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decreased pulses, decreased capillary refill, expanding hematoma
- ABI = ankle-brachial index = systolic pressure in leg at ankle / systolic pressure in ipsilateral arm
- IEI = injured extremity index = systolic pressure in injured extremity / systolic pressure in uninvolved arm
- ABI > 0.90 is normal
- ABI < 0.90 is abnormal. Highly sensitive and specific for vascualr injury requiring surgical repair.
- Diagnostic Arteriography: 19 gauge butterfly, 3-way stopcock, 20-30cc syringe, Full strength contrast; Arterial puncture proximal to injury/repair, Inflow occlusion if possible, X-ray toward end of injection.
Vascular Repair
- Obtain exposure with longitudinal incision
- Obtain proximal and distal control
- Thrombectomoy
- Proximal and distal heparin injection (1000u Heparin/1 liter saline)
- Debride vessels to normal wall.
- Shut or repair (contralateral saphenous graft)
- Fasciotomy
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