Peripheral Vascular Injury Management

Hard findings Soft findings
  • Absent distal pulses
  • Pulsatile bleeding
  • Audible bruit
  • Palpable thrill
  • Expanding or pulsatile hematoma
  • Distal signs of ischemia such as pallor, cyanosis, decreased temperature
  • Palpable but diminished (sometimes grouped with hard)
  • Isolated peripheral nerve injury
  • History of haemorrhage in the field
  • Unexplained hypotension
  • Complex fracture
  • Stable, non-pulsatile hematoma
  • Proximity of injury to major vascular structures
  • Blind clamping of vessels can lead to nerve damage.
  • Target systolic blood pressure in hypotensive resuscitation is 90.
  • Major vascular injuries should be repaired within six hours to prevent long-term damage.



Emergency Medicine Kenya Foundation