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Vascular trauma

Introduction Fewer than 10% of patients with polytrauma have associated vascular injuries, but these injuries can cause significant morbidity and mortality. In most European countries, the majority of vascular trauma is caused by blunt (traffic accidents) and iatrogenic injuries. In South Africa, injuries are mostly penetrating and have also changed from predominantly stab wounds to injuries caused by firearms. A clear understanding of the pathophysiology of…

Management of acute lower limb ischaemia

Introduction The revised (2007) TASC Inter-Society Consensus defines acute leg ischaemia as any sudden decrease in limb perfusion causing a potential threat to limb viability. Symptoms of acute limb ischaemia (ALI) are usually present for less than 2 weeks. However, some overlap with chronic limb-threatening ischaemia (CLTI) is inevitable and increasingly common. The severity of ischaemia is best defined according to the modified Rutherford criteria (…

Revision vascular surgery

Introduction Revision of vascular reconstructions and interventions is frequently required beyond the first 6 weeks because of progressive atherosclerosis, graft occlusion , aneurysm formation or infection . Up to 40% of femorodistal bypass surgery grafts require re-intervention within 5 years. The same is true for endovascular intervention where it has been shown that up to 30% of the patients need a re-intervention within 5 years after…

Amputation, rehabilitation and prosthetic developments

Introduction Amputation is defined as the partial or complete removal of a limb or extremity arising from surgery, underlying disease or trauma. Minor amputations are those performed in the foot and major amputations are those above the level of the ankle. Over 90% of major leg amputations carried out in England are attributed to peripheral arterial disease (PAD) with similar rates in the United States. Therefore…

The diabetic foot

Introduction Foot problems are one of the most common complications of diabetes, with 15% of patients developing a foot ulcer in their lifetime. They account for more hospital admissions than other complications of diabetes and are associated with high mortality, worse than many common forms of cancer. The term diabetic foot disease actually encompasses a number of different conditions, including peripheral sensory neuropathy and/or neuropathic pain,…

Intervention for chronic lower limb ischaemia

Introduction Peripheral artery disease (PAD) is a process characterised by the formation of atheromatous plaque and calcification within the arteries of the lower extremity. Typically, this leads to luminal stenosis or occlusions of both large and small arteries. Patients who suffer from the condition may either be asymptomatic or complain of a broad variety of clinical symptoms ranging from calf claudication to ischaemic tissue loss. Interventional…

Medical treatment of chronic lower limb ischaemia

Introduction The number of patients with peripheral artery disease (PAD) is continuously increasing in the setting of an aging population and increasing global disease burden of diabetes. A recent meta-analysis of 34 studies estimated that over 202 million people worldwide suffer from PAD. In the Edinburgh Artery Study of men and women aged 55–74 years, 4.5% had symptomatic PAD. However, a further 8% had evidence of…

Assessment of chronic lower limb ischaemia

Introduction Chronic lower limb ischaemia often referred to as peripheral arterial disease (PAD) is characterised by impaired circulation in the lower limb extremities. The worldwide prevalence of PAD is over 200 million and this disease burden is expected to increase with the aging global demographics and rise in diabetes. The early assessment and recognition of PAD is crucial as these patients are at 2–4 times the…

Epidemiological risk factors and risk stratification for peripheral arterial disease

Introduction Atherosclerotic peripheral artery disease (PAD) involving one or more major vessels of the lower limb is common. The global spread of abdominal adiposity, its associated metabolic disorders and smoking has led to a significant increase in PAD, particularly in lower- and middle-income countries (LMIC). Current estimates suggest that over 200 million people globally are affected by PAD, with a marked increase in those affected over…

Medications in Emergency Trauma Management

Algorithm: Selection of vasopressors in the management of shock Open full size image Must-Know Essentials: Vasopressor Agents Selection of Vasopressors in Shock ■ Septic/vasodilatory shock ■ First choice ■ Norepinephrine ■ Additional choices ■ Epinephrine may be added to or replaced the Norepinephrine. ■ Vasopressin ■ Low-dose vasopressin may be added to decrease requirements for other adrenergic agents. ■ It is not recommended as a single…

