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Trauma Flashcards

1
Q

What are the 2 main types of vascular trauma?

A

Blunt and Penetrating

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2
Q

What lower extrimity trauma mechanism is more lethal?

A

Blunt injuries experience mortality rates between 2% and 5%, whereas penetrating injuries generally result in fewer deaths.

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3
Q

What lower extremity arterial injury results in greater mortality?

A

Proximal arteries

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4
Q

What factors and injuries predict amputation?

A

Blant trauma.
Involvment of fracture.
Arterial injury.

Venous and nerve injuries do not predict amputation!!!

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5
Q

“Hard Signs” of Extremity Arterial Injury?

A
  • Absent distal pulse
  • Palpable thrill or audible bruit
  • Actively expanding hematoma
  • Active pulsatile bleeding
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6
Q

“Soft Signs” of Extremity Arterial Injury?

A
  • Diminished distal pulse
  • History of significant hemorrhage
  • Neurologic deficit
  • Proximity of wound to named vessel
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7
Q

What is the management of patient with lower extremity Hard sign?

A

Operative exploration and repair.

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8
Q

What is the management of patient with lower extremity Soft sign?

A

Complete pulse examination and Doppler pressures.
If the index is < 1.0, a further diagnostic and localization
study should be performed.

The proximity of wound to named vessel alone (without the findings above) should not prompt a localization study.

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9
Q

What is the modality of choice to localization of injury in a stable patient with lower extremity soft signs.

A

CTA initial diagnostic and localization modality of choice with soft signs of extremity arterial injury.

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10
Q

What arterial injuries do not mandate surgical theraphy

A

injuries that produce no active hemorrhage or distal ischemia:
small (non–flow-limiting) intimal defects and flaps.
small pseudoaneurysms.
small arteriovenous fistulas.

Keep high index of suspicion!!!

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11
Q

When is endovascular treatmnet is most appropriate in extremity trauma?

A

There is no clear EBM to favore endovascular treatment.

Can be used when the morbidity difference between open and endovascular is greatest:

  • Injuries to junctional vessels (such as the subclavian and iliac).
  • If the traumatic vascular lesion can be safely traversed with a guide wire.
  • Catheter-directed embolization in smaller
    vessels, small pseudoaneurysms and arteriovenous fistulas of the crural and deep femoral branch arteries.
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12
Q

What are the 3 option for extremity arterial injury repair?

A
  • End to End anastomosis.
  • Debridement of artery with patch angiplasty.
  • Interposition graft.
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13
Q

Whan is it acceptable to use prosthetic graft as interposition graft in extremity arterial injury?

A

Arterial injury to porximal vessel (axillary or CFA) where size match with GSV may be problematic.

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14
Q

Arterial demage control shunts have a very low patency in which atreries?

A

Forarm
Tibial

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15
Q

What is the patency of venous demage control shunts?

A

93%

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16
Q

Ligation of major extremity veins will be done if?

A

patient’s condition will not tolerate the additional operative time.

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17
Q

What physical examination should be preformed before ligation of forarm artery?

A

Allen test to reveal patent palmar arch.

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18
Q

If both the radial and ulnar arteries are injured. Preferance to repair what artery should be made?

A

Unlar is most commonly the dominant contributor.

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19
Q

When would you consider fasciotomy after arterial injury?

A

All patients with restoration of distal perfusion after ischemia. Especially after multiple fractures or arterial injuries is present.

Thigh and upper arm for proximal arterial injury if proximal venous occlusion and outfloe is not restored.

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20
Q

What are the Zones of the RP?

A

Zone 1 upper midline RP from hiatus to bifurcation and laterally from hilum to hilum. subdivided into supramesocolic and inframesocolic. Axis, SMA/SMV, distal RV, prox RA, sepraceliac IVC, portal vein.

Zone 2 Lateral perinephric area. infrarenal aorta, infrarenal IVC

Zone 3 Pelvic RP from bifurcation inferiorly

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21
Q

What are symptoms of RP hematoma?

A

non-specific groin/back or lower abdo pain
thigh pain or numbness/weakness from femoral nerve compression

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22
Q

What are findings on exam of RP hematoma?

A

flank ecchymosis/hematoma-grey-turner
umbilicus hematoma-cullens
lower quad fullness on exam
flexion/external rotation of the hip with extension causing pain (from illipsoas spasm)
pain-paresthesias in antero-medial thigh (lat cutaneous branch fem nerve)

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23
Q

What is the management?

A

conservative first
bed rest
reverse anticoagulants

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24
Q

What are indications for intervention?

