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Emergency Vascular Surgery A Practical Guide - part 2

Mức độ nghiêm trọng điểm (BP huyết áp) Các loại năng lượng trung bình thấp năng lượng cao lòng năng lượng khổng lồ gây sốc (BP) thoáng bình thường hạ huyết áp hạ huyết áp kéo dài Không thiếu máu cục bộ xa nhẹ thiếu máu cục bộ vừa thiếu máu cục bộ thiếu máu cục bộ | Vascular Injuries to the Thoracic Outlet Area 2 CONTENTS 2.1 Summary. 15 2.2 Background. 15 2.2.1 Magnitude of the Problem.16 2.2.2 Etiology and Pathophysiology.16 2.2.2.1 Penetrating Trauma .16 2.2.2.2 Blunt Trauma .16 2.3 Clinical Presentation . 17 2.3.1 Medical History.17 2.3.2 Clinical Signs . 17 2.3.2.1 Physical Examination.18 2.4 Diagnostics .18 2.5 Management and Treatment .19 2.5.1 Management Before Treatment.19 2.5.1.1 Management in the Emergency Department.19 2.5.1.2 Patients in Extreme Shock.20 2.5.1.3 Unstable Pa tients .22 2.5.1.4 Control of Bleeding .22 2.5.1.5 Stable Pa tients .23 2.5.1.6 Nonsurgical Management .24 2.5.2 Operation .24 2.5.2.1 Preoperative Pr eparation and Proximal Control.24 2.5.2.2 Exposure and Repair .25 2.5.2.3 Endovascular Repair and Control .27 2.5.3 Management After Treatment .28 2.6 Results .29 Further Reading .29 2.1 Summary Always exclude injuries to the great thoracic aortic branches after injury to the cervical clavikular and thoracic regions One third of patients who survive thoracic vascular trauma has minor or lack external signs of thoracic injury. A plain chest X-ray shall be performed in all patients with thoracic injuries Moderate restoration of BP to 100- 120 mmHg is advisable to avoid rebleeding Be liberal with insertion of a chest tube in patients with moderate or severe hemothorax 2.2 Background This chapter is focused on injuries to the intratho-racic parts of the great aortic branches from their origin in the aortic arch to the thoracic outlet. It also includes the retroclavicular vessels - the distal subclavian and the proximal axillary arteries. These injuries are often difficult to diagnose and distinguish from aortic arch injuries i.e. injuries to the aorta the pulmonary vessels and the heart itself . Because cardiothoracic surgeons and not vascular surgeons usually manage the latter they will not be covered here. A vascular injury to this region of the body is less common but is associated with high .