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Vascular injuries
Citation preview
02/01/2014
Vascular InjuriesMohammad Shihata
Objectives
✤ Principles of trauma management
✤ Vascular zones of the body
✤ Mechanisms of vascular trauma
✤ Recognition of vascular injuries
✤ Management of Vascular injuries
My ATLS App for smart phones and tablets
A, B, C, D, E
Primary survey–A Airway maintenance with cervical spine protection–B Breathing and ventilation–C Circulation with hemorrhage control–D Disability : Neurological status–E Exposure/Environmental control : completelyundress the patient,but prevent hypothermia
Resuscitation
✤ Control Bleeding
✤ Protect and maintain airway
✤ Two large bore IVs for rapid infusion
Secondary survey
Secondary survey does not begin untilthe primary survey (ABCDEs) iscompleted, resuscitative efforts arewell established, and the patient isdemonstrating normalization of vitalfunctions.
Secondary Survey
– Total patient evaluation• history : AMPLE• physical examination– Complete neurologic examination– Head and skull– Maxillofacial– Neck– Chest– Abdomen– Perineum/rectum/vagina– Musculoskeletal– Tubes and fingers in every orifice
“He Who wants to be a surgeon, should go to war”
Hippocrates (460 - 377 BC)
Mechanisms of Vascular Injuries
✤ Penetrating Trauma
✤ Blunt Trauma
✤ Blast injuries
✤ Iatrogenic Injuries
Ask yourself
Is this blunt or penetrating injury ?Is this blunt or penetrating injury ?
Is this Arterial or Venous injury ?Is this Arterial or Venous injury ?
Should I take the patient to the operating room or do further Should I take the patient to the operating room or do further investigations?investigations?
Arterial injuries
✤ Low pressure
✤ Dark blood
✤ Non-expanding hematoma
Venous Injuries
Upper Extremity
Lower Extremity
Neck Vessels
Thoracic Aorta
Aortic Arch Tear
Aortic Arch Transection
✤ Common in deceleration ( blunt ) type injuries
✤ Most common site is the ligamentum attachment ( isthmus)
✤ Free rupture is incompatible with life
✤ Contained rupture is associated with increased risk of free rupture
✤ Usually associated with other life threatening injuries
Principles of Vascular Repairs
✤ Know your anatomy ( Course, Feeding vessel, Run-off)
✤ Adequate Exposure
✤ Proximal and distal control
✤ Tension free repair
✤ Adjuncts (intra op tPA, Imaging, .....)
✤ Assess the need for fasciotomy
Options for peripheral vascular repair
✤ Primary Repair
✤ Patch Angioplasty
✤ Endovascular treatment
No Transection
Complete Transection
✤ Primary end to end anastomosis
✤ Interposition graft
✤ Bypass
Patch angioplasty
End to End anastomosis
Complications of Vascular Injuries
✤ Life threatening bleeding
✤ End organ ischemia
✤ Associated injuries
✤ Sensory / Motor Loss
✤ AV fistula
✤ Pseudoaneurysm
Thank You