Blunt aortic injury in adults: Diagnostic algorithm in the hemodynamically stable patient

BAI: blunt aortic injury; CXR: chest radiograph; PA: posterior-anterior; CT: computed tomography; MDCT: multidetector computed tomography; IV: intravenous; TEE: transesophageal echocardiogram; MVC: motor vehicle collision; SBP: systolic blood pressure; HR: heart rate.

* For example, high-risk mechanisms of injury include (but are not limited to) MVCs with no seatbelt use, extensive vehicular damage, steering wheel deformity, or speed >40 miles per hour (>65 kilometers per hour); fall >20 feet (>6 meters); anything that causes rapid deceleration.

¶ The absence of these findings does not rule out aortic injury.

Δ Inadequate study may be due to patient movement, mistimed IV contrast injection, or inadequate aorta visualization. An equivocal study may be due to artifact obscuring the aorta or a rib fracture causing a small amount of mediastinal blood. The presence of other CT features (eg, mediastinal blood) raises suspicion of BAI but can occur in the absence of aortic abnormalities.

◊ Use short-acting IV beta-blocker (eg, esmolol IV) with approximate SBP goal of 100 mmHg and HR goal <100 beats per minute.