Abstract
Recognising and managing bleeding in ballistic trauma is an early priority, and all clinicians must be familiar with the initial lifesaving procedures required to arrest major haemorrhage, and maintain patient physiology in order to enable definitive treatment. The <C>ABC paradigm of advanced trauma management denotes that recognition and management of catastrophic haemorrhage is the initial consideration to prevent rapid exsanguination and early fatality [1]. The introduction of major haemorrhage protocols has improved the outcomes in major haemorrhage in many trauma centres worldwide [2].
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hodgetts TJ, Mahoney PF, Russell MQ, Byers M. ABC to <C>ABC: redefining the military trauma paradigm. Emerg Med J. 2006;23(10):745–6.
Khan S, Allard S, Weaver A, Barber C, Davenport R, Brohi K. A major haemorrhage protocol improves the delivery of blood component therapy and reduces waste in trauma massive transfusion. Injury. 2013;44(5):587–92.
Rasmussen TE, Tai NRM. Rich’s vascular trauma. Amsterdam: Elsevier; 2015.
Perkins ZB, De’Ath HD, Aylwin C, Brohi K, Walsh M, Tai NRM. Epidemiology and outcome of vascular trauma at a British Major Trauma Centre. Eur J Vasc Endovasc Surg. 2012;44(2):203–9.
Caps MT. The epidemiology of vascular trauma. Semin Vasc Surg. 1998;11(4):227–31.
Jena AB, Sun EC, Prasad V. Does the declining lethality of gunshot injuries mask a rising epidemic of gun violence in the United States? J Gen Intern Med. 2014;29(7):1065–9.
van Dongen TTCF, Idenburg FJ, Tan ECTH, Rasmussen TE, Hamming JF, Leenen LPH, Hoencamp R. Combat related vascular injuries: Dutch experiences from a role 2 MTF in Afghanistan. Injury. 2016;47(1):94–8.
Rasmussen TE, Clouse WD, Jenkins DH, Peck MA, Eliason JL, Smith DL. Echelons of care and the management of wartime vascular injury: a report from the 332nd EMDG/Air Force Theater Hospital, Balad Air Base, Iraq. Perspect Vasc Surg Endovasc Ther. 2006;18(2):91–9.
Lakstein D, Blumenfeld A, Sokolov T, Lin G, Bssorai R, Lynn M, Ben-Abraham R. Tourniquets for hemorrhage control on the battlefield: a 4-year accumulated experience. J Trauma. 2003;54(5):S221–5.
Mock CN, Jurkovich GJ, nii-Amon-Kotei D, Arreola-Risa C, Maier RV. Trauma mortality patterns in three nations at different economic levels: implications for global trauma system development. J Trauma. 1998;44(5):804–12.
Elias P. Wound ballistics: analysis of blunt and penetrating trauma mechanisms. Health Sci J. available at www.hsj.gr/abstract/Wound-ballistics-analysis-of-blunt-and-penetrating-trauma-mechanisms-3579 accessed 19 Aug 17.
Giannou C, Baldan M, Molde Å. War surgery: working with limited resources in armed conflict and other situations of violence, vol. 2. Geneva: International Committee of the Red Cross; 2013.
Stefanopoulos PK, Filippakis K, Soupiou OT, Pazarakiotis VC. Wound ballistics of firearm-related injuries—part 1: missile characteristics and mechanisms of soft tissue wounding. Int J Oral Maxillofac Surg. 2014;43(12):1445–58.
Symbas PN, Pfaender LM, Drucker MH, Lester JL, Gravanis MB, Zacharopoulos L. Cross-clamping of the descending aorta. Hemodynamic and neurohumoral effects. J Thorac Cardiovasc Surg. 1983;85(2):300–5.
Amiel I, Simon D, Merin O, Ziv A. Mobile in situ simulation as a tool for evaluation and improvement of trauma treatment in the emergency department. J Surg Educ. 2016;73(1):121–8.
Murray DJ, Freeman BD, Boulet JR, Woodhouse J, Fehr JJ, Klingensmith ME. Decision making in trauma settings. Simul Healthc. 2015;10(3):139–45.
Van Der Eng DM, van Beeck EF, Hoogervorst EM, Bierens JJ. Education, exposure and experience of prehospital teams as quality indicators in regional trauma systems. Eur J Emerg Med. 2016;23(4):274–8.
Walters TJ, Mabry RL. Issues related to the use of tourniquets on the battlefield. Mil Med. 2005;170(9):770–5.
