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S. Chakraverty, I. Zealley, D. Kessel  British Journal of Anaesthesia 

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Presentation on theme: "S. Chakraverty, I. Zealley, D. Kessel  British Journal of Anaesthesia "— Presentation transcript:

1 Damage control radiology in the severely injured patient: what the anaesthetist needs to know 
S. Chakraverty, I. Zealley, D. Kessel  British Journal of Anaesthesia  Volume 113, Issue 2, Pages (August 2014) DOI: /bja/aeu203 Copyright © 2014 The Author(s) Terms and Conditions

2 Fig 1 A 75-yr-old female pedestrian injured in road traffic collision. Permissive hypotension but unstable. (a) Sagittal reformat of MDCT showing ruptured internal iliac artery at its origin form common iliac artery (arrowed). Extensive pelvic haematoma and fractures. (b) Stent-graft placement (arrowed) lining iliac artery with immediate AP restoration. Time from ED to CT 45 min. Time from the patient coming off CT table to completion of stent-graft 15 min. In retrospect, balloon occlusion of the aorta or iliac artery while in CT could have been considered. Interval cholecystectomy at 14 days for presumptively ischaemic perforation. Patient died at 30 days from multi-organ failure. British Journal of Anaesthesia  , DOI: ( /bja/aeu203) Copyright © 2014 The Author(s) Terms and Conditions

3 Fig 2 Diagram to conceptualize the benefit of damage control surgery (DCS) over standard surgery in obtaining earlier haemostasis. The use of MDCT can shorten this overall time as it will guide DCS (or IR) to achieve directed haemostasis more quickly, even if the start of the therapeutic manoeuvre is slightly later than it might otherwise be. British Journal of Anaesthesia  , DOI: ( /bja/aeu203) Copyright © 2014 The Author(s) Terms and Conditions

4 Fig 3 A 40-yr-old male injured in road traffic collision. Permissive hypotension but unstable. (a) Coronal CT reformat shows splenic contusion, active extravasation from the spleen (arrowed), and free intraperitoneal blood. (b) Pre-embolization image at angiography. The patient had splenic artery embolization to area of vascular injury (arrowed) with immediate AP restoration. Time from ED to CT 60 min. Time from coming off CT table to last splenic artery coil 15 min. Temporary ileus in hospital. Patient discharged well at 14 days. If procedure had not been as straightforward, a more proximal splenic artery embolization could have been performed. British Journal of Anaesthesia  , DOI: ( /bja/aeu203) Copyright © 2014 The Author(s) Terms and Conditions

5 Fig 4 A 22-yr-old female injured in road traffic collision. Extensive pelvic injury, metabolic upset, and coagulopathy on delayed arrival. Extensive pelvic haematoma with no bleeding site identified, presumably due to transient loss of blood pressure control. Note size of femoral arteries (arrowed) below pelvic binder which might render access difficult even with ultrasound control. Time from ED to CT 25 min. CT also showed irretrievable head injury and resuscitation was abandoned. British Journal of Anaesthesia  , DOI: ( /bja/aeu203) Copyright © 2014 The Author(s) Terms and Conditions

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