Bageris Matthew H, Chassee Todd, Benner Chris
Pediatric Emergency Medicine, Helen Devos Children's Hospital, Grand Rapids, USA.
Emergency Department, Michigan State University College of Human Medicine, Grand Rapids, USA.
Cureus. 2023 Jan 10;15(1):e33611. doi: 10.7759/cureus.33611. eCollection 2023 Jan.
Trauma patients who are hemodynamically unstable or have certain signs of vascular injury should have immediate surgical exploration. For less severe signs of vascular injury, current literature states that endovascular intervention is optimal. This case presents the opportunity to review how signs of vascular injury were considered along with other diagnostic tools to inform decision-making after a penetrating stab wound injury to an extremity. A 15-year-old male presented to the emergency department (ED) as a trauma activation after being stabbed in the left thigh. The patient had an approximately 5 cm long laceration over the lateral superior aspect of his left thigh with visible subcutaneous tissue and biceps femoris muscle upon probing. He had an initial blood pressure of 101/61 mm Hg. Shortly after the tourniquet was removed, the patient developed brisk bleeding from the wound and his blood pressure decreased to 88/55 mm Hg. He was taken expediently to computed tomography (CT) for an angiogram of the lower extremity which showed active bleeding from a posterior peripheral branch arising from the deep femoral artery in the posterolateral thigh. Interventional radiology performed intravascular embolization, and hemostasis was achieved. The patient was admitted for observation and then discharged 17 hours after admission without ambulatory difficulty. We present a case of penetrating extremity trauma (PET) where the patient had a presentation with mixed hard signs and soft signs of vascular injury. The patient responded well to endovascular embolization. Early detection and intervention in PET are critical in minimizing blood loss and ischemia to distal structures. While following professional organization guidelines can help guide care, a collaborative approach by multiple specialty care teams is critical in providing optimal care in PET.
血流动力学不稳定或有某些血管损伤迹象的创伤患者应立即进行手术探查。对于血管损伤迹象较轻的患者，当前文献表明血管内介入治疗是最佳选择。本病例提供了一个机会，来回顾在肢体穿透性刺伤后，如何结合其他诊断工具来考虑血管损伤迹象，从而为决策提供依据。一名15岁男性因左大腿被刺伤后作为创伤激活患者被送往急诊科。患者左大腿外侧上方有一处约5厘米长的裂伤，探查时可见皮下组织和股二头肌。他的初始血压为101/61毫米汞柱。止血带拆除后不久，患者伤口出现大量出血，血压降至88/55毫米汞柱。他被迅速送往计算机断层扫描（CT）室进行下肢血管造影，结果显示大腿后外侧深股动脉的一支外周后分支有活动性出血。介入放射科进行了血管内栓塞，实现了止血。患者入院观察，入院17小时后出院，无行走困难。我们报告一例穿透性肢体创伤（PET）病例，该患者同时出现了血管损伤的硬体征和软体征。患者对血管内栓塞治疗反应良好。PET的早期检测和干预对于减少远端结构的失血和缺血至关重要。虽然遵循专业组织的指南有助于指导治疗，但多个专科护理团队的协作方法对于在PET中提供最佳护理至关重要。