Kragh JF, Dubick MA. Battlefield tourniquets: lessons learned in moving current care toward best care in an army medical department at war. US Army Med Dep J. 2015;(2–16):29–36.
Kragh JF, Walters TJ, Baer DG, Fox CJ, Wade CE, Salinas J, Holcomb JB. Practical use of emergency tourniquets to stop bleeding in major limb trauma. J Trauma. 2008;64(2 Suppl):S38–50.
Passos E, Dingley B, Smith A, Engels PT, Ball CG, Faidi S, Nathens A, Tien H. Tourniquet use for peripheral vascular injuries in the civilian setting. Injury. 2014;45(3):573–7.
Tanpowpong T, Kitidumrongsook P, Patradul A. The deleterious effects of exsanguination with a tight bandage on tourniquet tolerance in the upper arm. J Hand Surg Eur Vol. 2012;37(9):839–841.
Kragh JF. Use of tourniquets and their effects on limb function in the modern combat environment. Foot Ankle Clin. 2010;15(1):23–40.
Kragh JF, O’Neill ML, Walters TJ, Jones JA, Baer DG, Gershman LK, Wade CE, Holcomb JB. Minor morbidity with emergency tourniquet use to stop bleeding in severe limb trauma: research, history, and reconciling advocates and abolitionists. Mil Med. 2011;176(7):817–23.
Kozen BG, Kircher SJ, Henao J, Godinez FS, Johnson AS. An alternative hemostatic dressing: comparison of CELOX, HemCon, and QuikClot. Acad Emerg Med. 2008;15(1):74–81.
Satterly S, Nelson D, Zwintscher N, Oguntoye M, Causey W, Theis B, Huang R, Haque M, Martin M, Bickett G, Rush RM. Hemostasis in a noncompressible hemorrhage model: an end-user evaluation of hemostatic agents in a proximal arterial injury. J Surg Educ. 2013;70(2):206–11.
Grissom TE, Fang R. Topical hemostatic agents and dressings in the prehospital setting. Curr Opin Anaesthesiol. 2015;28(2):210–6.
Smith AH, Laird C, Porter K, Bloch M. Haemostatic dressings in prehospital care. Emerg Med J. 2013;30(10):784–9.
Glass GE, Pearse MF, Nanchahal J. Improving lower limb salvage following fractures with vascular injury: a systematic review and new management algorithm. J Plast Reconstr Aesthetic Surg. 2009;62(5):571–9.
Rasmussen T, Clouse W, Jenkins D. The use of temporary vascular shunts as a damage control adjunct in the management of wartime vascular injury. J Trauma. 2006;61:8–12. discussion 12–5
Hughes CW. Arterial repair during the Korean war. Ann Surg. 1958;147(4):555–61.
Sassoon A, Riehl J, Rich A, Langford J, Haidukewych G, Pearl G, Koval KJ. Muscle viability revisited. J Orthop Trauma. 2016;30(1):17–21.
Yazar S, Lin C-H, Wei F-C. One-stage reconstruction of composite bone and soft-tissue defects in traumatic lower extremities. Plast Reconstr Surg. 2004;114:1457–66.
Gonzalez EG, Corcoran PJ, Reyes RL. Energy expenditure in below-knee amputees: correlation with stump length. Arch Phys Med Rehabil. 1974;55(3):111–9.
Subramanian A, Vercruysse G, Dente C, Wyrzykowski A, King E, Feliciano DV. A decadeʼs experience with temporary intravascular shunts at a civilian level I trauma center. J Trauma. 2008;65(2):316–26.
Starnes BW, Beekley AC, Sebesta JA, Andersen CA, Rush RM. Extremity vascular injuries on the battlefield: tips for surgeons deploying to war. J Trauma. 2006;60(2):432–42.
Chambers LW, Green DJ, Sample K, Gillingham BL, Rhee P, Brown C, Narine N, Uecker JM, Bohman HR. Tactical surgical intervention with temporary shunting of peripheral vascular trauma sustained during operation Iraqi freedom: one unit’s experience. J Trauma. 2006;61(4):824–30.
Ding W, Wu X, Li J. Temporary intravascular shunts used as a damage control surgery adjunct in complex vascular Injury: collective review. Injury. 2008;39(9):970–7.
Johansen K, Bandyk D, Thiele B, Hansen ST. Temporary intraluminal shunts: resolution of a management dilemma in complex vascular injuries. J Trauma. 1982;22(5):395–402.
