Blunt Thoracic Aortic Injuries
In at least one large study, the average time from arrival at the emergency department to arrival in the operating room was nearly 6 hours. That 30% of survivors will die in the same amount of time underscores the need for rapid diagnosis and treatment. In blunt thoracic aortic injury, beta-blockers have been shown to reduce the incidence of rupture, and their use is rarely contraindicated. A working knowledge of the mechanisms of injury likely to produce this lesion, commonly associated injuries, clinically relevant and easily recognizable chest film findings, and appropriate use of beta-blockade can have a significant impact on mortality. Any physician responsible for evaluation of trauma patients should be familiar with this information.
Blunt Thoracic Aortic Injury (BTAI) is a frequently unrecognized cause of traumatic death. Seventeen percent of all motor vehicle collision fatalities are due to aortic rupture. Approximately 85% of people with traumatic aortic rupture die immediately, 30% of initial survivors die within 6 hours, and another 20% die within 24 hours. Untreated survival beyond 4 months is less than 2%. In contrast, survivability is reportedly as high as 70% if injuries are diagnosed and treated promptly. Many patients initially surviving aortic tears have an incomplete laceration with contained hematoma and an intact adventitia, which prevents immediate rupture. However, persistent or recurrent hypotension is usually not from aortic injuries, and other sources of hypotension should be considered. Free rupture does occur, but unlike other sources of bleeding, it is usually rapidly and irreversibly fatal. Thus, timely diagnosis and treatment of BTAI is of the utmost importance. A working knowledge of the risk factors for this injury and the ability to appropriately diagnose and initially manage such cases are basic skills that all physicians responsible for the evaluation of trauma patients should have.
In at least one large study, the average time from arrival at the emergency department to arrival in the operating room was nearly 6 hours. That 30% of survivors will die in the same amount of time underscores the need for rapid diagnosis and treatment. In blunt thoracic aortic injury, beta-blockers have been shown to reduce the incidence of rupture, and their use is rarely contraindicated. A working knowledge of the mechanisms of injury likely to produce this lesion, commonly associated injuries, clinically relevant and easily recognizable chest film findings, and appropriate use of beta-blockade can have a significant impact on mortality. Any physician responsible for evaluation of trauma patients should be familiar with this information.
Blunt Thoracic Aortic Injury (BTAI) is a frequently unrecognized cause of traumatic death. Seventeen percent of all motor vehicle collision fatalities are due to aortic rupture. Approximately 85% of people with traumatic aortic rupture die immediately, 30% of initial survivors die within 6 hours, and another 20% die within 24 hours. Untreated survival beyond 4 months is less than 2%. In contrast, survivability is reportedly as high as 70% if injuries are diagnosed and treated promptly. Many patients initially surviving aortic tears have an incomplete laceration with contained hematoma and an intact adventitia, which prevents immediate rupture. However, persistent or recurrent hypotension is usually not from aortic injuries, and other sources of hypotension should be considered. Free rupture does occur, but unlike other sources of bleeding, it is usually rapidly and irreversibly fatal. Thus, timely diagnosis and treatment of BTAI is of the utmost importance. A working knowledge of the risk factors for this injury and the ability to appropriately diagnose and initially manage such cases are basic skills that all physicians responsible for the evaluation of trauma patients should have.
Source...