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Traumatic Aortic Rupture
Traumatic Aortic Disruption: What Is It?Traumatic aortic disruption is caused by the shearing forces of high-speed front and side impact automobile accidents and by falls from great heights that tear the aorta away from the heart. The ER staff normally sees cases where the aorta is only partially disrupted because a complete disruption will kill a victim within moments of the accident, usually at the scene.
Unlike broken bones or bleeding wounds, partial aortic injury can be difficult to detect for a harried ER doctor. Further complicating matters is that many car accident victims have all sorts of other life-threatening injuries that demand immediate attention. A small minority of patients with traumatic aortic disruption may have chest or upper back pain that increase as blood pressure increases; this is a warning sign that the aorta is about to tear away completely from the heart. Even fewer complain of difficulty swallowing, difficulty speaking, hoarseness, or shortness of breath — all possible signs of a torn aorta. Frighteningly, most have no symptoms at all.
Traumatic aortic disruption often first shows up on a chest x-ray, although a chest x-ray does not always settle the matter. A normal chest x-ray does not completely rule out aortic injury and false-positive results are not uncommon. Part of the problem is that it can be difficult to move seriously injured patients into the best position to be x-rayed clearly. For this reason, doctors sometimes look for traumatic aortic disruption using other diagnostic techniques, such as transesophageal echocardiography (TEE), which can be done at the patient's bedside, or contrast-enhanced CT scan (computed tomography), also known as a CAT scan.
What's the Treatment?Once traumatic aortic disruption is confirmed, the only treatment is surgery. The question is whether or not to operate immediately. The answer depends on what other injuries the patient has suffered and whether the aortic rupture is likely to get worse suddenly. Since the forces that cause aortic injury are tremendous, they often cause other injuries that are more immediately life threatening. In these cases, the ER doctor may decide to treat these injuries before doing heart surgery.
Whatever the decision, the doctor must continue to watch carefully for elevated blood pressure. Elevated blood pressure can sometimes cause a ruptured aorta to tear away completely, which would be fatal. Finally, any procedure that can make a patient gag and vomit, such as the use of a nasogastric tube to remove blood from the stomach, should be avoided as the straining from gagging and vomiting could further injure the torn aorta. Emphasis has to be placed on keeping the patient as comfortable and calm as possible. As part of this effort, the patient needs to be given enough pain-relief medicine to help keep their blood pressure down.
ConclusionThough often hard to detect and, sometimes, virtually invisible, traumatic aortic disruption is one of the main causes of death after a car accident or similar severe injury. Survival is often a matter of getting to the ER right away — and finding an observant and alert medical staff.
May 1, 2000
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