Blunt Aortic Injury Work-Up

Patients are at risk for Blunt Aortic injury if:

• they have a deceleration from 30 mph or more
• they have an acceleration of 30 mph or more
• they have a sudden chest compression

Examples of these "mechanisms" are:

• car crash at 30 mph or more
• fall from 30 ft (3 stories) or more, ie. terminal velocity of 30 mph
• pedestrian struck and thrown (acceleration)
• crush to chest

If a patient has a complete rupture of their thoracic aorta, they are dead at the scene.
We want to identify those patients with a partial transection, ie. pseudoaneurysm.

Once we determine if a patient has "mechanism", we look for either a chest x-ray finding or a physical exam finding.

Some chest x-ray findings are:

• widened mediastinum (over 8cm)
• blunting of aortic knob
• rightward deviation of trachea or NGT
• downward displacement of left mainstem bronchus
• fracture of 1st or 2nd rib, sternum or scapula (indicates amount of force)

Physical findings may include:

• chest wall tenderness
• chest wall pain
• anterior chest wall abrasions

If a patient has mechanism plus either a CXR finding or a physical finding, they should have a CT of their aortic arch.

http://www.east.org/research/treatment-guidelines/aortic-blunt-injury-diagnosis-and-management