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  • Vascular Trauma: Dr. Stefanus Nangoi, M.Biomed, SPB

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    Vascular trauma can be caused by blunt trauma, penetrating trauma, or iatrogenically. Diagnosis involves looking for hard signs like external bleeding or expanding hematomas, and soft signs like history of bleeding or distal ischemia. Treatment depends on the vessel involved - arterial bleeding requires prompt surgery, while venous bleeding can often be managed conservatively. For iatrogenic injuries, complications like pseudoaneurysms may require surgery or ultrasound-guided treatments. The principles of management involve controlling hemorrhage, assessing for distal ischemia, and promptly operating on injuries with hard signs. Certain arteries can be ligated in an emergency but others carry high risks of limb loss.

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    Materi

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    Vascular Trauma Stn Koe

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    Vascular trauma can be caused by blunt trauma, penetrating trauma, or iatrogenically. Diagnosis involves looking for hard signs like external bleeding or expanding hematomas, and soft signs like history of bleeding or distal ischemia. Treatment depends on the vessel involved - arterial bleeding requires prompt surgery, while venous bleeding can often be managed conservatively. For iatrogenic injuries, complications like pseudoaneurysms may require surgery or ultrasound-guided treatments. The principles of management involve controlling hemorrhage, assessing for distal ischemia, and promptly operating on injuries with hard signs. Certain arteries can be ligated in an emergency but others carry high risks of limb loss.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    29 views26 pages

    Vascular Trauma: Dr. Stefanus Nangoi, M.Biomed, SPB

    Uploaded by

    Nindy
    Vascular trauma can be caused by blunt trauma, penetrating trauma, or iatrogenically. Diagnosis involves looking for hard signs like external bleeding or expanding hematomas, and soft signs like history of bleeding or distal ischemia. Treatment depends on the vessel involved - arterial bleeding requires prompt surgery, while venous bleeding can often be managed conservatively. For iatrogenic injuries, complications like pseudoaneurysms may require surgery or ultrasound-guided treatments. The principles of management involve controlling hemorrhage, assessing for distal ischemia, and promptly operating on injuries with hard signs. Certain arteries can be ligated in an emergency but others carry high risks of limb loss.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
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    of 26

    Vascular Trauma

    dr. Stefanus Nangoi, M.Biomed, SpB


    Back ground
    • Penyebab bisa trauma tumpul, trauma tusuk atau
    iatrogenic
    • Diagnosis dengan melihat hard sign dan soft sign
    • Penunjang dgn Doppler US, angiografi
    • Golden Period 6-8 jam
    Hard sign Soft sign
    • External pulsatile • History of arterial bleeding at the scene
    (no ongoing bleeding)
    bleeding
    • Small, non expanding, non pulsatile
    • Large, expanding, haematoma
    pulsatile haematoma • Shock with no other injury (suggesting
    • Palpable thrill or audible large volume blood loss)
    bruit • Weak pulse
    • Injury to anatomically related nerve
    • Absent distal pulse
    • Proximity of wound to vessel
    • Signs of distal ischaemia • Ankle brachial pressure index <0.9 or
    (pain, pallor, paralysis, arterial pressure index <0.9
    paraesthesia, perishingly • Dampened flow on Doppler
    cold) examination
    Prinsip Dasar
    • Selalu perhatikan ABC
    • IV line besar
    • Kompresi external untuk kontrol bleeding
    • Cari hard sign dari perdarahan arteri
    • Arterial • Perdarahan pulsatile
    - Pulse examination • Nadi distal absent.
    - Hard signs • Hematoma melebar
    • Distal ischemia
    • Thrill atau bruit
    • Venous
    - Perdarahan tekana rendah warna gelap
    - Hematoma tidak melebar
    - Shock jarang terjadi kecuali berkaitan dgn
    perdarahan arteria
    • Semua pasien dengan gejala ini segera ditangani
    secara pembedahan
    - Perdarahan external
    - Hematoma melebar disertai shock
    - Limb ischemia
    Iatrogenic

    • Venous : hematom pemasangan akses vena sentral


    Guide wire dislodgment

     Arterial : catheterization
    - Psudoaneurysm
    - Arterial dissection & Thrombosis
    - AV Fistula formation
    - Distal Embolization
    Psudoaneurysm
    • Conservative
    • U/S guided compression
    • U/S guided thrombin injection
    • Surgery
    Psudoaneurysm
    • Indications for surgical intervention:
    1) Evidence of ongoing bleeding
    2) Associated limb ischemia
    3) Nerve compression
    4) Need for aggressive anticoagulation
    5) Threatened skin viability
    6) Psudoaneurysm surrounded by large hematoma
    7) Expanding
    Community based trauma

    • Trauma tusuk : Penyebab tersering

    • Traum tumpul: berhubungan dengan cedera tulang


    Extremity vascular injury

    • 10% following penetrating ext. injury

    • 1% following blunt ext. injury ( 25-75% of Popliteal


    are due to blunt trauma)
    Vein patch angioplasty
    Tension-free primary repair
    Interposition autogenous vein
    graft
    Damage control
    • Arteries that can be ligated with few
    consequences:
    - The common and external carotid, subclavian,
    axillary , internal iliac arteries & Celiac axis.
    - ICA ligation : 10-20% stroke rate.
    - EIA,CFA & SFA: high risk of limb ischemia.
    - SMA & IMA : gut necrosis
    Damage control

    • Almost all veins including the IVC can be ligated


    when necessary
    Blunt Thoracic Aortic Trauma
    • Deceleration injury.
    • Multiple trauma victims
    • It is lethal if not recognize and treated promptly
    • Usually distal to left subclavian artery.
    Neck Trauma
    • Most commonly penetrating type.
    • Associated vascular injury in > 30%
    Thank You

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