Rich NM, Hobson RW, Wright CB, Fedde CW. Repair of lower extremity venous trauma: a more aggressive approach required. J Trauma. 1974;14(8):639–52.
Inaba K, Aksoy H, Seamon MJ, Marks JA, Duchesne J, Schroll R, Fox CJ, Pieracci FM, Moore EE, Joseph B, Haider AA, Harvin JA, Lawless RA, Cannon J, Holland SR, Demetriades D. Multicenter evaluation of temporary intravascular shunt use in vascular trauma. J Trauma Acute Care Surg. 2016;80(3):359–65.
Oliver JC, Gill H, Nicol AJ, Edu S, Navsaria PH. Temporary vascular shunting in vascular trauma: a 10-year review from a civilian trauma centre. S A J Surg. 2013;51(1):6–10.
Martin LC, McKenney MG, Sosa JL, Ginzburg E, Puente I, Sleeman D, Zeppa R. Management of lower extremity arterial trauma. J Trauma. 1994;37(4):591–8.
Griessenauer CJ, Fleming JB, Richards BF, Cava LP, Curé JK, Younan DS, Zhao L, Alexandrov AV, Barlinn K, Taylor T, Harrigan MR. Timing and mechanism of ischemic stroke due to extracranial blunt traumatic cerebrovascular injury. J Neurosurg. 2013;118(2):397–404.
Aucar JA, Hirshberg A. Damage Control For Vascular Injuries. Surg Clin North Am. 1997;77(4):853–62.
Hardin WD, Adinolfi MF, O’Connell RC, Kerstein MD. Management of traumatic peripheral vein injuries: primary repair or vein ligation. Am J Surg. 1982;144(2):235–8.
Hansen ST. Overview of the severely traumatized lower limb. Reconstruction versus amputation. Clin Orthop Relat Res. 1989;243:17–9.
Penn-Barwell JG. Outcomes in lower limb amputation following trauma: a systematic review and meta-analysis. Injury. 2011;42(12):1474–9.
Feliciano DV, Herskowitz K, O’Gorman RB, Cruse PA, Brandt ML, Burch JM, Mattox KL. Management of vascular injuries in the lower extremities. J Trauma. 1988;28(3):319–28.
Breeze J, Allanson-Bailey LS, Hunt NC, Delaney RS, Hepper AE, Clasper J. Mortality and morbidity from combat neck injury. J Trauma. 2012;72(4):969–74.
Demetriades D, Theodorou D, Cornwell E, Berne TV, Asensio J, Belzberg H, Velmahos G, Weaver F, Yellin A. Evaluation of penetrating injuries of the neck: prospective study of 223 patients. World J Surg. 1997;21(1):41–8.
Mandavia DP, Qualls S, Rokos I. Emergency airway management in penetrating neck injury. Ann Emerg Med. 2000;35(3):221–5.
Lee TS, Ducic Y, Gordin E, Stroman D. Management of carotid artery trauma. Craniomaxillofac Trauma Reconstr. 2014;7(3):175–89.
Amirjamshidi A, Abbassioun K, Rahmat H. Traumatic aneurysms and arteriovenous fistulas of the extracranial vessels in war injuries. Surg Neurol. 2000;53(2):136–45.
Ezemba N, Ekpe EE, Ezike HA, Anyanwu CH. Traumatic common carotid-jugular fistula: report of 2 cases. Tex Hear Inst J. 2006;33(1):81–3.
Jindal G, Fortes M, Miller T, Scalea T, Gandhi D. Endovascular stent repair of traumatic cervical internal carotid artery injuries. J Trauma Acute Care Surg. 2013;75(5):896–903.
Kleber C, Giesecke MT, Lindner T, Haas NP, Buschmann CT. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation. 2014;85(3):405–10.
Keller D, Kulp H, Maher Z, Santora TA, Goldberg AJ, Seamon MJ. Life after near death. J Trauma Acute Care Surg. 2013;74(5):1315–20.
Feden JP. Closed lung trauma. Clin Sports Med. 2013;32(2):255–65.
Dutton RP. Resuscitative strategies to maintain homeostasis during damage control surgery. Br J Surg. 2012;99(S1):21–8.
Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma—a review. Injury. 2006;37(1):1–19.
Puchwein P, Sommerauer F, Clement HG, Matzi V, Tesch NP, Hallmann B, Harris T, Rigaud M. Clamshell thoracotomy and open heart massage – a potential life-saving procedure can be taught to emergency physicians: an educational cadaveric pilot study. Injury. 2015;46(9):1738–42.
