Vascular Trauma Flashcards
(35 cards)
State some potential causes of peripheral vascular trauma
- Penetrating wounds
- Gunshot
- Stab
- IV drug abuse
- Blunt trauma
- Joint displacement
- Bone fracture
- Contusion (bruise)
- Invasive procedures
- Arteriography
- Cardiac catheterisation
- Balloon valvuloplasty
What do we mean by hard and soft signs of arterial injury?
- Hard signs= indicate presence of major vascular injury therefore immediate surgery is required
- Soft signs= indicate there might be a major vascular injury hence additional observation & diagnostic tests are required
State the 4 hard signs of arterial injury
- External arterial bleeding
- Rapidly expanding haematoma
- Palpable thrill, audible bruit
- Acute limb ischaemia (not corrected by reduction of dislocation or realignment of fracture)

State the 5 soft signs of arterial injury
- History of bleeding at the scene
- Proximity of penetrating wound or blunt trauma to major artery
- Diminished unilateral pulse
- Small non-pulsatile haematoma
- Neurogenic deficit

What investigations may be required for a pt with soft signs of arterial injury?
- Serial examination
- Duplex scan
- Arteriography (CT or MRI)
We have said that soft signs of arterial injury indicate there may be a major vascular trauma. Why are diagnostic studies done when a pt has soft signs of arterial injury?
- To prevent unnecessary operation
- Document presence of surgical lesion
- Localise vascular injury to plan operative approach
Certain limb fractures have a higher incidence of associated vascular injury; state 3
- Supracondylar #humerus in children
- High tibial ‘bumper fracture’
- Dislocation of knee
State some key principles of cannula insertion and fluid resuscitation in peripheral vascular trauma
- Gain adequete IV access (two large bore cannulas)
- Place lines into an uninjured upper or lower extremity
- Avoid placing cannulas into extremities as this will lead fluid directly to areas of tamponade or venous injury
- Preserve saphenous or cephalic veins (may be needed for repair)
Discuss the general principles of management of a peripheral vascular injury in the limb

Blunt injuries to major intrathoracic vascular structures present as a major challenge in both diagnosis and management. May require immediate management for tension pneumothorax and/or tamponade. If the pt is stable, what imaging would we do to help identify the arterial trauma?
CT scan
What is the most common intra-thoracic vascular injury?
Discuss its prognosis
- Disruption of the descending thoracic aorta at its isthmus- caused by rapid deceleration
- Prognosis:
- 90% die before reach hospital
- Of those reaching hospital 25% die within first 24hrs

State some causes of retroperitoneal bleeds
- Pelvic fractures
- Surgery in the pelvis
- Spontaneous (warfarin therapy)
- Following angiogram/angioplasty
State some signs & symptoms of peritoneal bleed
- Hypotension or drop in Hb
- Lower back pain
- May have iliac fossa mass/tenderness
- History of cause of peritoneal bleed e.g. had cardiac catheterisation
Discuss the management of retroperitoneal bleeds
- Fluid resuscitation
- Alert vascular surgeons
- Urgetn CT to confirm diagnosis
- Surgical repair or radiological intervention
Draw and label the different segments/sections of the aorta

Draw and label the aortic arch

What is an aortic dissection?
Tear in the tuica intima of aorta resutling in blood flowing between, and splitting apart, the tunica intima and tunica media

State some risk factors for aortic dissections- highlight the most important risk factor
- Hypertension
- Trauma
- Atherosclerotic disease
- Male
- Connective tissue disorders e.g. Marfan’s syndrome, Ehlers-Danlos syndrome
- Bicuspid aortic valve
- Pregnancy
- Syphilis
Who are aortic dissections more common in?
*Think about gender, age and underlyiing disorders
- Males
- 50-70yrs
- Connective tissue disorders e.g. Marfan’s, Ehlers-Danlos syndrome
Aortic dissections can be acute or chronic; explain the difference
- Acute= diagnosed =14 days
- Chronic= diagnosed >14 days
Discuss signs & symptoms of aortic dissection
Tearing chest pain that typically radiates to back
- Tachycardia
- Hypotension or hypertension (depending on if there is rupture)
- New aortic regurgitation murmur
- Pulse deficit (weak or absent carotid, brachial or femoral pulse)
- Variation(>20mmHg) in systolic BP between arms
- Limb ischaemia
- Hemiplegia is carotid artery supply affected
- Paraplegia if anterior spinal artery supply affected
- Anuria if renal artery supply affected
Aortic dissections can progress distally or proximally or in both directions; what do we call it if it progresses:
- Proximally
- Distally
- Proximally: retrograde (towards aortic valve)
- Distally: anterograde (towards iliac arteries)
Explain how retrograde aortic dissections can cause cardiac tamponade
- Retrograde propagation can result in prolapse of aortic valve
- Bleeding in the pericardium
- and hence cardac tamponade
State the two systems that can be used to classify aortic dissections
- Stanford
- DeBakey
Both classify anatomically



