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Thu Jan 11 09:43:13 GMT 2007

Karim,

Sorry, but why repeat CT? Was there something on the original? If you were
suspecting an aortic injury would you not move to an angiogram (I'm assuming
both were done in the Sensation)? Moving the patient two floors for a CT
that leads to a confirmatory angio, when you might have done the angio
anyway seems to me to involve both discomfort and potential risk to the
patient.

BP 160.......that seems a little high for a 36 y.o., particularly as I am
assuming all the adequate analgesia things have been done. Is this
consistent, and what happens when you try to wean off the labetalol?

Guy

----- Original Message ----- 
From: "Karim Brohi" <karim at trauma.org>
To: <trauma-list at trauma.org>
Sent: Monday, January 08, 2007 10:10 PM
Subject: Ascending Aortic Arch Injury

> Dear All
>
> 36yo male motocycle injury admitted 36 hours ago.
> Haemodynamically normal.
>
> Injury complex:
> ---------------
> GCS15, No head injury
> Fracture C7 through foramen transversarium (stable)
> Bilateral first rib fractures & multiple left sided fractures.
> Bilateral small haemothoraces and left lung contusion.
> Open fracture left femur - externally fixated at present.
>
> Initial CT showed some upper mediastinal haematoma, thought initially to
be
> related to the first rib fractures.
> Repeat CT today shows dissection flap in ascending aorta.  Starts above
left
> coronary.  No extension into neck vasculature (yet).
> Not visible on initial CT.
>
> BP = 160 systolic -> controlled with labetalol.
>
> Now what?
> Conservative management?
> Stent?
> Open repair? Technique?
>
> Karim
>
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Ascending Aortic Arch Injury