Larsson M, Forsman P, Hedenqvist P, Östlund A, Hultman J, Wikman A, Riddez L, Frenckner B, Bottai M, Wahlgren C-M. Extracorporeal membrane oxygenation improves coagulopathy in an experimental traumatic hemorrhagic model. Eur J Trauma Emerg Surg. 2016:1–9. https://doi.org/10/1007/s00068-016-0730-1
Sorrentino TA, Moore EE, Wohlauer MV, Biffl WL, Pieracci FM, Johnson JL, Barnett CC, Bensard DD, Burlew CC. Effect of damage control surgery on major abdominal vascular trauma. J Surg Res. 2012;177(2):320–5.
Nirula R, Maier R, Moore E, Sperry J, Gentilello L. Scoop and run to the trauma center or stay and play at the local hospital: hospital transferʼs effect on mortality. J Trauma. 2010;69(3):595–601.
Taylor DM, Coleman M, Parker PJ. The evaluation of an abdominal aortic tourniquet for the control of pelvic and lower limb hemorrhage. Mil Med. 2013;178(11):1196–201.
Holcomb JB. Methods for improved hemorrhage control. Crit Care. 2004;8(2):S57.
Morrison JJ, Percival TJ, Markov NP, Villamaria C, Scott DJ, Saches KA, Spencer JR, Rasmussen TE. Aortic balloon occlusion is effective in controlling pelvic hemorrhage. J Surg Res. 2012;177(2):341–7.
Hughes CW, Dotter CT, Lukas DS, Edwards WS, Salter PP, Carnaggio VA, Rafucci FL, Wangensteen OH, DeBakey ME, Cooley DA. Use of an intra-aortic balloon catheter tamponade for controlling intra-abdominal hemorrhage in man. Surgery. 1954;36(1):65–8.
Stannard A, Eliason JL, Rasmussen TE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. J Trauma. 2011;71(6):1869–72.
Sadek S, Lockey DJ, Lendrum RA, Perkins Z, Price J, Davies GE. Resuscitative endovascular balloon occlusion of the aorta (REBOA) in the pre-hospital setting: an additional resuscitation option for uncontrolled catastrophic haemorrhage. Resuscitation. 2016;107:135–8.
Rappold JF, Bochicchio GV. Surgical adjuncts to noncompressible torso hemorrhage as tools for patient blood management. Transfusion. 2016;56(S2):S203–7.
Avery LE, Stahlfeld KR, Corcos AC, Scifres AM, Ziembicki JA, Varcelotti J, Peitzman AB, Billiar TR, Sperry JL. Evolving role of endovascular techniques for traumatic vascular injury. J Trauma Acute Care Surg. 2012;72(1):41–7.
Desai SS, DuBose JJ, Parham CS, Charlton-Ouw KM, Valdes J, Estrera AL, Safi HJ, Azizzadeh A. Outcomes after endovascular repair of arterial trauma. J Vasc Surg. 2014;60(5):1309–14.
Robinson TN, Stiegmann GV. Minimally invasive surgery. Endoscopy. 2004;36(1):48–51.
Farber A, Tan T-W, Hamburg NM, Kalish JA, Joglar F, Onigman T, Rybin D, Doros G, Eberhardt RT. Early fasciotomy in patients with extremity vascular injury is associated with decreased risk of adverse limb outcomes: a review of the National Trauma Data Bank. Injury. 2012;43(9):1486–91.
Carden DL, Granger DN. Pathophysiology of ischaemia-reperfusion injury. J Pathol. 2000;190(3):255–66.
Darbari A, Tandon S, Ch M, Chandra G, Dwivedi Dm SK, Kumar A, Gupta A. Post-traumatic peripheral arterial pseudoaneurysms: our experience. Indian J Thorac Cardiovasc Surg. 2006;22:182–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Webster, C., König, T.C. (2017). Management of Vascular Trauma. In: Breeze, J., Penn-Barwell, J., Keene, D., O'Reilly, D., Jeyanathan, J., Mahoney, P. (eds) Ballistic Trauma. Springer, Cham. https://doi.org/10.1007/978-3-319-61364-2_19
Download citation
DOI: https://doi.org/10.1007/978-3-319-61364-2_19
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-61363-5
Online ISBN: 978-3-319-61364-2
eBook Packages: MedicineMedicine (R0)