Action
Calculate arterial pressure index (Class II)
- Lay the patient supine
- Using a traditional blood pressure cuff and an 8 mHz vascular Doppler probe placed at a 45° to 60° angle to the artery, inflate the cuff until there is cessation of flow
- For the lower extremity, the probe should be placed immediately superior to the ankle
- Allow the cuff to deflate slowly until flow returns. This pressure is the SBP
- Repeat this measurement in an uninjured upper extremity
- Arterial Pressure Index = SBP of the injured limb / SBP of the uninjured upper limb
Any value <0.9 is concerning for an arterial injury, and computed tomography angiogram (CTA) should be considered
If obtaining this measurement is not feasible or suspicion of injury is high and the patient is hemodynamically stable (without indication for immediate surgical intervention), CTA can be performed instead.
Decision
Is arterial pressure index <0.9?
Yes
Perform computed tomography angiography (Class II)
- Evidence for vascular compromise? Obtain surgical intervention (Class I)
- No evidence for vascular compromise? Perform wound care (Class III), and discharge if no other serious injury
No
Perform wound care (Class III), and discharge if no other serious injury
