Vascular trauma Flashcards Preview

Phase II: Periop Pt1 > Vascular trauma > Flashcards

Flashcards in Vascular trauma Deck (17):
1

Outline the causes of peripheral vascular trauma

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

2

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

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

3

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

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)

4

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

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

5

Outline the principles of fluid resuscitation in peripheral vascular trauma

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

6

Outline the management of peripheral vascular trauma

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

7

What is the commonest cause of chest vascular trauma?

Rapid deceleration ➔ disruption of descending thoracic aorta

8

Name 2 common emergency pathologies seen alongside chest vascular trauma?

Tension pneumothorax
Cardiac tamponade

9

Describe the prognosis of chest vascular trauma?

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

10

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

CT scan - locates arterial trauma

11

What is the treatment of chest vascular trauma?

Stent graft

12

Name 3 causes of retroperitoneal bleeding

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)

13

What are the clinical signs of retroperitoneal bleeding?

Following femoral artery catheterisation
Acute abdominal/flank pain
Hypotension
Anaemia

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

14

What investigation is required to confirm retroperitoneal bleeding?

CT scan

15

Outline the medical management of retroperitoneal bleeding

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

16

Outline the definitive management of retroperitoneal bleeding

Endovascular:
-Stent graft
-Arterial embolisation

Surgical decompression (rare)

17

Name the retroperitoneal organs

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