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1、CHAPTER64VASCULARTRAUMAMichaelJ.SiseandStevenR.Shackfordprovidecollateralflow.Asaresult,ischemiaisworsenedorexag-generalapproachtovasculartraumagerated.Penetratinginjuryisgenerallyclassifiedaslowvelocityspecificinjuries(<2500ft/sec;e.g.,stabwound,fragmentinjury,handgunoperativete
2、chniquesforextremityfasciotomywound)orhighvelocity(>2500ft/sec;e.g.,militaryriflepostoperativemanagementwound).4High-velocityweaponsproducesignificantlymoreoutcomesandfollow-uptissuedamagethanlow-velocityweaponsforthreemain5,6reasons:•Energyimparted—energyequalsthemassoftheprojec
3、tileVasculartraumaremainsoneofthemostsignificantchallengesmultipliedbythevelocitysquared.inthemanagementofinjuredpatients.Theadventoftrauma•Tractcavitation—themissilecreatesarapidlyexpandingandsystemsandimprovedprehospitalcarehaveresultedinanrapidlycontractingcavitythatcanreachas
4、izeequalto30increasingnumberofpatientswithwhatwerepreviouslyfataltimesthediameteroftheprojectile,atrightanglestothevascularinjuriesarrivingattraumacentersstillalive,butinmissiletract,whichstretchesandtearstheadjacenttissue.1,2immediatedangerofdeath.Vasculartraumaisnotalways•Leads
5、platter—fragmentsofthedeterioratingprojectileobviousandtimelyrecognitionmaybedifficultinpatientswithbecomemissilesthemselves.3multipleinjuries.Thetimeurgencyandhigh-riskpotentialinTraumatoabloodvessel(arteryorvein)canproducemanagingtheseinjuriesrequiresanorganizedapproachtohemorr
6、hage,thrombosis,orspasm,aloneorincombination,deliverappropriatecareinatimelyfashion.Becausesomuchisdependingonthemagnitudeoftheforceappliedtothevesselatstake,thisisahigh-riskclinicalenvironmentrequiringsys-andonthedegreeofinjury.Hemorrhageisproducedwhenalltematicplanning,preparat
7、ion,andtheuseofpracticeguidelinesofthelayers,theintima,media,andadventitia,aredisruptedorforsuccessfulearlyrecognitionandeffectivetreatment.lacerated.Ifthebleedingiscontrolledlocally,ahematomaisThischapterreviewsthepathophysiology,clinicalpresenta-produced,whichmayormaynotbepulsa
8、tile.Ifbleedingisnottion,diagnosticworku
