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1


What percentage of subjects survive long enough following blunt thoracic injury

20%

2


The majority of blunt injuries to the thoracic aorta occur where

Aortic Isthmus

3


Blunt aortic injury may be a result of a "water hammer" effect, explain.

It is a sudden compression of the abdomen due to a sudden impact occluding the aorta, leading to rupture of the proximal, intrinsically weak isthmus

4


In what order of the aortic layes do aortic rupture occur?


intimal, medial, and then the adventitia

5


What you look for on a plain film for aortic trauma


wide mediastinum

obscure, indistinct or enlargedaortic knob or arch

Left apical cap or bld in the L apicies of the lung

displacement of the L mainstem bronchi

right ward deviation of the trachea

6


What is the diagnostic test of choice for Blunt aortic injury detection


CT

7


What you may see on CT


Aortic contour abnormality

pseudoaneurysm

contained rupture

vessel wall disruption

intimal flap

luminal filling defect

active extravasation

8


Aortic Grading 1-4


I. Intimal tear

II. Intramural hematoma

III. Pseudoaneurysm

IV. Rupture

9


Type I Injury managment

nonopertively

medically therapy with Beta blockers

serial imaging

10


Type II, III, IV treatment

under go repair

Unless comorbidities perclude repair

Delay is an option for hemodynamically stable patients providing there are no signs of rupture, aortic thrombus, massive pneumothorax, luminal encroachment or pseudoaneurysm

11


Heart rate control while awating repair is what?


Esmolol at less than 100

12


BP should be maintained with what? At what? while awaiting surgery


SBP at 100

Nitroglycerin or Nipride

13


Overall survival of a traumatic blunt aortic injury is what


10-20%