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Traumatic Aortic Rupture
Dr. Lynn Schrader is board certified in emergency medicine and is currently an Assistant Professor of Emergency Medicine at the University of Arkansas where her focus is on EMS disaster medicine and trauma care.
Suppose you are suddenly called to the hospital because your son or brother has been in a car accident. He survives and makes it to the local emergency room, awake and apparently in pretty good shape, but then turns out to have suffered a serious heart injury. His aorta, the main trunk through which the heart pumps blood into the arteries, is ruptured, or partially torn away from the heart. Called traumatic aortic disruption, this is a common cause of death in automobile collisions and other accidents. As serious and as common as it is, however, traumatic aortic disruption can be surprisingly difficult for doctors or emergency medical staff to detect.
The following scenario is designed to take you through a typical case and to tell you what you would want to know if you were to find yourself or a loved one in this all-too-common situation.
EMS Radio Report"County emergency! This is EMS Unit 201 en route with a single patient from a two-car, head-on road crash," the EMS radio broadcasts.
The patient is a 21-year-old male, un-seatbelted passenger who was briefly trapped in the vehicle. The steering wheel was broken and the windshield smashed. Bystanders report that the patient was unconscious for a few minutes after the accident. However, he is now awake but confused and agitated.
"The patient has slightly elevated blood pressure, facial cuts and blood in both nostrils. Breathing okay, lungs are clear. No obvious damage to the abdomen," the EMTs radio.
The patient has been strapped to a board and put in a cervical collar to protect his spine from further injury, and has been given an oxygen mask and IV saline.
"We will be in the department in two minutes."
Arrival in the EROn arrival in the emergency room, the patient complains loudly of neck, back, chest and knee pain. He remains agitated, giving the ER staff a hard time. His blood pressure is taken again and is now a bit higher. His neuro exam appears normal. No apparent neck or back injury. With his stethoscope, the doctor hears some crackling sounds around the left lung. The patient's chest is slightly bruised but the doctor hears no unusual sounds from the heart. Pulse is strong. The doctor orders x-rays of the neck, spine, chest and pelvis.
When the ER doctor looks at the chest x-ray, he is surprised to find signs of traumatic aortic disruption, a potentially fatal heart injury. Indeed, nearly 90% of patients with aortic injuries die before they even get to the ER. Among those who have this injury and arrive alive at the hospital, 20-30% will die in the first six hours, 40-50% in the first 24 hours and 60-80% in the first week.
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