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Neck and upper limb vascular trauma: aetiology, pathogenesis, classification, management, guidelines, outcomes 

Neck and upper limb vascular trauma: aetiology, pathogenesis, classification, management, guidelines, outcomes
Chapter:
Neck and upper limb vascular trauma: aetiology, pathogenesis, classification, management, guidelines, outcomes
Author(s):

Wayne Sapsford

DOI:
10.1093/med/9780199658220.003.0019
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date: 22 September 2019

In the prehospital environment catastrophic haemorrhage from arterial injuries is best managed by direct digital pressure and haemostatic dressings. Tourniquets may be life-saving when applied to an extremity in some cases. In the emergency department attention must be paid to whether the patient is haemodynamically unstable and/or whether there are hard signs of arterial injury. In both cases, the further management of the patient should, with few exceptions, be in the operating theatre. Haemodynamically-stable patients should be further investigated by CT angiogram before addressing a vascular injury operatively. Some patients with minor arterial and most venous injuries can be observed. Longer-term follow-up will be required to identify and manage potential complications of minor arterial injury before they become symptomatic. Arterial injuries are managed with proximal and distal control, and then repair or ligation. Optimal access to the proximal vessel may be via the chest cavity. In the neck distal injuries may be inaccessible at the base of the skull and balloon occlusion may be required followed by embolization.

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