Podcast
Questions and Answers
What is the primary goal of definitive treatment for arterial injury without division?
What is the primary goal of definitive treatment for arterial injury without division?
What complication can develop from intra-arterial drug injection?
What complication can develop from intra-arterial drug injection?
What is the initial treatment to prevent thrombosis following intra-arterial drug injection?
What is the initial treatment to prevent thrombosis following intra-arterial drug injection?
In the case of a complete arterial injury with division and a gap, what is the suitable graft type for a large artery?
In the case of a complete arterial injury with division and a gap, what is the suitable graft type for a large artery?
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What is a common presentation following intra-arterial drug injection?
What is a common presentation following intra-arterial drug injection?
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Which of the following treatments is used for arterial injury with a partial division showing a transverse tear of more than 1/2 circumference?
Which of the following treatments is used for arterial injury with a partial division showing a transverse tear of more than 1/2 circumference?
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What is a key component of acute compartment syndrome?
What is a key component of acute compartment syndrome?
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What is the recommended action for temporary control of bleeding?
What is the recommended action for temporary control of bleeding?
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What is a common cause of arterial injury?
What is a common cause of arterial injury?
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What type of arterial injury is characterized by the outer coat remaining intact?
What type of arterial injury is characterized by the outer coat remaining intact?
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Which mechanism of injury is NOT mentioned in relation to trauma to blood vessels?
Which mechanism of injury is NOT mentioned in relation to trauma to blood vessels?
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What clinical sign indicates a complete division of an artery?
What clinical sign indicates a complete division of an artery?
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Which investigation method is considered the most accurate for localizing traumatic A/V fistula?
Which investigation method is considered the most accurate for localizing traumatic A/V fistula?
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What does the primary survey in management focus on?
What does the primary survey in management focus on?
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What type of arterial injury can result in a pulsating hematoma?
What type of arterial injury can result in a pulsating hematoma?
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Which of the following is NOT a potential outcome of trauma to a blood vessel?
Which of the following is NOT a potential outcome of trauma to a blood vessel?
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Study Notes
Arterial Injuries
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Definition: Sudden interruption of arterial supply to an organ or limb due to injury.
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Incidence: Common due to car accidents, war injuries, falls, or iatrogenic causes (like invasive procedures).
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Etiology:
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Open Injury: Stab wounds, gunshot wounds, or iatrogenic injuries.
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Closed Injury:
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Direct: Plaster or tourniquet compression, road traffic accidents.
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Indirect: Fractures or dislocations of bones (e.g., supracondylar humerus fracture causing brachial artery injury, supracondylar femur fracture causing popliteal artery injury).
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Types of Arterial Injury (Without Division):
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Arterial Spasm: Due to irritation near the artery (e.g., missile, cannulation). Often associated with intimal flap, thrombosis, or occlusion.
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Arterial Contusion: Outer arterial coat remains intact but can be associated with an intimal tear and superimposed thrombosis.
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Types of Arterial Injury (With Division):
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Complete Division: Both ends bleed profusely initially, but bleeding reduces due to intimal curls and media contraction. Divided stumps retract. Pulse is lost distally.
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Partial Division: Bleeding continues (pulsating hematoma). The pulse is weak distally.
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Mechanism of Injury: Trauma may cause spasm, intimal flap, subintimal hematoma, thrombosis/occlusion, hemorrhage, laceration, transection, or arteriovenous fistula.
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Clinical Picture: Includes history of trauma, general exam (vital signs to assess blood loss), and local exam (hard signs vs soft signs).
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Hard Signs: 6 Ps (pain, pulse, pallor, paresthesia, paralysis, poikilothermia), pulsatile hemorrhage, pulsatile hematoma, palpable thrill, bruit, and absent distal pulse. Urgent exploration without investigations needed.
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Soft Signs: Hematoma (non-pulsating, non-expanding), nerve injury, wound near major vessel, and delayed capillary refill time. Urgent investigations (angiography, Doppler, X-ray).
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Investigations: Blood tests (CBC, RBS, KFT, cross-matching), plain X-ray to detect foreign bodies (bullets) or fractures, Doppler and duplex scans to detect collaterals, and angiography (most accurate) to pinpoint the site of traumatic arteriovenous fistulas (AV fistula).
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Management:
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First Aid: Temporary control of bleeding (external compression, elevation, tourniquet). Anti-shock measures, antibiotics, and analgesics. Heparin injection. Fix associated fractures (stabilize repair.
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Definitive Treatment: Immediate exploration and fasciotomy (to prevent compartment syndrome), then treatment based on the type of arterial injury.
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No Division:
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Spasm: Intra-arterial papaverine injection or Fogarty balloon catheter dilatation. If unsuccessful, arteriotomy to identify intimal tear, excise spastic segment, and graft.
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Contusion: Excise the contused segment and graft.
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With Division:
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No gap: Direct end-to-end anastomosis.
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Gap: Small artery: natural graft (saphenous vein). Large artery: synthetic graft (Dacron or PTFE), or bypass.
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Partial Division:
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Longitudinal tear: Small artery: vein patch graft. Large artery: direct suture.
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Transverse tear: <1/2 circumference: direct anastomosis. > 1/2 circumference: turning the tear to complete before treatment.
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Intra-arterial Drug Injection: Drug addicts or anesthetists may inject into arteries instead of veins, leading to burning discomfort, coolness, cyanosis, and potential digital gangrene.
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Treatment: Heparin, dexamethasone, low molecular weight dextran, strong analgesics, and amputation for severe gangrene.
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Etiology: Drug addiction or during anesthesia induction.
Acute Compartment Syndrome
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Definition: Increased pressure within a closed compartment compromises blood circulation and tissue function.
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Limb Compartment Syndrome: Acutely raised pressure in the osseo-facial compartment of a limb, commonly in legs or forearms, but can occur in thighs, buttocks, feet or arms.
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Anatomy: Number of compartments in each limb are noted (e.g., Thigh: 3 compartments; Leg, Foot, Arm, Forearm, Hand = 4 each;).
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Common Causes: Ischemia and reperfusion injury, combined arterial and venous injuries, bone fractures, tight bandages (cast), and circumferential burns.
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Management: Remove constrictive bandages or casts, avoid elevating the affected limb, hydrate the patient with diuretics, and perform fasciotomy (surgical incision to relieve pressure).
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Description
This quiz explores the definition, incidence, and various types of arterial injuries. It covers both open and closed injuries, including arterial spasm and contusion. Test your knowledge on the causes and consequences of these injuries in medical scenarios.
