Vascular trauma Flashcards

1
Q

Outline the causes of peripheral vascular trauma

A

Penetrating wounds: gunshot, stab, IVDU
Blunt trauma: joint displacement, fracture, contusion (bruise)
Invasive procedure: angiography, cardiac catheterisation, balloon angioplasty

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2
Q

What are the hard signs of arterial injury, and what do these indicate?

A

External arterial bleeding
Rapidly expanding haematoma
Palpable thrill, audible bruit
Obvious acute limb ischaemia - not corrected by reduction of dislocation or realignment of fracture

These indicate definite injury to an artery ➔ require immediate surgery

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3
Q

What are the soft signs of arterial injury, and what do these indicate?

A
History of bleeding at the scene
Proximity of penetrating wound or blunt trauma to a major artery
Diminished unilateral pulse
Small non-pulsatile haematoma
Neurogenic deficit

Probable injury to an artery ➔ may require investigation (duplex USS or angiography)

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4
Q

Which fractures/dislocations have a higher incidence of associated vascular injury?

A

Supracondylar humerus fracture in children ➔ brachial artery
High tibial ‘bumper fracture’ ➔ anterior tibial artery
Dislocation of knee ➔ popliteal artery

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5
Q

Outline the principles of fluid resuscitation in peripheral vascular trauma

A

Adequate IV access
Access into uninjured limb
Avoid lines leading to potential areas of tamponade or venous injury
Preserve saphenous or cephalic veins

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6
Q

Outline the management of peripheral vascular trauma

A

Majority require surgical exploration and repair
Aims: control life-threatening haemorrhage, and prevent limb ischaemia
Warm ischaemia time of 6hr - after this limb survival is unlikely
After 8hr - organ damage

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7
Q

What is the commonest cause of chest vascular trauma?

A

Rapid deceleration ➔ disruption of descending thoracic aorta

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8
Q

Name 2 common emergency pathologies seen alongside chest vascular trauma?

A

Tension pneumothorax

Cardiac tamponade

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9
Q

Describe the prognosis of chest vascular trauma?

A

90% mortality in thoracic aorta damage prior to reaching hospital
25% mortality within 24hr of reaching hospital

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10
Q

What investigation is used for stable patients with chest vascular trauma?

A

CT scan - locates arterial trauma

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11
Q

What is the treatment of chest vascular trauma?

A

Stent graft

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12
Q

Name 3 causes of retroperitoneal bleeding

A
Pelvic fracture
Pelvic surgery
Ruptured AAA
Spontaneous bleed - Warfarin
After angiography/angioplasty - femoral puncture

Rare: Wunderlich syndrome (spontaneous non-traumatic renal haemorrhage ➔ acute flank pain + flank mass + hypovolaemic shock)

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13
Q

What are the clinical signs of retroperitoneal bleeding?

A

Following femoral artery catheterisation
Acute abdominal/flank pain
Hypotension
Anaemia

Often no associated haematoma at groin puncture site
Iliac fossa mass/tenderness

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14
Q

What investigation is required to confirm retroperitoneal bleeding?

A

CT scan

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15
Q

Outline the medical management of retroperitoneal bleeding

A

IV fluid resuscitation + Blood transfusion
Reverse anticoagulation therapy
Correct clotting disorders
Inform vascular surgeon

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16
Q

Outline the definitive management of retroperitoneal bleeding

A

Endovascular:

  • Stent graft
  • Arterial embolisation

Surgical decompression (rare)

17
Q

Name the retroperitoneal organs

A
Suprarenal glands (aka the adrenal glands)
Aorta/IVC
Duodenum (2nd and 3rd segments)
Pancreas (head, neck, and body)
Ureters
Colon (ascending and descending colons)
Kidneys
Esophagus
Rectum