Australian guidelines Working Guidelines

Hard and soft signs of vascular injury pdf

Hard and soft signs of vascular injury pdf
Hard Signs Major hemorrhage/hypotension delayed diagnosis of popliteal vascular injury are the result of overlooking hard signs, rather than an absence of signs, on initial presentation. Fabian TC, Turkleson ML, Connelly TL, et al: Injury to the popliteal artery. Am J Surg 143:225–228, 1982 . Doppler ultrasound Determine presence/absence of arterial supply Assess adequacy of flow
extent of a vascular injury and demonstrates the trajectory or tract of the wound for potential aerodigestive injury, is invaluable for the management planning. 23
Download vascular trauma or read online here in PDF or EPUB. Please click button to get Patients with “hard” signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with “soft” signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is

Vascular injuries represent a significant burden of mortality and disability. Blunt injuries to the neck vessels can present with signs of stroke either immediately or in a delayed fashion.
These Neurological Soft Signs (NSS) have been generally called “soft” neurological signs, in keeping with their reputed lack of specificity, validity, or localizing value. However, recent research indicates that these “soft” signs may have some measure of neuroanatomical validity.
Background/Aim Vascular trauma is a common life-threatening injury leading to serious consequences if not timely and efficiently managed. Although they represent less than 3% of all injuries, they
of soft signs of arterial injury. ο Consider as routine for knee dislocations where occult arterial injuries may occur, and undetected delayed popliteal artery thrombosis may lead to major amputation. 27.3 Vascular Injuries Management Aspects Initial management. ο Control external bleeding immediately! Blind or imprecise placement of vascular clamps in a bloody field is discouraged. Direct
The hard signs of vascular trauma warrant urgent or immediate operative exploration and intervention . In many instances, these patients present with systemic shock, and resuscitative efforts are best coordinated in the operating room. The soft signs of vascular injury (see
SIGNS OF VASCULAR INJURY ¨Hard signs¨ Arterial bleeding Ongoing hemorrhage with shock Absent distal pulses Limb ischemia Expanding or pulsatile hematoma Bruit or thrill over area of injury ¨Soft signs¨ History of serious bleeding now stopped Small, non expanding hematoma Injury to anatomically related nerve Diminished distal pulses Anatomic proximity of wound to a major vessel (< 1cm
The neck is a particularly tricky area of assessment and management in the trauma patient, as it is the location for many vital structures. Concern for vascular, neurologic, digestive tract, and airway injury are of paramount importance in the evaluation of these patients, as all can be life
classic “hard signs” of vascular injury such as arterial bleeding, expanding hematoma, lack of pulses, bruit, thrill, or shock should still be taken immediately to the operating theater for open exploration with, or without on table angiography if necessary; patients with soft signs

REASONS FOR DIAGNOSTIC STUDIES

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Are arteriograms necessary in penetrating zone II neck

Forty-five patients who had soft signs of vascular injury or in whom the injury was in proximity to a major vessel underwent arteriography to rule out vascular injury. The rate of arteriography was 23/50 of the gunshot wounds, 17/42 of the stab wounds, 4/7 shotgun wounds, and 1/10 for lacerations. Twenty-seven of these 45 test results were negative and eight showed injury to noncritical
Hard signs of vascular or aerodigestive injury include active hemorrhage, pulsatile or expanding hematoma, bruit or thrill in the region of the wound, hemodynamic instability, unilateral upper- extremity pulse deficit, massive hemoptysis or hematemesis, air bubbling in the wound, and airway compromise.
Vascular Injury in Trauma The vascular system is made up of vessels that carry blood throughout the body. Arteries and veins carry this blood to and from the heart and carry oxygen to all parts of the body. In this type of injury, there is damage to blood vessels as they are torn or cut by piercing or crushing injuries, such as a gunshot wound or stab wound. blunt trauma that results in bone
Penetrating Neck Trauma Presley Regional Trauma Center Department of Surgery University of Tennessee Health Science Center Memphis, Tennessee . Introduction • Management of penetrating cervical injury has undergone major change during the last decade • At the end of WWII, surgeons extrapolated routine exploration of penetrating neck injuries into the care of civilian injuries
The classical hard signs of vascular injury include arterial bleeding, expanding or pulsatile hematoma, lack of distal pulse, bruit, thrill, and shock without other explanation.
Patients with “hard” signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with “soft” signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is necessary. Computed tomography arteriography has become the most commonly used method of imaging
Extremity vascular injuries account for 40 to 75% of vascular injuries treated in civilian trauma centers. Their management is specially challenging due to associated soft tissue injury , orthopedic trauma, nerve damage and contamination. The clinical diagnosis of extremity vascular trauma is classically associated with diligent search for hard and soft signs(3). Hard signs are an absolute
Patients (without hard signs of vascular injury) who have abnormal physical examination findings and/or an Ankle-Brachial Index (ABI) < 0.9 should have further evaluation to rule out vascular injury. 3.
PAH Neck Injury Module Revised 2016 Hard Signs of Significant Injury Soft Signs of Significant Injury VASCULAR Pulsatile/severe haemorrhage Expanding/pulsatile haematoma


