{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Episode 929: Traumatic Aortic Injury","description":"Contributor: Aaron Lessen MD Educational Pearls:   Aortic injury occurs in 1.5-2% of patients who sustain blunt thoracic trauma    Majority are caused by automobile collisions or motorcycle accidents   Due to sudden deceleration mechanism accidents    Clinical manifestations    Signs of hypovolemic shock including tachycardia and hypotension, though not always present   Patients may have altered mental status    Imaging    Widened mediastinum on chest x-ray, though not highly sensitive   CT is more sensitive and specific, and signs of thoracic injury include an intimal flap, aortic wall outpouching, and aortic contour abnormalities   In hemodynamically unstable or otherwise unfit for CT patients, transesophageal echocardiogram may be used    Four types of aortic injury (in order of ascending severity)    I: Intimal tear or flap   II: Intramural hematoma   III: Pseudoaneurysm   IV: Rupture    Management    Hemodynamically unstable: immediate OR for exploratory laparotomy and repair   Hemodynamically stable: heart rate and blood pressure control with beta-blockers   Minor injuries are treated with observation and hemodynamic control   Severe injuries may receive surgical management    Some patients benefit from delayed repair   An endovascular aortic graft is a surgical option     Mortality    80-85% of patients die before hospital arrival   50% of patients that make it to the hospital do not survive    References   Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma [published correction appears in J Trauma Acute Care Surg. 2015 Feb;78(2):447]. J Trauma Acute Care Surg. 2015;78(1):136-146. doi:10.1097\/TA.0000000000000470   Lee WA, Matsumura JS, Mitchell RS, et al. Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg. 2011;53(1):187-192. doi:10.1016\/j.jvs.2010.08.027   Osgood MJ, Heck JM, Rellinger EJ, et al. Natural history of grade I-II blunt traumatic aortic injury. J Vasc Surg. 2014;59(2):334-341. doi:10.1016\/j.jvs.2013.09.007   Osman A, Fong CP, Wahab SFA, Panebianco N, Teran F. Transesophageal Echocardiography at the Golden Hour: Identification of Blunt Traumatic Aortic Injuries in the Emergency Department. J Emerg Med. 2020;59(3):418-423. doi:10.1016\/j.jemermed.2020.05.003   Steenburg SD, Ravenel JG, Ikonomidis JS, Sch\u00f6nholz C, Reeves S. Acute traumatic aortic injury: imaging evaluation and management. Radiology. 2008;248(3):748-762. doi:10.1148\/radiol.2483071416   Summarized by Jorge Chalit, OMS3 | Edited by Meg Joyce &amp;amp; Jorge Chalit Donate: https:\/\/emergencymedicalminute.org\/donate\/ &amp;nbsp; ","author_name":"Emergency Medical Minute","author_url":"https:\/\/www.emergencymedicalminute.com","html":"<iframe title=\"Libsyn Player\" style=\"border: none\" src=\"\/\/html5-player.libsyn.com\/embed\/episode\/id\/33770617\/height\/90\/theme\/custom\/thumbnail\/yes\/direction\/forward\/render-playlist\/no\/custom-color\/fa102a\/\" height=\"90\" width=\"600\" scrolling=\"no\"  allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen><\/iframe>","thumbnail_url":"https:\/\/assets.libsyn.com\/secure\/item\/33770617"}