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Question: Trauma

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You are seeing a 2yo who was being carried by a teenager who fell through a glass sliding door. The toddler has a 1.5 inch laceration of the right neck at the level of the thyroid cartilage. 

Which of the following is a “hard sign” concerning for vascular injury?
16 votes

pemsou5_wp • December 15, 2020

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  1. Kelly December 21, 2020 - 12:29 am Reply

    E) Vascular bruit
    The presence of “hard” signs for vascular injury necessitates immediate emergent management, typically surgical consultation and operative exploration. In addition to vascular bruit or thrill, other hard signs include: expanding or pulsatile hematoma, uncontrolled hemorrhage, fluid-resistant shock, weak distal pulses, and neurologic deficit indicative of cerebral ischemia. “Soft” signs require close observation and frequent reevaluation for development of hard signs: hemoptysis, hematemesis, oropharyngeal blood, fluid-responsive shock, dysphonia, dysphagia, dyspnea, non-pulsatile non-expanding hematoma, mild bleeding, subcutaneous or mediastinal air, chest tube air leak, and focal neurologic deficit not concerning for cerebral ischemia.

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