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Vascular Injury
Patients with uncontrollable haemorrhage, expanding
haematomas or who are in shock need immediate haemorrhage
control. Usually this will mean transfer of the patient
to the operating room. However, where interventional
radiology is immediately available, angiography may
be invaluable in temporary or definitive control of
haemorrhage.
There should be no delay in attempting to fluid resuscitate
the patient. This will only result in increased haemorrhage,
continued cooling and coagulopathy (See Damage
Control). Large-bore venous access should be gained
and blood sent for rapid cross-match. No other investigations
are required at this stage. If there is time, a chest
X-ray is useful to determine if there is intra-thoracic
penetration.
Patients without overt shock or haemorrhage should
have their management determined by the site of the
injury and the results of physical examination.
The neck is usually divided anatomically into three
zones, and management of a vascular injury will be different
depending on the site of the injury.
Extends from the clavicles to the cricoid cartilage.
It includes the subclavian and innominate vessels, the
common carotids and lower vertebral arteries and the
jugular veins.
Extends from the cricoid cartilage to the angle of the
mandible.
It includes the common carotid, carotid bifurcation,
the vertebral arteries and the jugular veins.
Extends from the angle of the mandible to the mastoid
process.
It contains the branches of the external carotid artery,
the internal carotid artery, vertebral artery and the
internal jugular and facial veins.
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