Vascular Trauma Flashcards
What are three main anatmocally distinct categories of vascular trauma?
- Peripheral arterial trauma
- Chest vessel trauma
- Retroperitoneal bleeding
What are some causes of peripheral vascular trauma?
- Penetrating injuries (e.g. stab wound)
- Blunt objects (e.g. fractures)
- Invasive procedures (e.g. arteriography)
What are the two types of signs of an arterial bleed?
- Hard signs
- Soft signs
What are some hard signs of an arterial bleed?
- Rapidly expanding haematoma
- Area with a palpable thrill/audible bruit
- External arterial bleed
- Acute limb ischaemia following trauma (not corrected by reduction/relocation of limb)
If hard signs are present how should the patient be managed?
Urgent surgery
What are some soft signs of an arterial bleed?
- Bleeding
- Wound/trauma near to a major artery
- Diminshed unilateral pulse
- Small haematoma
- Neurogenic defecit
If soft signs are present how should the patient be managed?
- Consider duplex USS
- Consider referral to vascular
How are limb vasculature injuries managed?
- Surgery (mostly)
What is key to managing limb vasculature injuries?
Managing the haemorrhage and preventing ischaemia
What are prioritised over limb injuries?
Head injuries and trunk blood loss
After what period of ischaemia are limbs unlikely to survive?
6-8 hours
How are chest vascular injuries managed?
- Management of possible pneumothorax/tamponade first
- If stable sent for CT chest
How do most thoracic vessel injuries occur and where?
Rapid deceleration in RTA leading to damage at the isthmus of the thoracic aorta
What percentage of people die before reaching hospital with an injury to the isthmus of the descending aorta?
90%
How is a throacic vascular injury managed?
- Fluids
- Aortic stent/open repair
