Acute aortic syndrome: traumatic aortic injury

ESC CardioMed ◽  
2018 ◽  
pp. 2605-2606
Author(s):  
Johnny Steuer ◽  
Mario Lachat
Keyword(s):  
Life Support ◽  
Motor Vehicle ◽  
Expectant Management ◽  
Aortic Injury ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Extent Of Damage ◽  
Intimal Tear

Blunt traumatic thoracic aortic injury (BAI) is a life-threatening emergency, the second most common cause of death in trauma patients, outnumbered only by intracranial haemorrhage. BAI is most frequently related to sudden deceleration in motor vehicle accidents, and the injury most commonly occurs at points of fixation in the descending aorta. In clinical series, it is predominantly in the region of the aortic isthmus. As victims of high-impact collisions often have multiple injuries, they are initially managed according to the Advanced Trauma Life Support® (ATLS®) concept. With improved pre- and in-hospital resuscitation, expeditious computed tomography angiography on arrival to the hospital, and increased awareness of the condition, patients who survive the initial impact are more likely to undergo successful treatment. All traumatic aortic injuries are not equally severe, as the extent of damage to the aortic wall may vary from an intimal tear to complete transection and rupture. Serial imaging and expectant management is advocated in patients with only an intimal tear but no external contour abnormality, whereas repair is recommended in most other cases. In recent years, thoracic endovascular aortic repair has emerged as the preferable treatment of patients with BAI, regardless of age. The initial outcome is highly dependent on the severity of other injuries, and most deaths are unrelated to the aortic injury per se, once the stent graft is in place. Long-term survival in patients discharged from the primary hospital admission is excellent. Early reintervention is fairly common, whereas late reinterventions are very uncommon.

Trauma

2018 ◽  
Author(s):  
David A. Young
Keyword(s):  
Cause Of Death ◽  
Life Support ◽  
Motor Vehicle ◽  
The United States ◽  
Motor Vehicle Accidents ◽  
Advanced Trauma Life Support ◽  
Traumatic Injuries ◽  
Vehicle Accidents ◽  
One Year ◽  
Uncontrolled Bleeding

Traumatic injuries are the most common cause of death within the United States for children above one year of age Most traumatic injuries in children are a result of motor vehicle accidents, child abuse (or nonaccidental trauma), drowning, thermal injury, or falls. Motor vehicle accidents are the leading cause of death for children above the age of one year. Strategies of Advanced Trauma Life Support (ATLS) utilize a standardized approach to promptly identify and manage life-threatening traumatic injuries. These strategies include recognition of cardiopulmonary disorders, volume resuscitation, and prevention of additional injuries including to the cervical spine. A management plan for severe and uncontrolled bleeding is critically important to have established when caring for children with traumatic injuries. Many strategies have been developed to manage severe and uncontrolled bleeding including the use of massive transfusion protocols, damage control surgery, and hemostatic agents.

scholarly journals Shock Index as a Predictor for Angiographic Hemostasis in Life-Threatening Traumatic Oronasal Bleeding

2021 ◽  
Vol 18 (21) ◽  
pp. 11051
Author(s):  
Fang-Yu Hsu ◽  
Shih-Hsuan Mao ◽  
Andy Deng-Chi Chuang ◽  
Yon-Cheong Wong ◽  
Chih-Hao Chen
Keyword(s):  
Motor Vehicle ◽  
Early Recognition ◽  
Arterial Embolization ◽  
Maxillary Artery ◽  
Trauma Patients ◽  
Shock Index ◽  
Packed Red Blood Cells ◽  
Vehicle Accidents ◽  
Life Threatening ◽  
Craniofacial Trauma

The objective of this retrospective study was to identify predictors of angiographic hemostasis among patients with life-threatening traumatic oronasal bleeding (ONB) and determine the threshold for timely referral or intervention. The diagnosis of traumatic, life-threatening ONB was made if the patient suffered from craniofacial trauma presenting at triage with unstable hemodynamics or required a definitive airway due to ONB, without other major bleeding identified. There were 4404 craniofacial trauma patients between January 2015 and December 2019, of which 72 (1.6%) fulfilled the diagnosis of traumatic life-threatening ONB. Of these patients, 39 (54.2%) received trans-arterial embolization (TAE), 11 (15.3%) were treated with other methods, and 22 (30.5%) were excluded. Motor vehicle accidents were the most common cause of life-threatening ONB (52%), and the internal maxillary artery was the most commonly identified hemorrhaging artery requiring embolization (84%). Shock index (SI) was significantly higher in the angiographic hemostasis group (p < 0.001). The AUC-ROC was 0.87 (95% CI, 0.88–1.00) for SI to predict angiographic hemostasis. Early recognition and timely intervention are crucial in post-traumatic, life-threatening ONB management. Patients initially presenting with SI > 0.95 were more likely to receive TAE, with the TAE group having statistically higher SI than the non-TAE group whilst receiving significantly more packed red blood cells. Hence, for patients presenting with life-threatening traumatic ONB and a SI > 0.95, TAE should be considered if preliminary attempts at hemostasis have failed.

