Category 1 (Hard Signs): These include pain, pallor, pulselessness, parasthesias, paralysis, pulsatile bleeding and large or expanding hematoma. If the patient shows these signs, he will have > 90% chance of vascular injury.
'Hard' signs are made up of distal circulatory deficit (ischaemia, diminished or absent pulse), bruit, expanding or pulsatile haematoma, and arterial bleeding.
Hard and soft signs
Signs of limb ischemia and elevated compartment pressure including the 5 "P's: pallor, paresthesias, pulse deficit, paralysis, and pain on passive extension of the compartment. Pain on passive extension is the earliest and most sensitive physical finding.
So what are the hard signs? We like this simple mnemonic: “HARD Bruit” (Figure): Hemodynamically unstable, Hemoptysis, Hematemesis, Arterial bleeding, Rapidly expanding hematoma, Deficit (whether vascular or neurologic), and a Bruit or thrill. If they have any of these findings, stop.
The soft signs of penetrating neck trauma include minor hemoptysis, hematemesis, dysphonia, dysphagia, subcutaneous, or mediastinal air, non-expanding hematoma. Beware that penetrating injuries involving zones 1 and 3 have a higher risk for occult vascular injury.
Symptoms and Severity Classification
Characteristic physical findings of ALI include the 5Ps—acute onset of progressive pain in the affected limb (pain), pulselessness, pallor, paresthesia, and paralysis.
Six Ps — The six Ps of acute ischemia include pain, pallor, poikilothermia, pulselessness, paresthesia, and paralysis. Pain – Pain associated with acute arterial occlusion is usually located distally in the extremity, gradually increases in severity, and progresses proximally with increased duration of ischemia.
The most common ECG sign of myocardial ischemia is flat or down-sloping ST-segment depression of 1.0 mm or greater.
Category 1 (Hard Signs): These include pain, pallor, pulselessness, parasthesias, paralysis, pulsatile bleeding and large or expanding hematoma. If the patient shows these signs, he will have > 90% chance of vascular injury.
The liver is the most commonly injured organ in blunt abdominal trauma and the second most commonly injured organ in penetrating abdominal trauma [3-6].
An extensive wound or trauma is a severe damage to the soft tissues in the skin. It is a medical condition in which the soft tissues of the skin sustain injury or break down. These severe wounds or injuries can occur after accidents, or due to violence. These accidents may occur at home, or typify road accidents.
Soft signs refer to subtle abnormalities in sensory-perceptual, motor, or other central nervous system functions. They are findings that are pathological at any age, but more subtle manifestations of hard signs or behaviors that are abnormal because they persist beyond a normal age.
Neck trauma may be blunt, penetrating or a combination of both. Penetrating neck injuries in the older child may include those from gunshot wounds, stab wounds, or debris, such as glass or shrapnel, secondary to experimentation with flammable/explosive materials.
Head and neck injuries include clavicular fractures, as well as injuries to the brachial plexus, phrenic nerve, facial nerve, laryngeal nerve, and nasal skeleton.
Some people who have myocardial ischemia don't have any signs or symptoms (silent ischemia). When they do occur, the most common is chest pressure or pain, typically on the left side of the body (angina pectoris).
How is silent ischemia diagnosed? Silent ischemia is usually not discovered until someone undergoes a stress test for another reason, like angina or cardiovascular disease risk. An electrocardiogram may also find evidence of ischemia. A Holter monitor is a long-term electrocardiogram.
Ischemia of the Heart Symptoms and Signs
Chest pain (angina) Shortness of breath. Fast heartbeat. Shoulder or back pain. Neck, jaw, or arm pain.
There are three main stages of acute limb ischemia, which include Stage 1 (limb is not immediately threatened, no sensory loss), Stage 2 (limb is salvageable), and Stage 3 (limb has major tissue loss or permanent nerve damage inevitable).
The majority of serious traumatic injuries are due to blunt trauma from motor vehicle crashes and pedestrian injuries. Falls are also an important cause, particularly in the elderly. Direct blows, assaults, and sporting injuries are also common.
Signs of life were considered present with any of the following: pupillary response, spontaneous ventilation, presence of carotid pulse, measureable or palpable blood pressure, extremity movement, or cardiac electrical activity.
Neck injury may result in the laceration of major vessels, potentially leading to hemorrhagic shock. Extracranial arterial injuries to the brachiocephalic, common carotid, and vertebral arteries can result in major neurologic deficits.