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Peripheral Vascular Injuries Treatment & Management

  • Author: Niels K Rathlev, MD, FACEP; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Oct 08, 2015
 

Prehospital Care

Perform the following for peripheral vascular injuries:

  • Stabilize the extremity in the anatomic position.
  • Control hemorrhage with direct pressure.
  • Apply a tourniquet proximal to the injury if direct pressure is not effective in controlling hemorrhage.
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Emergency Department Care

Immediately reduce displaced or angulated fractures if any evidence or suspicion of vascular compromise exists. Promptly reduce dislocations of the elbow and knee to prevent further injury to neurovascular structures.

External hemorrhage usually can be controlled with direct pressure, but a blood pressure cuff or tourniquet should be applied proximally to the injury if compression fails or is not possible.

Once the patient has been stabilized, identify peripheral vascular injuries and restore normal circulation as rapidly as possible.

Do not apply clamps or hemostats to vascular structures, since this may make definitive repair more difficult and damage surrounding tissues.

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Consultations

A vascular surgeon must be consulted whenever a major vascular injury is a concern.

Vascular injury sustained during battlefield combat is often managed via revascularization. Reconstruction methods should be a focus of combat surgery training. Ligation is also an effective intervention.[17]

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Contributor Information and Disclosures
Author

Niels K Rathlev, MD, FACEP Professor and Chair, Department of Emergency Medicine, Tufts University School of Medicine and Baystate Medical Center

Niels K Rathlev, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Society for Academic Emergency Medicine, Association of Academic Chairs of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

David B Levy, DO, FAAEM Senior Consultant in Emergency Medicine, Waikato District Health Board, New Zealand; Associate Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine

David B Levy, DO, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, Fellowship of the Australasian College for Emergency Medicine, American Medical Informatics Association, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

David A Peak, MD Associate Residency Director of Harvard Affiliated Emergency Medicine Residency; Attending Physician, Massachusetts General Hospital; Assistant Professor, Harvard Medical School

David A Peak, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, Undersea and Hyperbaric Medical Society, American Medical Association

Disclosure: Partner received salary from Pfizer for employment.

References
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