Blunt abdominal aortic injury – A hybrid approach to combined injuries

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Ohad Guetta ◽  
Gad Shaked ◽  
George Greenberg ◽  
Gilbert Sebbag ◽  
David Czeiger
Keyword(s):  
Motor Vehicle ◽  
Seat Belt ◽  
Hybrid Approach ◽  
Aortic Injury ◽  
Stent Deployment ◽  
Early Management ◽  
Vehicle Accidents ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
Seat Belt Injury

Blunt abdominal aortic injury (BAAI) is a relatively rare pathology, usually the result of a seat belt injury in motor vehicle accidents (MVA), mostly combined with other injuries. Time is a crucial factor for the successful early management of these cases. Hybrid operating theaters, which support the integration of surgical treatment and interventional radiology, provide opportunities to reduce the time-to-surgery for life threatening conditions. We report a case of a 24-year-old female who was involved in a high-kinematics MVA. On presentation she was hemodynamically stable but had a prominent seat belt sign and peritoneal signs. A computerized tomography (CT) scan revealed an intimal flap of the infra-renal aorta and a peri-aortic hematoma together with a suspected laceration of the small bowel. The patient was operated in a hybrid approach; emergent endovascular repair of the aortic injury with stent deployment immediately followed by an explorative laparotomy for the intestinal injury. Her postoperative course was uneventful. The hybrid staged approach allowed a clean and efficient repair of a potentially lethal aortic injury and addressing a contaminated injury in the same compartment, hence preventing redundant morbidity. With the advances and growing availability of endovascular techniques, the hybrid approach has to be an important component of trauma management in the modern era.

scholarly journals Motor Vehicle Accident during Pregnancy with Two Lifes at Risk: A Case Report

2021 ◽  
Vol 11 (7) ◽  
Author(s):  
Jason-Alexander Hörauf ◽  
André El Saman ◽  
Christoph Nau ◽  
Gernot Enterlein ◽  
Ingo Marzi Marzi ◽  
...  
Keyword(s):  
Case Report ◽  
Life Support ◽  
Motor Vehicle ◽  
Seat Belt ◽  
The Body ◽  
Advanced Trauma Life Support ◽  
Stressful Situation ◽  
Unborn Child ◽  
Life Threatening ◽  
In Pregnancy

Introduction: Major trauma is the leading non-pregnancy-related cause of maternal and fetal deaths. In particular, traffic accidents account for the majority of accident causes and present the highest mortality for the mother and fetus. Seat belt use has reduced mortality rates for both the mother and the unborn child, however, certain potential patterns of injury occur due to the restraining mechanical forces of the worn seat belts on the body. Since life-threatening injuries in pregnancy are nevertheless rare, trauma care of pregnant women continues to be an exceptional situation and a particularly stressful situation for the attending physicians, including the fact that two lives are potentially at stake. Case Report: In this article, we report on a patient in the 37th week of pregnancy who was involved in a high-speed trauma as a front passenger of a car. Initially awake as well as responsive and hemodynamically stable, the patient’s condition deteriorated on the way to the emergency room (ER). On arrival in the ER, according to the Advanced Trauma Life Support concept, interdisciplinary consensus had to be reached between the departments involved regarding further diagnostic and therapeutic procedures. With the knowledge of the special anatomical and physiological changes in the context of pregnancy, both the mother and the child could be stabilized in order to subsequently gain further important information about the present injury pattern during the performed diagnostics and finally to be able to adequately treat the trauma sequelae. Conclusion: Because the care of traumatic life-threatening injuries in pregnancy is rare overall, it poses a special challenge for the attending trauma team in the ER. In order to avert the fatal fate of both the mother and the unborn child, a structured, symptom and patient-oriented interdisciplinary approach is indispensable, especially in these exceptional situations, in order to achieve the best possible outcome for those aff

scholarly journals Blunt traumatic aortic injury: CT angiography images and short review of current literature

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Sok-Sithikun Bun ◽  
Duygu Ozgul ◽  
Yasin Guzel ◽  
Erol Aksungur
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Short Review ◽  
High Energy ◽  
Aortic Injury ◽  
Vehicle Accidents ◽  
Vehicle Accident ◽  
Threatening Condition ◽  
Life Threatening ◽  
Blunt Traumatic Aortic Injury

Blunt traumatic aortic injury in high-energy motor vehicle accidents is a rare but life-threatening condition. Proper treatment after prompt and accurate diagnosis is critical to reduce the death rate. The purpose of this article was to highlight the points to be considered in blunt traumatic aortic injury due to high-energy motor vehicle accident.

