Vascular injury

Types

Transection

Thrombosis

Embolism

Reversible spasm

Lacerations

Intimal flaps

Pseudoaneurysm

A/V fistula

Compartment syndrome

6 hours (10% irreversible damage)

12 hours (90% irreversible damage)

1 Absent distal pulses

2 signs of distal ischemia

    Pain, pallor, paresthesia, paralysis, poikilothermia

3 palpable bruit or audible thrill at injury site

4 active pulsatile hem

5 large expanding hematoma

6 pulsatile hematoma

1 small nonexpanding hematoma

2 periferal nerve deficit

3 hx of pulsatile or significant hem at time of injury

4 unexplained hypotension

5 bony injury (fx, dislocation, penetration) or proximity penetrating wound

Doppler-determined arterial systolic pressure in injured limb divided by pressure in uninjured limb

<0.90 abnormal

allows for serial, objective monitoring

only detects obstructive lesions

unreliable in proximal injuries, popliteal injuries, shotgun wounds, multiple wounds, shock

false negative with deep femoral artery injury

S 95-100%; Sp 97-100%; Acc 98-100%

sens for vessel injury, thrombosis, pseudoaneurysm, intimal flap and A-V fistula

Immediate arterial exploration without further investigation

API --> if < 0.9 obs/admit for 24h, serial API, consider:

Doppler U/S

CTA

Eval of compartment syndrome

Birnbaumer, Donaldson

Authors: