Evaluation and Management of Peripheral
Vascular Injury
Part 1

Annotation for Point B

“Hard” or overt signs of an arterial injury in an extremity are as follows: (1) external bleeding; (2) a rapidly expanding hematoma; (3) any of the classical signs of arterial occlusion (pulselessness, pallor, paresthesias, pain, paralysis = 5 “P”s); and (4) a palpable thrill/ audible bruit.^17,23 Immediate operation on the injured extremity is appropriate in the patient without other life-threatening injuries (see notes “C’ and “D”). In the patient with an intracranial hematoma with midline shift of the brain, hemorrhage in the chest, abdomen or pelvis, gastrointestinal contamination in the abdomen, or injuries to vessels in two extremities, two operative teams, are appropriate. One team should manage the life-threatening injury elsewhere, while the second team should control peripheral arterial (or venous) hemorrhage or correct arterial occlusion and insert a temporary intraluminal shunt in the injured artery or vein.²⁴