Soft signs of vascular injury: proximity of wound to major vessels, hx of hemorrhage/shock, non-expanding hematoma, diminished pulse and anatomically related nerve injury. 3.
The risk of limb loss is the greatest for injuries with combined bony instability, vascular injury (particularly combined arterial and venous injury), and soft tissue injury. An example is blunt injury to the popliteal region, which can injure the popliteal artery and vein [ 66,67 ].
Objectives. By the end of this discussion, you will be familiar with: Surgical anatomy. Indication for operative intervention. Surgical approach. Answers of few important questions
In the patient without ‘hard’ signs of a peripheral vascular injury, a careful history (bleeding), physical examination including measurement of ankle–brachial (ABI) or brachial–brachial index and liberal use of CT arteriography depending on an ABI <0.9 should essentially make the diagnosis if an arterial injury …
The shortcoming of lattending physicians was because they were not conversant with hard and soft signs of vascular injuries with attendant limb loss and death of one of the victims. This short coming can be averted by training and retraining of doctors.
Only cases with hard signs of vascular injury (Cone 1989) were considered. 12 patients were treated; all were men. A minor soft-tissue involvement. Despite the healing problems we encountered after external fixation, our material is too limited to claim that external fixation is an inferior method in the treatment of femoral frdc- tures. But it illustrates that the choice of fracture fixa
4. Vascular Trauma – Download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online.
mechanism and extent of injury Signs classically divided into 'hard' and 'soft' sign .Clinical features Depends on site. Hard signs of vascular injury Absent pulses Bruit or palpable thrill Active haemorrhage Expanding haematoma Distal ischaemia .


Patients with wartime vascular trauma typically present with hard signs of vascular injury and are best managed with prompt exploration. Patients with soft signs are evaluated clinically and would benefit from CT angiography if available to further guide the management. Proximal and distal control are essential prior to exploring the injured area and exploring the missile trajectory. In
Hard and soft signs of vascular injury are presented in Table 20.1. Paleness of the extremity distal of the supposed lesion is a warning sign of vascular compromise if the patient is hemodynamically normal. Palpation of the peripheral pulses guides further need for evaluation. If there is no palpable pulse in a patient without further hemodynamic problems, then further evaluation is needed
The incidence of vascular injuries in such patients ranges from 3% to 25%, depending on which soft sign or combination of soft signs is present. 63,64 The presence of peripheral pulses equal to

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Diagnosis of Vascular Injury ScienceDirect

17/11/2017 · In general, hard signs of injury (eg, a change in pulse quality compared to the opposite extremity or a loss of pulse in the extremity) are absolute indications for further diagnostic studies (eg, arteriography or exploration and direct visualization in the operating room).
The presence of hard signs of vascular injury mandates immediate operative intervention. Usually the site of injury is obvious, and angiography is unnecessary. If in doubt, angiography can be performed emergently on the operating room table. Unnecessary interventions and investigations should be avoided to minimise the delay to definitive care. So-called ‘soft signs’ of vascular injury are
Patients with soft signs of vascular injury (List 2) require further assessment with a low threshold for imaging 4 . Those with penetrating injury have 3-25% chance of significant injury.
Popliteal vascular trauma remains a challenging entity, and carries the greatest risk of limb loss among the lower extremity vascular injuries. Operative management of traumatic popliteal vascular injuries continues to evolve. We aim at describing our experience with such complex injuries, with associated patterns of injury, diagnostic and
i. Hard sign-ers: obvious vascular arterial injury 1. “HARD Bruit” (mnemonic from Neck Trauma episode) 2. To do: Page surgery / take the patient to the OR ii. Soft sign-ers: 1. Soft signs: continuous oozing, hematoma 2. To do: Obtain ABI (ankle brachial index) 3. Abnormal ABI (< 0.9) + other signs of vascular injury = a. Order CT angiogram to r/o vascular injury iii. No sign-ers 1. No
17/11/2017 · Vascular injuries can be classified clinically into hard signs and soft signs of injury on the basis of examination. Classic so-called hard signs of vascular injury include the following: Classic so-called hard signs of vascular injury include the following:
Chapter 48 – Vascular Trauma Episode Overview: 1. List three types/mechanisms of occlusive and four types of non-occlusive vascular injuries. 2. What are the hard and soft signs of peripheral vascular injury? 3. What are maximum cold and warm ischemia times? 4. How are vascular injuries diagnosed in the ED? List 5 investigations that assist in the diagnosis of peripheral vascular injury

