Blunt aortic injury

Posted by e-Medical PPT Friday, July 15, 2011
Blunt aortic injury (BAI) is the second most common cause of death in blunt trauma patients.The majority of patients die at the scene with only 13-15% arriving at the hospital with signs of life.The remainder of patients will die within the first few days of hospitalization if the BAI is not promptly diagnosed and treated.The most common mechanism of BAI appears to be from a motor vehicle collision with frontal and lateral impacts occurring with approximately equal frequency. The presence or absence of restraints does not appear to affect the incidence of BAI. Other common mechanisms include pedestrian/vehicular incidents and falls.Most patients who sustain BAI die at the scene or during transport. Of the patients who arrive alive to the hospital, there are many varied signs and symptoms they may present with. The most commonly noted signs in these patients are pseudocoarctation and intrascapular murmur.Absence of any of these signs does not entirely rule out BAI, as it has been reported with a normal physical examination. Angiography has been used as the “gold standard” diagnostic test for BAI.It is the test to which all others are compared. There is a small incidence of false positive angiograms resulting from anatomic abnormalities such as ductus diverticulum that the physician should be aware of.
Once the diagnosis of BAI is made, most authors agree that prompt surgical repair is the best approach. Immediate repair may not be possible in all patients,however. These include patients who are unstable from intra-abdominal injuries who require laparotomy.Another subset of patients are those who are elderly or have
comorbidities which prohibit emergency thoracic surgery.These patients may be safely managed medically until these other factors have been resolved.Pharmacologic control of blood pressure with beta-blockers or nitroprusside is extremely important when delayed.Several different techniques of repairing the BAI have been reported. These include both direct suture repair and placement of a prosthetic graft.

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