3. INTRODUCTION
• Major peripheral vessel injuries
may be life-threatening and pose a
threat to viability of the affected
limb.
• Could be penetrating or blunt
9. CLINICAL FEATURES
HARD SIGNS
Absent Distal pulses
Signs of distal ischemia
(5Ps)
Audible bruit
Palpable thrill at injury site
Active pulsating hemorrhage
Expanding hematoma
Pulsatile hematoma
SOFT SIGNS
Non-expanding, stable hematoma
Peripheral nerve deficit
History of significant hemorrhage at
scene
Diminished pulse or ABI of injured
extremity
Unexplained hypotension
Bony injury or proximate penetrating
wound
Hard: >90% risk of arterial injury; 92-
95% SN require intervention
SOFT: 30% risk of arterial injury; Minor non-occlusive
injuries, consider Conservative management
10. EVALUATION
• Ankle-Brachial Index (PPV-95%)
• Arterial Pressure Index (SN and SP>95%, high NPV and PPV)
• Doppler USS
• CT angiography
• X-ray
Lab tests
• ABO
• Cross-match
• Creatinine
11. MANAGEMENT
• Direct digital pressure
• Clamping of visible vessel
• Tourniquet
• Permissive hypotension
• Surgical repair of major vascular injury
• Vasodilators/ Nitroglycerine/ CCB/Warm saline for Arterial spasm
• Antibiotics- indications?
What is Warm ischemia?
Principles for
each??
- 80% of deaths were from penetrating injuries (mostly gunshots)
Ankle –Ankle Index
Warm ischemia is phenomenon where a limb with compromised blood flow is left at room temp with no specific measures to cool it.
Takes 6 hrs until complete muscle and nerve damage…10% will have permanent damage.
After 12 hrs- 90% will have permanent/ irreversible damage.