A

Neuro deficits
hemodynamic instability
ongoing bleeding
severe pain

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25
what are interventions?
endovascular, embolization open evacuation?
26
what are surgical approaches for evacuation?
supra-iguinal groin
27
what are RF for soon RPB?
HD, anticoagulants, bleeding abnormality Heparin greater risk then warfarin
28
what is the incidence of spontaneous vs iatrogenic RPB on anticoagulation?
spon 0.6-6% on anticoagulation iatro 0.15-0.5 with fem cannulation higher with bigger calibre
29
What is the equation for impact kinetic energy?
IKE= 1/2mass x velocity squared
30
What kind of injuries can occur from a blast injury?
direct blast pressure penetrating fragments collision with objects thermal injury
31
What are principles of management for non compressible truncal haemorrhage?
minimize delay to OR permissive hypotension balancced resuscitation procoagulant adjuncts (tranexamic acid) damage control surgery/shunts
32
Most common injured abdo vessels?
IVC aorta SMA Portal
33
What are the zones of the carotid? And how do you obtain control of each zone?
Zone I Below the cricoid cartilage—proximal control obtained in the chest Zone II b/w the cricoid cartilage and the angle of the mandible—proximal and distal control obtained in the neck most commonly injured zone III above the angle of the mandible—distal control difficult to obtain
34
In what time period should you attempt revascularization if neurological defects?
within 24 hours
35
What is treatment for BCVI?
heparin can consider warfarin
36
What is treatment for BCVI?
heparin can consider warfarin
37
What is classification of aortic injury?
grade I intimal tear grade II intramural hematoma grade III PSA Grade IV rupture
38
What are mechanisms of blunt aortic trauma?
stretching sudden BP elevation osseous pinching water-hammer effect
39
What injuries would you consider initial management of blunt AI in grade I?
cardiac RF head injury pulmonary injury coagulopathy severe abdo injury
40
What injuries would you consider initial management of blunt AI in grade I?
cardiac RF head injury pulmonary injury coagulopathy severe abdo injury
41
What are the zones of the abdomen?
zone 1 aortic hiatus to sacral promontory zone 2 L and R kidney, paracolic gutter and renal vessels Zone 3 pelvic retroperitoneum and iliacs zone 4 liver
42
When should RPB be explored?
penetrating unless stable and non-expanding paraduodenal (rule out duodenal injury) root of mesentery with ischemic bowel
43
When to do damage control?
coagulopathic hypothermic BE \>15 mmol signif bowel edema
44
At what pressure is abdo compartment syndrome suspected?
\>20mmHg with organ dysfunction 20-30 consider decopression
45
What are RF for ACS?
Massive blood transfusion Vascular injury Prolonged hypotension, aortic cross clamping Damage control procudreus Tight closure of abdo wall.
46
What are the zones of the SMA?
Zone 1 b/w aortic origin and inferior pancreaticoduodenal artery zone2 b/w inf pancduo and middle colic artery zone 3 distal to middle colic artery zone 4 segmental intestinal branches
47
What zones of the SMA can be ligated with limited ischemia?
3 and 4
48
What veins does the IVC receive?
lumbar right gonadal renal right adrenal hepatic phrenic
49
What veins does the IVC receive?
lumbar right gonadal renal right adrenal hepatic phrenic
50
What is hepatic vascular isolation clamp order?
clamp infradiaphragmatic aorta, suprahepatic IVC, infrahepatic IVC above renals and portal triad
51
What is the portal vein formed by?
confluence of SMV and splenic vein
52
What are had signs?
Absent distal pulses Palpable thrill or audible bruit Actively expanding hemotoma Active pulsatile bleeding
53
What are soft signs?
Diminished pulses History of significant hemorrhage Neurologic defecit Proximity of wound to named vessel
54
What are soft signs?
Diminished pulses History of significant hemorrhage Neurologic defecit Proximity of wound to named vessel
55
For bypass in LE injury, was conduit do you use?
Take vein form non injured side to preserve collateral venous drainage as vein injury rate is high
56
What are features of the MESS score?
type of injury degree of limb schema hemodynamic instability age
57
What score correlates with primary amp?
\>/= 7
58
What is treatment for frostbite?
Local, intr-arterial CDT, close observation, limb rewarming, wound care
59
What are the segments of the vertebral artery?
V1 readily accessible V2 within bony foramen of cervical canal V3 exit foramen and enter skull V4 intracranial
60
What is the grading scale for blunt cerebrovascular injury?
grade I, luminal irreg or disection 25% of lumen Grade III PSA Grade IV occlusion Grade V transection
61
Who should be screened for BCVI?
GCS

Vascular Surgery (37 decks)

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