Blunt Aortic Injury
Aortic injury occurs due to either:
- Rapid deceleration causing shearing of the aorta between the mobile arch and the fixed descending aorta which is tethered by the ligamentum arteriosum
- Direct trauma
Epidemiology and Risk Factors
Pathophysiology
Aetiology
Clinical Manifestations
History:
- Rapid deceleration
- High-speed
- MVA >50km/h
- Motorbike crash
- Pedestrian vs. car
- Fall >3m
Diagnostic Approach and DDx
Investigations
Bedside:
- TOE
- Sensitive
- Limited imaging of the proximal arch and major branches.
- Portable
Can be performed in the OR or in ED.
Laboratory:
Imaging:
- CXR
Widened mediastinum is unreliable and CT should be performed in at-risk cases. - CT angiography
Other:
Management
Resuscitation:
Specific therapy:
- Pharmacological
- Procedural
- Physical
Supportive care:
Disposition:
Preventative:
Marginal and Ineffective Therapies
Anaesthetic Considerations
Complications
Prognosis
Overwhelming majority (>90%) are fatal at scene. Of those who survive to hospital:
- 90% have significant injury
- 50% die within 24 hours
Key Studies
References
- Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.