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R9 > Chapter 180 - Epidemiology and natural history of vascular trauma > Flashcards

Chapter 180 - Epidemiology and natural history of vascular trauma Flashcards

1
Q

Rank in the causes of mortality

A

3 #1 in age 1-46 #1 preventable mortality in wartime = hemorrhage

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2
Q

WHO definition of epidemiology

A

Study of the distribution and determinants of health-related states or events in specified population Goal: to control health problems

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3
Q

Galen 2nd century in vascular trauma

A

Vessel ligation techniques

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4
Q

Ambroise Pare 16th century

A

French military surgeon: vessel ligation in trauma

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5
Q

Alexis Carrell 1902 french surgeon

A

Arterial anastamosis; won nobel prize 1912

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6
Q

WWII incidence of vascular injury

A

1% Attempted revasc 5% Amputation rate 49%

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7
Q

Korea war incidence of vascular injury

A

2% Attempted 88% Amputation rate 13%

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8
Q

Colonel Carl Hughes

A

Demonstrated decrease amputation rates from WWII to Korea Faster evacuation Venous repairs

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9
Q

Improvements brought upon by Vietnam war

A

Registry existence Venous repair was emphasized Published by Rich et al

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10
Q

Global war on terror brought improvements

A

Tournequet use on field Tactical combat casualty care guidelines More extremity less truncal injuries

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11
Q

Different wars and their researchers

A

WWI - Makins WWII - Debakey Korea - Hughes Vietnam - Riel, McNamara GWOT - Dua, White

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12
Q

Vascular trauma categories

A

Tier 1: periphery, extremity –> distal to axillary or CFA/V Tier 2: proximal groin or axillary Tier 3: intracavitary wounds

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13
Q

Neck trauma incidence

A

0.2% incidence: 41% penetrating 59% blunt

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14
Q

Carotid artery trauma location

A

37% internal 20% CCA 10% mixed 33% unknown

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15
Q

Blunt trauma mechanism of carotid artery

A

1) stretch from hyperflexion, extension, rotation at base of internal carotid 2) high velocity MVC 79% with 50% severe brain injury

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16
Q

Rate of bilateral carotid or associated vertebral injury

A

20-50%

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17
Q

Mortality after blunt carotid injury

A

50%

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18
Q

Neurologic deficit in survivors of carotid injury

A

16%

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19
Q

Vertebral injury incidence

A

1-7% of penetrating neck 1% of blunt neck trauma

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20
Q

Vertebral injury mortality

A

10-20% if isolated 50% if also carotid 78% if associated spine #

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21
Q

Vertebral injury association

A

40% of spine fracture has vertebral injury posterior stroke 24%

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22
Q

Non-compressible torso hemorrhage treatment principles

A

1) minimize delay in transfer from ER to OR 2) permissive hypotension until VSx control obtained 3) balanced/hemostatic resuscitation with early use of blood 4) procoag adjunct (TXA) 5) damage control surgery with intravascular shunt

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23
Q

Thoracic Aortic injury causes

A

90% penetrating

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24
Q

Most common region of penetrating aortic injury

A

28% thoracic

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25
Q

Blunt trauma in thoracic aorta most common location

A

98% at ligamentum arteriosum or distal to origin of LSCA

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26
Q

Blund TAI grades

A

Gr 1: intimal tear Gr 2: intimal flap/IMH Gr 3: pseudoaneurysm Gr 4: rupture

27
Q

Ascending aortic blunt injury causes

A

1) sudden displacement of intact sternum 2) displace # or dislocated sternum 3) torsion tear of heart apex (98% die of tamponade)

28
Q

Fabian 1997 AAST-1 study treatment technique and outcome for thoracic aortic injury

A

35% clamp and sew 65% bypass Mortality 31% Paraplegia 9%

29
Q

Modern practice for thoracic aortic injury and outcome

A

TEVAR 76% Mortality 8.6% Aortic mortality 2.5% Paraplegia 0.5%

30
Q

Outcome following injury to great vessels

A

90% death in 30 min

31
Q

Incidence of great vessel injury

A

5% gun 2% stab <1% blunt

32
Q

Great vessel injury patency of repair

A

>90%

33
Q

Great vessel injury chance to be multivessel

A

65%

34
Q

Arm ischemia rate after LSCA coverage

A

4-5%

35
Q

Upper extremity injury rate

A

1.7% 23% involve axillary and subclavian 1/3 involve venous injury

36
Q

Upper extremity blunt injury key points

A

1) shear force 2) clavicle # 3) concomitant nerve injury 40-100% 4) amputation 3-15% 5) Mortality 25%

37
Q

Abdominal injury incidence and types

A

34% Penetrating 89% Multivessel 36% Venous 53% Arterial 47% Both 53%

38
Q

Abdominal injury mortality following number of vessels injured

A

1 vessel: 45% 2 vessels: 60% 3 vessels: 73%

39
Q

Strongest independent predictor of death following abdominal injury

A

Hypotension 25%

40
Q

Mortality following types of vessel injured in abdomen

A

IVC: 52% Aorta: 35% SMA: 45% Portal/hepatic venous: 22%

41
Q

Zones of abdominal injury

A

Zone 1: central (aorta, ivc) Zone 2: lateral (Renal) (penetrating 50%) Zone 3: iliac (Blunt 70%) Zone 4: hepatoportal

42
Q

Morbidity and mortality with retroperitoneal hematoma

A

60% morbidity 13-40% mortality

43
Q

Zone 1 blunt aortic injury cause

A

56% death due to seatbelt most common at junction of IMA and aorta or aortic bifurcation

44
Q

Signs of Zone 1 blunt aortic injury

A

1) bruising 2) arterial insufficiency 3) acute abdomen 4) weakness

45
Q

Mortality after zone 1 blunt aortic injury

A

20-40% 83% if > 65 years old

46
Q

Zone 1 penetrating aortic injury causes

A

Gun 78%

47
Q

Mortality after zone 1 penetrating aortic injury

A

33-81%

48
Q

Rate of zone 1 penetrating aortic injury by location in aorta

A

Infrarenal 45% Suprarenal 37% Subdiaphragmatic 18

49
Q

San Diego study for penetrating aortic injury

A

Straight to OR and bypass ER Reduced mortality from 78% to 40%

50
Q

Zone 1 IVC injury incidence

A

6.7% of all penetrating injuries 3.4% of all blunt injuries Most common in infrarenal IVC

51
Q

Associated injury with IVC injury

A

Duodenum 31% Liver 29% Pancreas 26%

52
Q

Mortality after IVC injury

A

70% 78% if combined venous injury

53
Q

Celiac/mesenteric vessel injury incidence and mortality

A

Rare Usually have associated other injuries Mortality 20-40%

54
Q

Zone 2 renal injury causes

A

50/50 blunt/penetrating Associated injury 77%

55
Q

Mortality following zone 2 renal injury

A

30% nephrectomy needed in 51%

56
Q

Zone 3 iliac vessels injury incidence

A

< 1% 56% will have multiple injuries

57
Q

Mortality after Zone 3 iliac injury

A

28-49%

58
Q

Causes of zone 3 iliac injuries

A

Gun 86-95%

59
Q

Location of iliac injury Zone 3

A

CIA + EIA 68% IIA 32%

60
Q

Zone 4 hepatoportal vessels mortality

A

92-100%

61
Q

Extremity trauma incidence

A

1-2% LE 66% UE 34%

62
Q

Mortality and limb loss after extremity trauma

A

10% LE worse

63
Q

Natural History of Various Types of Vascular Injuries and Potential Future Complications

A

R9 (200 decks)

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