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Old 12-10-2012
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Default Traumatic transection of aorta, next best step?

would be really grateful if someone could help me out with the following scenarios:

A middle age man sustained high speed motor vehicle accident, brought to ER, hemodynamically stable, CXR reveals mediastinum widening, next best step?
(in my opinion spiral CT is the next best step)


A middle age man sustained high speed motor vehicle accident, brought to ER, hypotensive and tachycardiac, CXR reveals mediastinum widening, next best step?
(in my opinion patient should be taken to OR for repair)


which investigation should be ordered if there is a high suspicion of aortic transection but the CXR is normal?


Lastly, when is trans-oesophageal echo done in cases of traumatic aortic transection?
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Old 12-10-2012
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Quote:
Originally Posted by nudrat View Post
would be really grateful if someone could help me out with the following scenarios:

A middle age man sustained high speed motor vehicle accident, brought to ER, hemodynamically stable, CXR reveals mediastinum widening, next best step?
(in my opinion spiral CT is the next best step)


A middle age man sustained high speed motor vehicle accident, brought to ER, hypotensive and tachycardiac, CXR reveals mediastinum widening, next best step?
(in my opinion patient should be taken to OR for repair)


which investigation should be ordered if there is a high suspicion of aortic transection but the CXR is normal?


Lastly, when is trans-oesophageal echo done in cases of traumatic aortic transection?
Sound about right but depends on associated injuries and their severity.

Quote:
Patients with aortic injury fall into two main groups. Those who have a full-thickness tear and are haemodynamically unstable from this, and those with a contained injury. Patients with a contained aortic injury may be haemodynamically unstable from haemorrhage from another organ, such as a liver or spleen injury. Haemorrhage control remains a primary priority in these patients.
If the aorta is injured, but is not the source of active haemorrhage, it should be low on the list of management priorities, after haemorrhage control and neurologic stabilization.
Most aortic injuries will need to be repaired. Some minor injuries, such as small intimal flaps or small pseudoaneurysms, have been managed entirely non-operatively. However, the natural history of these remains relatively unknown, and there are reports of delayed rupture or fistula formation many years after injury.
Quote:
Clinical signs of traumatic aortic injury are rarely present, and diagnosis is based on a high index of suspicion based on mechanism of injury, and the results of imaging studies. However, a chest tube placed for haemothorax that drains a large initial rush of bright red arterial blood, or has significant on-going losses (>200mls) has a major intra-thoracic injury and should be transferred to the operating room for thoracotomy.
Quote:
The main advantage of TEE is its portability and repeatability at the bedside in patients with multiple traumatic injuries consistent with management strategies
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Future Radiolog (12-11-2012), nudrat (12-10-2012)



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