thoracicAorticTraumaApr05

- Thoracic Aorta Trauma Charles E Smith MD Professor of Anesthesia Director Cardiothoracic Anesthesia MetroHealth Medical Center Case Western

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Thoracic Aorta Trauma Charles E. Smith, MD Professor of Anesthesia Director, Cardiothoracic Anesthesia MetroHealth Medical Center Case Western Reserve University Cleveland, Ohio April, 2005
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Objectives Incidence Pathophysiology Diagnosis Anesthetic management Preop evaluation, monitoring Anesthetic agents Neuroprotection One-lung ventilation
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Smith: Am J Surg 1986;152:660 Incidence 12- 30 % blunt trauma deaths 8000 deaths/yr, USA 2nd most common cause of death in 1 study (after head injury) Majority (80-85%) die at scene Etiology: MVAs, falls, crush, pedestrian struck, airplane crash
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Fabian et al: J Trauma 1997;42:374-80 Mechanism of Injury 0 50 100 150 200 250 Number of Patients MVA MCA Ped Struck Falls Other
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Wall MJ et al: Surg Clin N Am 2001;81(6):22. Fabian: J Trauma 1997;42: Pathophysiology Survivors have intact adventitia Hematoma contained by parietal pleura + surrounding tissue: “false aneurysm” Most common injury near ligamentum arteriosum, distal to left subclavian (prox descending): 65-93% Other sites of injury: Ascending / Arch: 7-14% Mid or Distal Descending: 4-12% Multiple Sites: 4-13%
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EAST: www.east.org; Vignon et al: Anesthesiology 2001;94:615-22 Diagnosis Abnormal mediastinum on CXR: predominant initial finding in 85%; good screening tool Spiral Chest CT: high negative predictive value useful as screening + diagnosis Aortography: gold standard at MHMC TEE: sensitive + specific; also useful for BCI may not be as available as CT or angio may miss ascending /arch injuries + branches
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Criado et al: J Vasc Surg 2002;36:1121-8 Anesthetic Management Depends on location + extent of injury Ascending / Arch: requires CPB + possible circulatory arrest Descending- clamp + sew vs. distal perfusion Timing of surgery- delayed vs. emergent repair Endovascular stent-graft repair: feasible in some centers, but still risk paraplegia, death. ..
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Besson + Saegesser 1983; Switzerland, N= 1485 chest injuries Blunt Chest Trauma: Extra-thoracic Injuries Incidence 0 25 50 C e r b o n c t S k u l F x a i p U E L w P v s A d m %
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Besson, 1983 Management
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Delayed Repair Historically- 1% mortality per “unoperated” hr 1981: 14/44 had repair 2-79 days after injury, no rupture while waiting [Akins] 1989: 15/21 had repair after 4 wks, no rupture while
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This note was uploaded on 12/16/2011 for the course BIOLOGY 101 taught by Professor Mr.wallace during the Fall '11 term at Montgomery College.

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- Thoracic Aorta Trauma Charles E Smith MD Professor of Anesthesia Director Cardiothoracic Anesthesia MetroHealth Medical Center Case Western

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