Flashcards in Vascular trauma Deck (17)
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
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
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
Probable injury to an artery ➔ may require investigation (duplex USS or angiography)
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
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
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
What is the commonest cause of chest vascular trauma?
Rapid deceleration ➔ disruption of descending thoracic aorta
Name 2 common emergency pathologies seen alongside chest vascular trauma?
Describe the prognosis of chest vascular trauma?
90% mortality in thoracic aorta damage prior to reaching hospital
25% mortality within 24hr of reaching hospital
What investigation is used for stable patients with chest vascular trauma?
CT scan - locates arterial trauma
What is the treatment of chest vascular trauma?
Name 3 causes of retroperitoneal bleeding
Spontaneous bleed - Warfarin
After angiography/angioplasty - femoral puncture
Rare: Wunderlich syndrome (spontaneous non-traumatic renal haemorrhage ➔ acute flank pain + flank mass + hypovolaemic shock)
What are the clinical signs of retroperitoneal bleeding?
Following femoral artery catheterisation
Acute abdominal/flank pain
Often no associated haematoma at groin puncture site
Iliac fossa mass/tenderness
What investigation is required to confirm retroperitoneal bleeding?
Outline the medical management of retroperitoneal bleeding
IV fluid resuscitation + Blood transfusion
Reverse anticoagulation therapy
Correct clotting disorders
Inform vascular surgeon
Outline the definitive management of retroperitoneal bleeding
Surgical decompression (rare)