Penetrating neck trauma WikEM

An acute knee dislocation is an uncommon injury, with a high rate of associated vascular and neurologic injuries as well as potentially limb-threatening complications. High-energy trauma is the most common cause of an acute knee dislocation, although
This episode of CRACKCast covers Rosen’s Chapter 048, Peripheral Vascular Trauma. These injuries can still carry a high morbidity and mortality rating, though advances in our ability to intervene now make it even more important to identify the injury in the emergency department.
arterial injury and none for isolated venous injury (hard signs: 62.0%, soft signs: 11.4%, and no signs: 0.7%). no serious complications resulted from computed tomography angiography. Conclusion: Computed tomography angiography is a safe and effective imaging modality
Patients (without hard signs of vascular injury) who have abnormal physical examination findings and/or an Ankle-Brachial Index (ABI) 0.9 may be discharged (in the absence of other injuries requiring admission).
Clinical findings of vascular injury from penetrating or blunt trauma as described by Compton and Rhee can be categorized into hard and soft signs. Hard signs include absent or diminished pulses, active hemorrhage, large expanding or pulsatile hematoma, bruit, thrill, or distal ischemia. Soft signs include a small stable hematoma, injury to an anatomically related nerve, unexplained
Indications for surgery were determined based on physical findings (classic hard/soft signs for vascular trauma), computed tomography angiograms (CTAs), or contrast angiograms. Indications for performing extremity fasciotomies were also recorded. Associated soft tissue, nerve, and bony injuries were recorded, and the sequence of treatment was evaluated to determine if it was based on Advanced
SOFT SIGNS Hypotension or shock Neurologic deficit due to primary nerve injury occurs immediately after injury. In contrast, ischemic neuropathy is delayed in onset (minutes to hours). Stable, non pulsatile or small hematoma Proximity of the wound to major vascular structures ( Beware of bone fr. ! )
Patients with “hard” signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with “soft” signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is necessary. Computed tomography arteriography has become the most commonly used method of
HARD SIGNS OF ARTERIAL INJURY (Immediate surgery) • External arterial bleeding • Rapidly expanding hematoma • Palpable thrill, audible bruit • Obvious arterial occlusion (pulseless, pallor, paresthesia, pain, paralysis, poikilothermia, especially after reduction of dislocation or realignment of fracture) SOFT SIGNS OF ARTERIAL INJURY (Consider arteriogram, serial examination, duplex

Peripheral Vascular Injuries SlideShare


Penetrating Neck Trauma University of Tennessee Health

Hard and Soft Signs of Vascular Injury associated with Extremity trauma Hard Signs: Pallor Paresthesia Pain Pulslessness (doppler) Paralysis Rapidly expanded hæmatoma External pulsatil bleeding Soft Signs: History of arterial bleeding Proximity related injury Hæmatoma over a named artery Diminished distal puls, Doppler flow Neurological deficit . Hard and Soft Signs of Vascular Injury
conversant with hard and soft signs of vascular injuries with attendant limb loss and death of one of the victims. This short coming can be averted by training and retraining of doctors.
Introduction. Vascular trauma with vessel disruption presents in a variety of settings and results in findings that range from life-threatening hemorrhage and/or significant ischemia (i.e., hard signs of vascular injury) to less-detectable or soft signs of injury.
Vascular Injuries Soft ignsS • Mild Bleeding • Nonexpanding hematoma • Paresthesia Hard signs • Severe external bleeding • Expanding ematomah • Pulsatile swelling • Bruit, thrill • Pulse ficit de • Neurologic deficit . www.downstatesurgery.org. Nervous Injuries CNSpinal cord.- S PNS. VII through XII, sympathetic chain, – CN peripheral nerve roots, brachial plexus
evaluation is required. As a general principle, the presence of a hard sign of vascular injury (Table 1) warrants immediate operation for exploration and earliest possible control of vascular hemorrhage. Patients who present with soft signs (see Table 1) suggestiveofoccult vascular injury,however, benefit from additional diagnostic imag-ing. A variety of imaging options are available, each
Hard signs for vascular injury // Soft signs. Categories.trauma-vascular Tags card. Please post any discussion to the emupdates reddit page. Post navigation. Previous Post Previous 1212. Warm ischemia time // Types of vascular injury // Three classes of vascular injury based on history and physical. Next Post Next 1214. What is a proximity wound? // Other wounds at high risk for vascular
Clinical signs of arterial injury have been stratified based on their predictive value into “hard” and “soft” signs (table 1). The presence of a “hard” sign of vascular injury mandates an immediate surgical exploration and vascular repair [ 26 , 30 – 32 ].
The ‘hard’ and ‘soft’ signs of vascular injury have been previously discussed. In dealing with extremity vascular injuries, it is vital to free drape an unaffected leg for harvest of saphenous vein, as this is the conduit of choice for all peripheral reconstructions.