Case Report: FAST Ultrasound Interpretation in Trauma Resuscitation

POCUS Journal ◽  
2016 ◽  
Vol 1 (3) ◽  
pp. 13-14
Author(s):  
Stuart Douglas, PGY4 ◽  
Joseph Newbigging, MD ◽  
David Robertson, MD
Keyword(s):  
Case Report ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Life Support ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Ultrasound Probe ◽  
Trauma Resuscitation ◽  
Highly Sensitive ◽  
Pouch Of Douglas

FAST Background: Focused Assessment with Sonography for Trauma (FAST) is an integral adjunct to primary survey in trauma patients (1-4) and is incorporated into Advanced Trauma Life Support (ATLS) algorithms (4). A collection of four discrete ultrasound probe examinations (pericardial sac, hepatorenal fossa (Morison’s pouch), splenorenal fossa, and pelvis/pouch of Douglas), it has been shown to be highly sensitive for detection of as little as 100cm3 of intraabdominal fluid (4,5), with a sensitivity quoted between 60-98%, specificity of 84-98%, and negative predictive value of 97-99% (3).

scholarly journals TEVAR versus open repair of blunt traumatic descending aortic injury in polytraumatic patients involved in motor vehicle accidents

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Imthiaz Manoly ◽  
Mohamed El Tahan ◽  
Maymoona Al Shuaibi ◽  
Fatimah Adel ◽  
Mohammed Al Harbi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Hospital Stay ◽  
Open Repair ◽  
Motor Vehicle ◽  
Aortic Injury ◽  
Motor Vehicle Accidents ◽  
Time Interval ◽  
Vehicle Accidents ◽  
Severity Scores ◽  
The Mean

Abstract Background Thoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA). Results Between February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13). Conclusion The results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.

scholarly journals Risk and resilience factors of persons exposed to accidents

2016 ◽  
Vol 89 (2) ◽  
pp. 257-266
Author(s):  
Dana - Cristina Herta ◽  
Paula Brindas ◽  
Raluca Trifu ◽  
Doina Cozman
Keyword(s):  
Motor Vehicle ◽  
Motor Vehicle Accidents ◽  
Risk And Resilience ◽  
Reasons For Living ◽  
Vehicle Accidents ◽  
Physical Suffering ◽  
Accident Victim ◽  
Life Threatening ◽  
Resilience Factors ◽  
Reasons For Living Inventory

Background and aims. Resilience encompasses factors promoting effective functioning in the context of adversity. Data regarding resilience in the wake of accidental trauma is still scarce. The aim of the current study is to comparatively assess adaptive, life – promoting factors in persons exposed to motor vehicle accidents (MVA) vs. persons exposed to other types of accidents, and to identify psychological factors of resilience and vulnerability in this context of trauma exposure.Methods. We assessed 93 participants exposed to accidents out of 305 eligible patients from the Clinical Rehabilitation Hospital and Cluj County Emergency Hospital. The study used Reasons for Living Inventory (RFL) and Life Events Checklist. Scores were comparatively assessed for RFL items, RFL scale and subscales in participants exposed to motor vehicle accidents (MVA) vs. participants exposed to other life – threatening accidents.Results. Participants exposed to MVA and those exposed to other accidents had significantly different scores in 7 RFL items. Scores were high in 4 out of 6 RFL subscales for both samples and in most items comprising these subscales, while in the other 2 subscales and in some items comprising them scores were low.Conclusions. Low fear of death, physical suffering and social disapproval emerge as risk factors in persons exposed to life – threatening accidents. Love of life, courage in life and hope for the future are important resilience factors after exposure to various types of life – threatening accidents. Survival and active coping beliefs promote resilience especially after motor vehicle accidents. Coping with uncertainty are more likely to foster resilience after other types of life – threatening accidents. Attachment of the accident victim to family promotes resilience mostly after MVA, while perceived attachment of family members to the victim promotes resilience after other types of accidents.  

scholarly journals Impact of Implementation of Sequential Trauma Education Programs (STEPs) Course on Missed Injuries in Emergency Polytrauma Patients, Ismailia, Egypt

