= 1/2mass x velocity squared
What kind of injuries can occur from a blast injury?
direct blast pressure
penetrating fragments
collision with objects
thermal injury
What are principles of management for non compressible truncal haemorrhage?
minimize delay to OR permissive hypotension balancced resuscitation procoagulant adjuncts (tranexamic acid) damage control surgery/shunts
Most common injured abdo vessels?
IVC
aorta
SMA
Portal
What are the zones of the carotid? And how do you obtain control of each zone?
Zone I
Below the cricoid cartilage—proximal control obtained in the chest
Zone II
b/w the cricoid cartilage and the angle of the mandible—proximal and distal control obtained in the neck
most commonly injured
zone III
above the angle of the mandible—distal control difficult to obtain
In what time period should you attempt revascularization if neurological defects?
within 24 hours
What is treatment for BCVI?
heparin
can consider warfarin
What is treatment for BCVI?
heparin
can consider warfarin
What is classification of aortic injury?
grade I intimal tear
grade II intramural hematoma
grade III PSA
Grade IV rupture
What are mechanisms of blunt aortic trauma?
stretching
sudden BP elevation
osseous pinching
water-hammer effect
What injuries would you consider initial management of blunt AI in grade I?
cardiac RF head injury pulmonary injury coagulopathy severe abdo injury
What injuries would you consider initial management of blunt AI in grade I?
cardiac RF head injury pulmonary injury coagulopathy severe abdo injury
What are the zones of the abdomen?
zone 1 aortic hiatus to sacral promontory
zone 2 L and R kidney, paracolic gutter and renal vessels
Zone 3 pelvic retroperitoneum and iliacs
zone 4 liver
When should RPB be explored?
penetrating unless stable and non-expanding
paraduodenal (rule out duodenal injury)
root of mesentery with ischemic bowel
When to do damage control?
coagulopathic
hypothermic
BE >15 mmol
signif bowel edema
At what pressure is abdo compartment syndrome suspected?
> 20mmHg with organ dysfunction
20-30 consider decopression
What are RF for ACS?
Massive blood transfusion Vascular injury Prolonged hypotension, aortic cross clamping Damage control procudreus Tight closure of abdo wall.
What are the zones of the SMA?
Zone 1 b/w aortic origin and inferior pancreaticoduodenal artery zone2 b/w inf pancduo and middle colic artery zone 3 distal to middle colic artery zone 4 segmental intestinal branches
What zones of the SMA can be ligated with limited ischemia?
3 and 4
What veins does the IVC receive?
lumbar right gonadal renal right adrenal hepatic phrenic
What veins does the IVC receive?
lumbar right gonadal renal right adrenal hepatic phrenic
What is hepatic vascular isolation clamp order?
clamp infradiaphragmatic aorta, suprahepatic IVC,
infrahepatic IVC above renals
and portal triad
What is the portal vein formed by?
confluence of SMV and splenic vein
What are had signs?
Absent distal pulses
Palpable thrill or audible bruit
Actively expanding hemotoma
Active pulsatile bleeding
