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Tue Nov 29 14:49:56 GMT 2005

Please define significant VS insignificant vascular injury?

Sincerely

P Navsaria

meredith mcbride wrote:

> Sorry - typo. Should read 'ratio NOT less than 1.0...' Or more simply: ABI of 1.0 or greater rules out signficant injury.
>
>   Some series used ratios of 0.9 as cutoff, and achieved similar sensitivity in detecting injury.
>
> meredith mcbride <mmcbridemd at yahoo.com> wrote:
>   ABI's (ankle-brachial indices) would be a more reasonable starting point on an injured limb with palpable but possibly diminished pulses. Noninvasive, simple to perform at bedside presuming obstructing dressings or fixation not present.
>
> Ratio less than 1.0, or else symmetric with the uninjured contralateral limb would essentially rule out any hemodynamically significant vascular injury.
>
> Felix Albers wrote:
> Hi folks,
>
> we had this case last week. a 55 year old man was struck by a van. Came to our ED 7 hours after the incident. Only identifiable injury was a fractured right femur (closed) with important edema, with diminished but simetrical peripheral pulses, consistent with the shock state (first inaudible, after ressuscitation 60/30). This patient was not considered to have important vascular injury, and treatment was skeletal traction and ICU support. On the next day in the ICU he developed compartment syndrome and fasciotomy was performed. Still on the same day edema progressed to the lower leg and fasciotomy was performed there too. Persistent shock, rabdomiolysis, ARF, and sepsis from and infected leg occured. The leg was amputated but the patient died 9 days after the accident.
>
> We will be discussing this case on 01/12/05. To me it looks like there was indication for arteriography on arrival. What do you think? This is one of the points I want to make.
>
> Felix.
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