penetrating vascular trauma: bleeding subclavian avf

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Tried to send this with an image but no one ever commented. I spoke  to ron 
gross who said it never was received by the message board, although i got  it
 
i was surprised by lack of comments so I will send the post again but  attach 
rather than embed the image.
 
sal
 
 
 
In a message dated 4/19/2006 11:07:47 A.M. Eastern Standard Time,  
roydanks at hotmail.com writes:

EAST has  published guidelines for these.  I generally follow them, but will  
deviate as needed.

This is how I handle them:

1)  Physical  exam: 
Wound:  Any signs of expanding  hematoma or pulsatile mass?  If so, go to OR


I had a recent interesting "deviation" from that recommendation
 
28 year old male sustained stab wound of the left shoulder. on admission  
hypotensive but responded with volume with improved pulses but bleeding from the  
wound which was  managed by pressure.
take a deep breath, trauma surgeons.....
 
patient brought to angio with manual pressure applied. attached angio  showed 
a subclavian arteriovenous fistula. This was treated by stent graft which  
controlled the bleeding and repaired the vessel in about forty  minutes. 
 
he was discharged on fourth hospital day. Followup angio at five  weeks 
showed good flow and equal upper extremity blood  pressures.
 
 i see more of this happening in the future
 
 
 
sal
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