Vascular injury Flashcards
signs of aortic injury on plain film
widened mediastinum, apical cab, loss of aortic notch
management of acute bleed from tracheoinnominate fistula
place ET through trach and inflate cuff beyond the bleeding
apply pressure caudally and anteriorly behind sternum
perform sternotomy and resect involved segment of artery
place tissue flap in place to prevent fistula formation
what is delta P in relation to compartment syndrome
the difference between the diastolic blood pressure and the measured compartment pressure; if the difference between DBP and compartment pressure is less than 30, compartment syndrome requiring fasciotomy should be considered
soft signs of vascular injury include:
history of significant bleeding, injury proximity to named vessel, diminished pulse, neurologic deficit
complete disruption of the shoulder girdle that is associated with massive bleeding is called what? what is first step in management?
scapulothoracic dissociation
first step is to reduction and immobilization to prevent hematoma expansion
then IR for embolization if needed
avoid taking to OR because it often leads to massive blood loss
how do you expose the infrarenal aorta
reflect transverse mesocolon cephalad, eviscerate small bowel mesentery to right, then open the infracolic retroperitoneum until the left renal vein is exposed
how do you expose the suprarenal aorta
left medial visceral rotation (mattox)
how do you expose the IVC
right medial visceral rotation (cattell braasch)
Under what circumstances should intraabdominal retroperitoneal hematomas be explored?
All zone 1 injuries
expanding or pulsatile zone 2 and zone 3 injuries, all with penetrating mechanism
EAST Guidelines for screening blunt cerebrovascular injury with CTA:
neuro abnormalities not explained by axial imaging or epistaxis from suspected arterial source
pts with DAI
petrous bone fracture
C1-C2 fx or patient with fx through foramen transversarium
C spine fx with rotational or subluxational component
LeFort II and III fxs
effect of REBOA in zone 1:
similar to aortic clamping in thoracotomy
effect of REBOA in zone 2:
contraindicated; decreases perfusion to intraabdominal organs
effect of REBOA in zone 3:
reduces pelvic bleeding and LE bleeding; most effective landing zone for this device; placed below renal arteries but above bifurcation
which retroperitoneal hematomas must be explored?
all zone 1, all penetrating, all expanding/pulsatile
how to expose the infrarenal aorta:
reflect transverse mesocolon cephalad, eviscerate SB to patient’s right, midline retroperitoneum opened until the left renal vein is exposed
