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Emergency Vascular Surgery A Practical Guide - part 3

Chấn thương đặc điểm vết thương đâm gãy xương đơn giản đóng cửa, các vết thương đạn bắn cỡ nòng nhỏ Mở gãy xương, gãy xương nhiều, những chỗ hỏng, vết thương lòng nhỏ nổ Shotgun, vết thương đạn bắn tốc độ cao Logging, tai nạn đường sắt BP ổn định ở trang web và tại bệnh viện BP | 36 Chapter 3 Vascular Injuries in the Arm Table 3.4. MESS Mangled Extremity Severity Score BP blood pressure Types Injury characteristics Points Low energy Stab wounds simple closed fractures small-caliber gunshot wounds 1 Medium energy Open fractures multiple fractures dislocations small crush injuries 2 High energy Shotgun blasts high-velocity gunshot wounds 3 Massive crush Logging railroad accidents 4 No shock BP normal BP stable at the site and at the hospital 1 Transient hypotension BP unstable at the site but normalizes after fluid substitution 2 Prolonged hypotension BP 90 mmHg 3 No distal ischemia Distal pulses no signs of ischemia 1 Mild ischemia Absent or diminished pulses no signs of ischemia 2a Moderate ischemia No signals by continuous-wave Doppler signs of distal ischemia 3a Severe ischemia No pulse cool paralyzed limb no capillary refill 4a 30 years old patient 1 30 years old patient 2 50 years old patient 3 a Points are doubled if ischemia lasts longer than 6 h. 3.5.2 Operation 3.5.2.1 Preoperative Preparation Hemodynamically stable patients are placed on their back with the arm abducted 90 on an arm surgery table. The forearm and hand should be in supination. Peripheral or central IV lines should not be inserted on the injured side. Any continuing bleeding is controlled manually directly over the wound. If the site of injury is the brachial artery or distal to it a tourniquet can be used to achieve proximal control. It is then placed before draping and should be padded to avoid direct skin contact with the cuff. This minimizes the risk for skin problems during inflation. The arm is washed so the skin over the appropriate artery can be incised without difficulty. The draping should allow palpation of the radial pulse and inspection of finger pulp perfusion. One leg is also prepared in case vein harvest is needed. The position of the arm is the same for more proximal injuries. Proximal control of high brachial and axillary artery trauma may involve .