Traumatic Aortic Rupture

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This should be fun...

C.M. Ursic, M.D.
UCSF-East Bay
Oakland, CA


--- Kari_Schrøder_Hansen <kari.hansen@haukeland.no>
wrote:
> 85 year old male pedestrian hit by a car (50 km/h).
> Arrives ED 50 min. after the accident: Syst BP: 114.
> Pulse:70 GCS:14.
> 20 min after admission: Syst BP: 70. Pulse 100
> GCS:10 Chest X-ray shows a
> widened mediastinum.
> After another 30 min the patient dies (at the
> CT-lab!). Post mortem exam.
> shows rupture of aortae distal to left subclavian
> artery.
> 
> Some questions about traumatic aortic rupture (TAR):
> 1.  Most TAR occures at the location described in
> this case. What is the
> chance for another location (outside pericard)?
> 
> 2.  If our patient had been young and healthy (and
> with a TAR that obviously
> was bleeding while in ED), what would have been the
> chance of saving his
> life if he had gone to the OR instead of the CT-lab?
> 
> 3.  When in the OR and you suspect a TAR but do not
> know the exact location.
> Would you go for an left thoracotomy or a sternum
> split?
> 
> 4.  Some years ago aortography was considered the
> "Golden standard". What is
> considered as the best diagnostic tool today:
> aortography, helical CT or
> transoesoph. sonosound? 
> 
> 
> 
> 
> Kari Schrøder Hansen
> Consultant
> Emergency Dept.
> Haukeland University Hospital
> N-5121 Bergen
> Norway
> 
> --
> trauma-list : TRAUMA.ORG
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