Vascular Surgery – Vascular Injury: By Adam Power M.D. and Yiting Hao R.N. скачать в хорошем качестве

Vascular Surgery – Vascular Injury: By Adam Power M.D. and Yiting Hao R.N.

medskl.com is a global, free open access medical education (FOAMEd) project covering the fundamentals of clinical medicine with animations, lectures and concise summaries. medskl.com is working with over 170 award-winning medical school professors to provide content in 200+ clinical presentations for use in the classroom and for physician CME. Vascular Surgery – Vascular Injury Whiteboard Animation Transcript with Adam Power, MD and Yiting Hao RN https://medskl.com/module/index/vascu... Vascular injury, both as penetrating or blunt trauma, can be a life-threatening presentation to the emergency room and is often complicated by non-apparent hemorrhage, for instance into the retro-peritoneal space. Left untreated, vascular injuries can lead to hemorrhagic shock, thrombosis, and compartment syndrome. Blunt vascular injuries occur frequently during motor vehicle collisions, and commonly affect the thoracic and abdominal aorta. Blunt aortic injury is thought to occur following rapid deceleration and tearing of the aorta distal to the origin of the left subclavian artery. [Parmley, 1958] Penetrating trauma causes crushing and separation of tissues along the penetrating object and often affects the extremities. This type of injury is mostly associated with gunshot and knife wounds. On initial presentation be sure to follow the ATLS guidelines and complete a systematic primary assessment, using the ABDCDE approach. Treatment priority is based on injuries, vitals and injury mechanism. The primary goals of intervention are to locate the bleeding, stop it, and restore intravascular volume while maintaining homeostasis through a functional blood composition. Remember, the clinical features of a patient with blunt vascular trauma may range from asymptomatic to severe hypotension and shock. It is essential to keep in mind the sources of severe and life-threatening hemorrhage. ATLS guidelines suggest to look for “blood on the floor and then four more” (chest, abdomen, pelvis/retroperitoneum, and long bones). In the extremities, the most common presentation of arterial injury is acute ischemia. Hard signs of arterial injury are: an audible bruit or palpable thrill pulsatile hematoma expanding hematoma active bleeding signs of ischemia The classic 5 P’s of acute limb ischemia include: Pain Pallor Paralysis Paresthesia Pulselessness We then investigate more thoroughly with a secondary assessment, using FAST scans, as well as pelvic, chest and abdominal x-rays. Laboratory studies are essential for monitoring these patients: Blood group and crossmatch is sent quickly but patients often require O negative blood due to urgency. Complete blood count to monitor hemoglobin is useful in slow bleeding, and is typical obtained every 6 hours in series. It is of limited used in acute severe hemorrhage. Coagulation parameters must be assessed and any anti-coagulation medication the patient has been taking must be reversed. Coagulopathy may be observed in a trauma patient following acidosis, hypothermia, and hemodilution following aggressive intravascular resuscitation. Compartment syndrome is a serious complication associated with vascular injuries and needs to be monitored after limb ischemia and then reperfusion. It is the increase in intracompartmental pressure that impairs tissue perfusion and can lead to tissue death. Although this is a clinical diagnosis, creatinine kinase and myoglobin in addition to renal function, must also be monitored with increased. Tell-tale clinical signs include: Pain out of proportion to injury not relieved by analgesicsPain with contraction of compartment Pain with passive stretch Severe swelling Loss of arterial pulse is a late finding Therapy is often dependent on the hemodynamic status. While expectant management can be reserved for intimal tears and some small pseudoaneurysms, definitive therapy in the form of operative or endovascular repair is reserved for injuries penetrating the outer vessel wall or occluded arteries.