How Do I Know if the Trauma Damaged a Blood Vessel?

N.Vinoth Narasingam

Sometimes the bleeding is external, and you have no problem recognizing that there is a vascular trauma due to the amount of blood coming out of the wound. However, this is not always the case. There are some criteria to take into account when evaluating an injury:

HARD SIGNS

SUBTLE SIGNS

• Active hemorrhage • Absence of distal pulses or ischemia • Expanding or pulsatile hematoma • Bruit or thrill

• Subjective reduced or unequal pulses • Large non-pulsatile hematoma

Shots, impact trauma, and vascular trauma from fracture or dislocation are sometimes tricky. Gunshot wounds usually have some degree of vascular damage. One of the worst I’ve seen was a patient with two wounds in the abdomen and one pierced the vena cava to lodge in the dorsal spine. That patient died. In the case of the stab wounds, which usually have external bleeding, I also remember one where the weapon made a small wound in the heart that could be repaired. Thus, it is important to look for signs of peritoneal irritation and to evaluate the degree of mucosal skin paleness and peripheral pulses, depending on the site of the wound. Complicated fractures and dislocations can cause compression damage or cause a real blood vessel injury. The first thing to do in the case of a fracture where the ends of the bone are displaced, or a dislocation, is to check the pulses of the limb and the color and temperature of the skin, looking for cyanosis (bluish skin); then align the bone again. Only with this maneuver can you secure the irrigation of the limb, which may be blocked by compression.

James Heilman, MD, Own work, CC BY-SA 3.0

IF YOU SUSPECT VASCULAR INJURY, STOP THE BLEEDING AND CALL 911.