Surgery (Batch 18)

Signs of vascular trauma ◼️This is an essential part to recognize, a trauma to an artery may lead to acute spasm, or formation of a subintimal hematoma or acute thrombosis, all may occlude the vessel, alternatively a trauma may cause laceration of the vessel either completely or partially, remember: Partial laceration causes more bleeding than complete laceration. ◼️The HARD SIGNS of vascular trauma include (1) Pulsatile bleeding, (2) Pulsatile hematoma, (3) Signs of acute limb ischaemia, (4) Thrill or bruit due to traumatic AV fistula or a false aneurysm, (5) Rapidly Expanding hematoma. ◼️Soft signs include (1) Non pulsatile stable hematoma, (2) Unexplained shock or falling hemoglobin, (3) Injury at an anatomical site of an artery, (4) Evidence of nerve injury in proximity to an artery, (5) History of significant hemorrhage at time of trauma and before presentation. ◼️Describe the clinical findings you see in the above figure?

د.زكي

Indications of thoracotomy in chest trauma ◼️Blood volume on initial drainage of the chest is more than 1500 mL. ◼️Continued bleeding of more than 200 mL per hour for three hours or more. ◼️Brisk bleeding of more than 100 mL/ 15 Minutes. ◼️Unusually large air leaks indicating injury to tracheobronchial tree, for example inability to keep the lung expanded despite the use of functioning multiple chest tubes, or the chest x ray showing massive pneumothorax with displacement of the lung hilum downwards. ◼️Rupture of esophagus or diaphragm, or pericardial temponade failing to respond for percutaneous aspiration.

1_Murphy's sign 2_Ortner sign tender right costal margin when tap over it 3_ Georgivskiy sign (myussi sign) is phrenic sign in which tender occur when press the grove of the lower edge of sternocleidomastoid muscle 4_boas sign increase the sensitivity below the right scapula (phrenic nerve irritation)

1_Murphy's sign 2_Ortner sign tender right costal margin when tap over it 3_ Georgivskiy sign (myussi sign) is phrenic sign in which tender occur when press the grove of the lower edge of sternocleidomastoid muscle 4_boas sign increase the sensitivity below the right scapula (phrenic nerve irritation)