Chapter 182 - Thoracic vascular trauma Flashcards
Physical signs of thoracic vascular trauma
1) Distended neck veine
2) Tracheal deviation
3) subcutaneous emphysema
4) chest wall instability
5) absent breath sounds
6) muffled heart sounds
7) absent UE pulse
8) hemothorax/pneumothorax
BTAI CXR signs
1) widened mediastinum
2) apical capping
3) loss of normal radiographic cardiac/aortic arch silhouette
Sensitivity 41%
IVUS for BTAI advantage and disadvantages
1) no contrast
2) no radiation
1) cost
2) need large sheath
3) OR time use
Indications for emergency OR after BTAI
1) shock
2) chest tube output > 1500
3) chest tube output > 250/hr x 3 hours
Incisions for treating BTAI and indications
1) Median stenotomy with right and left neck extension –> injury to heart, proximal aorta, innominate
2) Left posteriorlateral thoracotomy –> descending thoracic aortic injury
3) Left anteriolateral thoracotomy –> left subclavian; can turn into clamshell modification by extenting posterior mid line
4) Book thoracotomy
Surgical treatment for lung injury in trauma
1) Pneumonorrhaphy
2) staple wedge resection
3) tractotomy and ligation of bleed
4) lobectomy
Key movement to expose lung
Inerior pulmonary ligament ligation
Techniques for hilar control of blled
1) lung torsion
2) manual compression
3) vascular clamp
BTAI is the cause of how much MCV death
1/3
Definition of widened mediastinum
1) 8cm at aortic knob
2) width exceed 25% of total chest width
Treatment of BTAI - BP control
Reduce stress on wall and reduce rupture risk from 12% to 1.5%
Betablock + vasodilator
Target for BTAI BP
SBP < 100
MAP < 80
1st approved TAAA endograft
Gore 2005
used for BTAI off label until 2008 became on label
Open approach exposure
left post-lat thoracotomy through 4th space
Left heart bypass cannulation sites
Left inferior pulmonary vein
Distal thoracic aorta
