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Aortic "Dissection"

KMATTOX at aol.com KMATTOX at aol.com
Sat Dec 29 18:06:39 GMT 2012


I have seen ONE aortogram following blunt trauma which MIGHT be considered  
to be a dissection, and even there it appears to be a extra aortic wall  
hematoma, contained by the mediastinal parietal  pleura.      
 
If you really have a dissection of the thoracic aorta following trauma it  
is a REPORTABLE CASE.  
 
k
 
 
In a message dated 12/29/2012 11:49:54 A.M. Central Standard Time,  
jlundy1313 at yahoo.com writes:

I  admitted a young male adult patient with similar mechanism who had 
traumatic  aortic injury consistent with transaction and part of imaging 
diagnoses was  dissection from site of transection to level of diaphragmatic hiatus. 
No  distal ischemia. Patent was treated with endovascular thoracic aortic 
stent  graft. First time I've ever seen a component of dissection with 
transection in  blunt trauma. 

Sent from my iPhone

On Dec 29, 2012, at 10:19,  Mahmoud Fekry <fekry_mahmoud at ymail.com> wrote:

> I think  aortic dissection from the shearing force on ligamentum 
arteriosum during a  acceleration deceleration
> Sent from my iPhone
> 
> On  ٢٩‏/١٢‏/٢٠١٢, at ٢٠:٠٧, K Mattox <kmattox at aol.com> wrote:
>  
>> Aortic dissection does happen, but virtually never following  blunt 
trauma.    One can have a traumatic pseudo-aneurysm or an  aortic transaction.   
 If the patient truly had a post traumatic  dissection, the pathophysiology 
and treatment is different.     
>> 
>> Precision in descriptions in surgery is  essential.   
>> 
>> k
>> 
>>  Sent from my iPhone
>> 
>> On Dec 29, 2012, at 10:36 AM,  "McSwain, Norman E" <nmcswai at tulane.edu> 
wrote:
>>  
>>> What ere the kinematics? Head on? rotational? lateral?.  Damage to the 
vehicles involved? What is high speed?
>>>  
>>> What does HFOV mean?
>>> 
>>> Sorry I  do not know what " Head with IPH. MRI with profound DAI" means 
 either
>>> 
>>> Norman
>>>  
>>> Norman McSwain MD, FACS
>>> Professor of Surgery,  Tulane University
>>> Trauma Director, Spirit of Charity Trauma  Center, ILH
>>> Medical Director PreHosptial Trauma Life Support  (PHTLS)
>>> 504 988 5111
>>> 
>>>  -----Original Message-----
>>> From:  trauma-list-bounces at trauma.org 
[mailto:trauma-list-bounces at trauma.org] On  Behalf Of Keith Lamb
>>> Sent: Saturday, December 29, 2012 9:49  AM
>>> To: International Critical Care Medicine Group; Trauma  & Critical Care 
mailing list
>>> Subject: interesting trauma  case
>>> 
>>> Will be brief but I need input if  possible.
>>> 
>>> 38 Year old female. unrestrained  driver in high speed MVC. Fatalities 
at the scene.
>>>  
>>> GCS 5T Upon arrival which quickly deteriorates to  3T.
>>> 
>>> Major Injuries:
>>>  
>>> CT Chest abdomen and pelvis and Head
>>>  
>>> Large opacities t/o chest fields. Bilateral pneumothoracies.  Pulmonary 
contusions. Bilateral chest tubes placed. AORTIC  DISSECTION
>>> 
>>> Abdomen with liver, pancreas, and  kidney injuries. Laparotomy done. No 
occult repairs.
>>>  
>>> Pelvis with fracture but no gross blood.
>>>  
>>> Head with IPH. MRI with profound DAI.
>>>  
>>> Much difficulty in oxygenation and  ventilation.
>>> 
>>> Today on Volume Assist Control  (f) 32, VT 450 (6ml/kg/pbw), FIO2 100%, 
PEEP 14 7.19, paCO2 55, PaO2 78, HCO3  20
>>> 
>>> PCVIRV, APRV, etc has been attempted with  worsening gas exchange.
>>> 
>>> Two questions right  away.
>>> 
>>> 1) I am concerned proning her with  aortic arch disection. Should I be?
>>> Worried about heart  torquing aorta.
>>> 
>>> 2) HFOV. Any  contraindications. Seems to me that lower pressure swings 
on HFOV should be  better not worse in terms of her aorta. Yes/No?
>>>  
>>> I will send images as soon as possible.
>>>  
>>> Thanks for your input.
>>> 
>>>  Keith
>>> 
>>> --
>>> Keith D.  Lamb
>>> RT II, Surgical Critical Care
>>> Christiana  Care Health System
>>> Newark, Delaware USA
>>>  302.983.6178
>>> 
>>> Chair, Adult Acute Care  Section
>>> American Association for Respiratory  Care
>>> 
>>> Director, Board of  Directors
>>> American Association for Respiratory  Care
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