Commonly Used Scoring and Grading Systems in Trauma

Must-Know Essentials: Injury Severity Scores for Trauma Assessment Abbreviated Injury Scale (AIS) ■ An anatomical scoring system ■ Each injury is ranked on a scale of 1 to 6 based on the severity of the injury. AIS Score Injury severity 1 Minor 2 Moderate 3 Serious 4 Severe 5 Critical 6 Unsurvivable Injury Severity Score (ISS) ■ An anatomical scoring system ■ Provides an overall score…

Evaluation and Management of Trauma in Pregnancy

Algorithm: Evaluation of pregnant trauma patients Open full size image Must-Know Essentials: Evaluation of Pregnant Trauma Patients Trauma Basics ■ Trauma involves approximately 6%–7% of all pregnancies. ■ Trauma results in maternal and fetal injuries. ■ Causes ■ Motor vehicle collision (MVC) ■ Most common cause in the United States ■ Unrestrained drivers have a higher risk of fetal and maternal injuries. ■ Use of seat…

Evaluation and Management of Pediatric Trauma

Algorithm: Pediatric trauma initial evaluation & resuscitation Open full size image Must-Know Essentials: Pediatric Trauma Evaluation and Management Anatomical and Physiological Factors in Pediatric Trauma ■ Trauma is the leading cause of death among children >1 years of age. ■ Small body size ■ Multiple injuries can result from a single impact due to the proximity of multiple organs and the wide transmission of energy. ■…

Evaluation and Management of Extremity Fracture Emergencies

Algorithm: Evaluation and management of extremity fracture emergencies Open full size image Must-Know Essentials: Emergencies in Extremity Injuries Potentially Life-threatening Injuries ■ Major arterial hemorrhage ■ Crush injury (rhabdomyolysis) ■ Fat embolism Potentially Limb-threatening Injuries ■ Open-fracture and joint injury ■ Vascular injury ■ Traumatic amputation ■ Compartment syndrome ■ Neurologic injuries Must-Know Essentials: Extremity Vascular Injuries Fractures with High Incidence of Vascular Injuries ■ Distal…

Evaluation and Management of Pelvic Fracture Emergencies

Algorithm: Evaluation and management of pelvic fractures Open full size image Must-Know Essentials: Classification of Pelvic Fractures Isolated Fractures with Intact Ring ■ Avulsion fractures ■ Caused by violent contraction of muscles ■ Types of fractures and specific muscles involved ■ Anterior superior iliac spine: Sartorius muscle ■ Anterior inferior iliac spine: Rectus femoris ■ Pubis: Adductor longus ■ Part of the ischium: hamstrings (Biceps femoris,…

Evaluation and Management of Vascular Injuries (Upper and Lower Extremities)

Algorithm: Evaluation of vascular injury (upper & lower extremities) Open full size image Must-Know Essentials: Vascular Anatomy of the Upper Extremities Axillary Artery ■ A continuation of the subclavian artery ■ Extends from the lateral margin of the first rib to the lateral margin of the teres major muscle ■ Externally origin of the axillary artery corresponds with mid clavicle, courses deep in the deltopectoral groove,…

Evaluation and Management of Retroperitoneal Vascular Injuries

Algorithm: Evaluation and management of retroperitoneal vascular injuries Open full size image Must-Know Essentials: Anatomy of Retroperitoneal Vessels Abdominal Aorta ■ The abdominal aorta originates at the T12-L1 vertebra level as a continuation of the thoracic aorta. ■ It enters the abdomen through the aortic hiatus between the two crura of the diaphragm. ■ It bifurcates into the left and right common iliac arteries at the…

Evaluation and Management of Urological Injuries

Algorithm: Management of renal trauma Open full size image Must-Know Essentials: Management of Renal Trauma Anatomy of the Kidneys ■ Location ■ Paired retroperitoneal structures at the level of T12-L3 vertebra ■ Right kidney slightly inferior to the left due to liver ■ Covered with superficial to the deep with: ■ pararenal fat. ■ renal fascia (Gerota’s fascia or perirenal fascia): It encloses the kidneys and…