2021 ◽  
Author(s):  
Adel Hamed Elbaih ◽  
Maged El-Setouhy ◽  
Jon Mark Hirshon ◽  
Hazem Mohamed El-Hariri ◽  
Mohamed El-Shinawi
Keyword(s):  
Low Income ◽  
Life Support ◽  
University Hospital ◽  
Low Income Countries ◽  
Advanced Trauma Life Support ◽  
Trauma Patients ◽  
Education Programs ◽  
Missed Injuries ◽  
Polytrauma Patients ◽  
Trauma Education

Abstract IntroductionTrauma deaths account for 8% of all deaths in Egypt. Patients with multiple injuries are at high risk but may be saved with a good triage system and a well-trained trauma team in dedicated institutions. The incidence of missed injuries in the Emergency Department (ED) of Suez Canal University Hospital (SCUH) was found to be 9.0% after applying Advanced Trauma Life Support (ATLS) guidelines. However, this rate is still high compared with many trauma centers.AimImprove the quality of management of polytrauma patients by decreasing the incidence of missed injuries by implementing the Sequential Trauma Education Programs (STEPs) course in the ED at SCUH.MethodsThis interventional training study was conducted in the SCUH ED that adheres to CONSORT guidelines. The study was conducted during the 1-month precourse and for 6 months after the implementation of the STEPs course for ED physicians. Overall, 458 polytrauma patients were randomly selected, of which 45 were found to have missed injuries after applying the inclusion and exclusion criteria. We assessed the clinical relevance of these cases for missed injuries before and after the STEPs course.ResultsOverall, 45 patients were found to have missed injuries, of which 15 (12%) were pre-STEPs and 30 (9%) were post-STEPs course. The STEPs course significantly increased adherence to vital data recording, but the reduction of missed injuries (3.0%) was not statistically significant in relation to demographic and trauma findings. However, the decrease in missed injuries in the post-STEPs course group was an essential clinically significant finding.ConclusionSTEPs course implementation decreased the incidence of missed injuries in polytrauma patients. Thus, the STEPs course can be considered at the same level of other advanced trauma courses as a training skills program or possibly better in dealing with trauma patients. Repetition of this course by physicians should be mandatory to prevent more missed injuries. Therefore, the validation of STEPs course certification should be completed at least every 2 years to help decrease the number of missed injuries, especially in low-income countries and low-resource settings.Trial RegistrationProject manager for the Pan African Clinical Trial Registry (www.pactr.org) database has been accepted with the date of approval:18/11/2020. Current Controlled Trials number for the registry is PACTR202011853914203. Please note that the article state Retrospectively registered that my study adheres to CONSORT guidelines.

scholarly journals The Diagnostic Peritoneal Lavage: A Brief Review of the Current Literature and an Analysis of Its use and Teaching in Canada

2012 ◽  
Vol 1 (3) ◽  
pp. 150-153
Author(s):  
Colin A Clarkson ◽  
Darrell Boone
Keyword(s):  
Current Literature ◽  
General Surgery ◽  
Life Support ◽  
Peritoneal Lavage ◽  
Motor Vehicle ◽  
Penetrating Trauma ◽  
Advanced Trauma Life Support ◽  
Published Data ◽  
Grey Zone ◽  
Diagnostic Peritoneal Lavage

ABSTRACT Introduction The vast majority of the published data on the appropriate use of the diagnostic peritoneal lavage (DPL) is dated. Currently in Canada, there is a significant grey-zone surrounding the teaching and use of the DPL. The objectives of this article are to briefly review the recent literature, to analyze the patterns in the use of the DPL in Canada, and to determine whether general surgery residents are being taught the skill. Methods Literature review was conducted using PubMed and Ovid. The Canadian Institute for Health Information (CIHI) supplied the available data on DPL usage in Canada. General surgery program directors in Canada were contacted by e-mail to determine if the DPL was still being taught. Results Between the years of 2001 and 2006 in Canada, 38 DPLs were coded into the CIHI's database. Males accounted for 84.2% of the DPLs, and 23.7% of all DPLs resulted in a laparotomy. Motor vehicle crashes were the reason that 42% of the DPLs were performed. The majority of general surgery residency programs in Canada are not teaching the DPL outside of what is taught in the advanced trauma life support (ATLS) course. Discussion The literature reviewed shows that the DPL continues to play a role in the current management of patients suffering from both blunt and penetrating trauma, although a much more limited role than in the past. How to cite this article Boone D, Clarkson CA. The Diagnostic Peritoneal Lavage: A Brief Review of the Current Literature and an Analysis of Its use and Teaching in Canada. Panam J Trauma Critical Care Emerg Surg 2012;1(3):150-153.

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