Clinical Pathways
Clinical Pathways
Vascular Injury
Vascular Injury

Vascular Injury

View The Full Pathway

Action

Decision

Is there active arterial bleeding?

Yes

  • Arrange for operative management (Class I)

No

  • Perform ankle brachial index testing
  • Perform CTA

(Class I)

Background

Imaging

A patient with an ABI <0.9 mm Hg and/or abnormal physical examination findings concerning for vascular injury without hard signs (obvious pulse deficit, pulsatile bleeding, rapidly expanding hematoma, vascular bruit) needs further evaluation to examine the vasculature. The best imaging modality to evaluate for vascular injury is a CTA of the affected extremity.

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References
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    78. ®

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  86. Flaherty MR, Klig JE. Firearm-related injuries in children and adolescents: an emergency and critical care perspective. Curr Opin Pediatr. 2020;32(3):349-353.(Review)
  87. Parikh K, Silver A, Patel SJ, et al. Pediatric firearm-related injuries in the United States. Hosp Pediatr. 2017;7(6):303-312. (Review)
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  91. Nuttall AG, Paton KM, Kemp AM. To what extent are GCS and AVPU equivalent to each other when assessing the level of consciousness of children with head injury? A cross-sectional study of UK hospital admissions. BMJ Open. 2018;8(11):e023216. (Cross-sectional study; 5700 patients)
  92. Hoffmann F, Schmalhofer M, Lehner M, et al. Comparison of the AVPU scale and the pediatric GCS in prehospital setting. Prehosp Emerg Care. 2016;20(4):493-498.(Prospective cohort study; 302 children)
  93. Raza S, Thiruchelvam D, Redelmeier DA. Death and long-term disability after gun injury: a cohort analysis. CMAJ Open. 2020;8(3):E469-E478. (Cohort analysis; 8313 patients) DOI: 10.9778/cmajo.20190200
  94. Vella MA, Warshauer A, Tortorello G, et al. Long-term functional, psychological, emotional, and social outcomes in survivors of firearm injuries. JAMA Surg.2020;155(1):51-59. (Prospective cohort study; 183 patients)
  95. Joseph B, Aziz H, Pandit V, et al. Improving survival rates after civilian gunshot wounds to the brain. J Am Coll Surg. 2014;218(1):58-65. (Prospective study; 132 patients)
  96. Reginelli A, Pinto A, Russo A, et al. Sharp penetrating wounds: spectrum of imaging findings and legal aspects in the emergency setting. Radiol Med. 2015;120(9):856-865.(Review)
  97. Long B, April MD. Are patients with retained bullet fragments at greater risk for elevated blood lead levels? Ann Emerg Med. 2020;75(3):365-367. (Meta-analysis; 5 studies, 462 patients)
  98. Apte A, Bradford K, Dente C, et al. Lead toxicity from retained bullet fragments: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2019;87(3):707-716.(Systematic review and meta-analysis; 2102 articles)

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