Pitfalls in the management of peripheral vascular injuries


Carotid Artery Injury The American Association for the

API will miss non-obstructing vascular injuries and will give false positive results in patients with shock or elderly patients with significant peripheral vascular disease. Some trauma centers use a difference in API of >=0.1 as an indication of arterial injury in elderly patients and those with known pre-existing peripheral vascular disease.
“Soft” signs of arterial injury include a cool limb, change in color, nonexpanding hematoma, and nonpulsatile bleeding. The prevalence of arterial injury is lower when only soft clinical signs …
Guidelines for Peripheral Vascular Injury Neurovascular Exam-Palpable pulses -No hx PAD -Normal motor/sensory -Asymptomatic -Observe and Monitor PMS -Assess for fxs Normal Abnormal No Signs/symptoms but cannot feel pulse Assess ABI/BBI Soft Signs/High Clinical Suspicion -Post knee dx -Supracondylar fx/dx -Trajectory Hard Signs or Unstable
case report of vascular injury after femoral fracture external fixation Gregory R Staeheli1,3, Michael R Fraser Jr1,3,4* and Steven J Morgan2,3 Abstract Background: Placement of external fixation frames is an expedient and minimally invasive method of achieving bone and joint stability in the setting of severe trauma. Although anatomic safe zones are established for placement of external

CRACKCast E048 Peripheral Vascular Trauma – CanadiEM

Evaluation (WTA Algorithm) If hard signs or HD instability, attempt tamponade, secure airway, then OR. If no hard signs and yet suspect injury, CTA.
Soft signs of vascular injury include decreased pulses distal to the suspected area of injury, abnormal API, neurologic deficit, small hematoma, proximity of a wound to a major artery, history of hemorrhage at the scene of an injury, or unexplained hypotension.
Hard Signs (>90% risk of arterial injury; 50% require intervention) Immediate arterial exploration without further investigation Soft Signs (30% risk of arterial injury)


Hard signs of vascular injury was observed in 5.5% of patients with a 97.1% incidence of clinically significant injury requiring operative intervention. Eighty-three percent of patients had no signs of vascular injury with no missed injuries detected during follow-up. Eighty-nine MDCTAs were performed in the remaining 73 patients (11.5%) with soft signs. The mechanism of injury was penetrating

Extremity Vascular Trauma Workup Medscape Reference

Severe extremity injury in the adult patient UpToDate

Diagnosis and Management of Knee Dislocations


Peripheral Vascular Trauma Crashing Patient

Popliteal Artery Injury Multidisciplinary Approach

Surgical Management of Vascular Trauma
CT Angiography Signs of Lower Extremity Vascular Trauma

Vascular Injury in Trauma The vascular system is made up of vessels that carry blood throughout the body. Arteries and veins carry this blood to and from the heart and carry oxygen to all parts of the body. In this type of injury, there is damage to blood vessels as they are torn or cut by piercing or crushing injuries, such as a gunshot wound or stab wound. blunt trauma that results in bone
Objectives. By the end of this discussion, you will be familiar with: Surgical anatomy. Indication for operative intervention. Surgical approach. Answers of few important questions
17/11/2017 · Vascular injuries can be classified clinically into hard signs and soft signs of injury on the basis of examination. Classic so-called hard signs of vascular injury include the following: Classic so-called hard signs of vascular injury include the following:
Patients with “hard” signs of a vascular injury are taken to surgery emergently with a few exceptions to be described. In contrast, patients with “soft” signs of a vascular injury undergo a careful physical examination including measurement of vascular index to determine if radiologic imaging is necessary. Computed tomography arteriography has become the most commonly used method of
Hard Signs (>90% risk of arterial injury; 50% require intervention) Immediate arterial exploration without further investigation Soft Signs (30% risk of arterial injury)