vascular trauma

Question 1

2 major causes of vascular trauma

Answer 1

1. blunt trauma

2. penetrating trauma

Question 2

3 classes of vascular traumas

Answer 2

1. rupture 4 - repair NOW
2. grade 3 - delayed repair
3. just a nick 1- no repair

Question 3

2 general approaches

Answer 3

1. surgical - less common now

2. endovascular - better

Question 4

what is opposing side to bleeds

Answer 4

not perfusing

- can co-exist

Question 5

***4 hard signs of arterial injury

Answer 5

1. pulsatile bleeding
2. absent distal pulse
3. ischemic limb
   - no movement or sense
4. expanding hematoma/shock

Question 6

what are soft signs of art. injury

Answer 6

• hx of serioud bleeding, but stopped
• decreased distal pulse
• injury to adjacent nerve/art
• ## small hematoma

Question 7

*****3 injuries known ot be assoc. with vasc. injuries

Answer 7

1. elbow dislocation - brachial
2. knee dislocation - popliteal
3. proximal tib/fib

Question 8

3 special consideration injuries

Answer 8

1. PMHx of peripheral vasc. injury
2. shotgun/shrapnel
3. crush

Question 9

when to do surg. if have soft signs

Answer 9

1. high risk injury

2. positive CTA

Question 10

3 keys to good outcome

Answer 10

1. high index of suspician
   - investigate well
2. revasc. quickly
3. monitor quick;y

Question 11

2 basics of repair

Answer 11

1. removeing clot

2. restoring flow

Question 12

main way to get clot out

Answer 12

cath

Question 13

3 options to restore flow

Answer 13

1. open
2. bypass
3. endo

Question 14

***key to bypass

Answer 14

• use contralateral vein if possibl

Question 15

3 parts to compartment sysndrome

Answer 15

1. high index of suspician
2. beware PTs
   - sedated
   - long operations
   - leg inaccesable for exam
3. do fasciotomy if unsure

Question 16

when to operate on compartment

Answer 16

1. obvious

2. small incision reveals pressure

Question 17

2 issues when working with ortho

Answer 17

1. genrally makes sense to fix vascular first

2. if must do ortho first, consider shunt