Vascular Trauma Flashcards
What are the causes of peripheral vascular trauma?
Penetrating wounds, blunt trauma, invasive procedures.
Give an example of a penetrating wound causing peripheral vascular trauma.
Gunshot, stab, IV drug abuse.
Give an example of a blunt trauma causing peripheral vascular trauma.
Joint displacement, bone fracture, contusion.
Give an example of an invasive procedure causing peripheral vascular trauma.
Arteriography, cardiac catheterisation, balloon angioplasty.
What are the hard signs of arterial injury?
External arterial bleeding, rapidly expanding haematoma, palpable thrill, audible bruit, acute limb ischaemia.
What are the soft signs of arterial injury?
History of bleeding at the scene, proximity of penetrating wound or blunt trauma to major artery, diminished unilateral pulse, small non-pulsatile haematoma, neurogenic deficit.
How should patients with soft signs of arterial injury be assessed?
Serial examination, duplex scan, arteriography, ask vascular surgeon’s opinion.
What fractures/dislocations have a higher risk of vascular injury?
Supracondylar humerus fracture in kids, high tibial bumper fracture, dislocation of knee.
How should fluid resuscitation in peripheral vascular trauma be achieved?
IV access, lines into uninjured upper or lower extremity, avoid extremity leading fluid directly into potential areas of tamponade or venous injury, preserve saphenous or cephalic veins.
How are limb vascular injuries managed?
Surgical exploration and repair. Emergency repair to control life threatening haemorrhage and prevent limb ischaemia. Primary amputation if severely traumatised limb.
What is a bad prognostic sign for the limb in vascular injury?
> 6-8 hours of warm ischaemia.
Which intra-thoracic vascular injury is most disrupted in chest vascular trauma?
Descending aorta at isthmus - e.g. in car stopped by seatbelt causes rapid deceleration.
What can cause a retroperitoneal bleed?
Pelvic fracture, surgery in the pelvis, spontaneous (e.g. on warfarin), following angiogram/angioplasty.
What are the clinical signs of retroperitoneal bleeds?
Hypotension, drop in Hb after femoral artery catheterisation. Lower back pain. No associated haematoma often. Iliac fossa mass/tenderness.
How are retroperitoneal bleeds managed?
Resuscitation, alert seniors, confirm diagnosis with urgent CT.
