肢体创伤中血管损伤的非典型呈现超出目前的指导方针
Taylor Broudy1, Logan Gonsalves2, Jonathan King2
1Department of Surgery, Howard University College of Medicine, Washington, D.C., USA.
Cureus
|September 4, 2025
概括
计算机断层扫描 (CTA) 可以检测目前指导方针所忽略的血管损伤. 一个案例研究表明,CTA在一个创伤患者中发现了大腿动脉,脚和手臂指数正常,这强调了诊断中的临床判断.
科学领域:
- 创伤手术
- 血管成像
- 诊断放射学
背景情况:
- 计算机断层扫描 (CTA) 对于诊断创伤患者的血管损伤至关重要.
- 目前东部创伤外科协会 (EAST) 的指导方针建议CTA用于异常的身体发现或关节指数 (ABI) ≤0.9.
研究的目的:
- 突出目前EAST对创伤治疗的指导方针的局限性.
- 强调临床判断在诊断微妙的血管损伤的重要性.
主要方法:
- 一个32岁的男性在大腿上受枪伤.
- 尽管有正常的ABI和没有明显的物理发现,
- 审查EAST指南和临床决策.
主要成果:
- 根据ABI, CTA发现了一个创伤性大腿动脉,
- 患者成功地进行了内血管修复.
- 这一案例表明已建立的成像标准是不够的.
结论:
- 现有的EAST对CTA的指导方针可能不包括所有临床上显著的血管损伤.
- 对于及时诊断和治疗血管创伤至关重要.
- 即使不符合标准标准,CTA仍然是一个不可或缺的工具.
相关概念视频
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
33
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
33
Peripheral Artery Disease V: Postoperative Nursing Management
24
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
24
Assessment of the Cardiovascular System III: Palpation
491
Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
491
Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
33
The key difference between Superficial Vein Thrombosis (SVT) and Deep Vein Thrombosis (DVT) lies in their location and severity.Clinical ManifestationsSVT typically presents with localized pain, tenderness, and redness along the course of a superficial vein, often accompanied by a palpable, cord-like structure under the skin. This condition is usually less dangerous than DVT but can be uncomfortable and may lead to complications such as cellulitis or, rarely, a clot extension into the deep...
33
Aneurysm II: Clinical Manifestations and Diagnostic Studies
21
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
21
Peripheral Artery Disease IV: Nursing Management
42
The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
42


