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IVC TRAUMA NORTHERN TRAUMA CONFERENCE 2014. IVC TRAUMA Penetrating Blunt Non.

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Presentation on theme: "IVC TRAUMA NORTHERN TRAUMA CONFERENCE 2014. IVC TRAUMA Penetrating Blunt Non."— Presentation transcript:

1 IVC TRAUMA NORTHERN TRAUMA CONFERENCE 2014

2 IVC TRAUMA Penetrating Blunt Non

3 IVC Trauma due to penetrating injury High mortality (70%) Higher if other associated vascular injuries Recognised as a severe marker of injury Consider other involved structures

4 IVC TRAUMA - Imaging Range of injuries Severity of injury Difficulty of imaging - rate of blood loss and poor identification Rare finding. They often die before reaching CT

5 IVC TRAUMA - IMAGING SIGNS Index of suspicion. If you don't look for it, you won't find it. Active bleeding on CT Retro peritoneal haematoma Adjacent organ injury or other injuries Flat IVC Direct/indirect. Two lists

6 IVC Injury – Imaging signs DIRECT Extravasation Retroperitoneal haematoma INDIRECT Adjacent injuries Pericaval oedema Hypovolaemia

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10 American Association for the Surgery of Trauma Organ Injury Scale for Vascular Injuries OIS Grade * Artery InjuredVein Injured IIHepatic Splenic Gastric Gastroduodenal Inferior mesenteric Primary named vessels of superior mesenteric Splenic Inferior mesenteric IIIRenal Iliac Hypogastric Superior mesenteric Renal Iliac Hypogastric Vena cava (infrarenal) IVSuperior mesenteric (trunk) Celiac axis Aorta (infrarenal Vena cava (infrahepatic) VAorta (suprarenal)Vena cava (suprahepatic) Vena cava (retrohepatic) Portal Hepatic (extrahepatic)

11 IVC Injury - Penetrating 24 year old male 0100 Stabbed in back 0230 Arrived in TU ED 0500 CT scan 0730 Laparotomy 1000 Transfer to Cardiothoracic Surgery

12 IVC Injury - Penetrating

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14 IVC Injury

15 IVC Injury - Blunt 22 year old male RTC – two vehicle head on collision. Driver of vehicle Direct to MTC

16 IVC Injury - Blunt 22 year old male RTC – two vehicle head on collision. Driver of vehicle Direct to MTC Injuries include Left hepatic contusion Ruptured left hemidiaphragm

17 IVC Injury - Blunt 22 year old male RTC – two vehicle head on collision. Driver of vehicle Direct to MTC Injuries include Left hepatic contusion Ruptured left hemidiaphragm

18 IVC injury – blunt trauma

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20 IVC Injury - Blunt 22 year old male RTC – two vehicle head on collision. Driver of vehicle Direct to MTC Injuries include Left hepatic contusion Ruptured left hemidiaphragm Retroperitoneal haematoma 2ary to IVC laceration

21 IVC Injury - Blunt Repaired surgically (along with other injuries) Good recovery

22 IVC TRAUMA - SUMMARY Marker of v severe injury Rarely reaches imaging Awareness of potential allows recognition Underestimation of depth of penetration in penetrating injury Underestimation of haemorrhage in penetrating injury


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