Penetrating Thoracic Vascular Trauma


Background
  1. Most injuries are from penetrating trauma
  2. Blunt traumatic injuries are rare.
  3. Structures that may be involved.

Pathophysiology

  1. Direct injury to the vessel
  2. Bleeding occurs into
  3. Arterial injuries generally bleed more rapidly

Diagnostics

  1. History / exam
  2. Diagnostic tests

Differential Diagnosis

  1. Cardiac tamponade
  2. Tension pneumothorax
  3. Traumatic aortic rupture
  4. Penetrating cardiac injury
  5. Massive hemothorax

Treatment
Note: these injuries are very difficult to treat; management by ED physicians alone without trauma and/or CV surgery presence is NOT encouraged

  1. Initially as per ATLS primary / secondary surveys
  2. Unstable patients
  3. More stable patients
  4. Definitive treatment
  5. Tetanus prophylaxis