Arterial injury
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This document discusses vascular injuries, which can be caused by blunt or penetrating trauma or iatrogenically. Vascular trauma can range from life-threatening hemorrhage to minimal injuries with no detectable findings. Physical exam findings, imaging like Doppler and duplex scanning, and arteriography can help identify vascular injuries. Management involves resuscitation, proximal and distal vessel control, restoring circulation, and may include endovascular techniques. Complications from vascular injuries include blood loss, ischemia, pseudoaneurysms, compartment syndrome, and potential limb loss or death if not properly managed.
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Arterial injury
- 1. Dr Samer regal Professor of vascular surgery
- 2. The risk to life and limb remains significant and the margin for error is very thin. Either delay in recognition of or failure to adequately manage vascular injuries remains alarmingly common in trauma centers.
- 3. It is common either in war or civil times .caused by: blunt (diffused )or penetrating injury(more focal) iatrogenic injury(post cardiac catheters)
- 4. Blunt injury associated with higher amputation rate due to: .delayed diagnosis .associated with significant fracture or tissue loss .diffused form of injury . disrupts smaller vessels that would normally provide collateral flow
- 6. Vascular trauma produces a spectrum of findings from life-threatening hemorrhage from major vessel laceration to no overtly detectable findings in minimal injuries.
- 8. .proximity of the vessels to the bone .vessels nearly fixed beside joints (popliteal artery injury in knee dislocation) .superficial location of the vessels
- 11. Physical exam Doppler pressure (Ankle/brachial systolic pressure index) Duplex scanning Arteriogram Exploration
- 12. HARD SIGNS OFVASCULAR INJURY absent pulses bruit or thrill active hge expanding hematoma distal ischemia SOFT SIGNS OFVASCULAR INJURY hematoma hx of hge at seen of accident unexplained hypotension peripheral nerve deficit
- 19. Blood loss (significant in abdomen and chest) Ischemia-thrombosis Pseudoaneurysm Arteriovenous fistula Compartment syndrome Tissue necrosis Amputation Death
- 20. .local pressure on the wound .compression against bony prominence .dont use tourniquet unless needed(in hand and foot) .dont apply crushing instrument on a bleeding artery
- 21. narrow tourniquet not control arterial bleeding and increase venous bleeding 10cm wide is perfect - sphygmomanomet er cuff is the best deflate every hour
- 22. Resuscitation Heparinization Proximal and distal control of blood vessels Restoration of circulation Endovascular management
- 29. Antithrombotic measures Avoid hypotension Distal pulse examination Limb blood pressure