# Injury of the circulatory system - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD35 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Vascular Extremity Trauma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK536925/ · Huber GH, Manna B. Vascular Extremity Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: April 19, 2023. - Verified date: 2026-08 ## Verified against - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Referral & Advice) ## Complete treatment card ```text INJURY OF THE CIRCULATORY SYSTEM Sources: ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class KD35 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Vascular Extremity Trauma - StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK536925/ · Huber GH, Manna B. Vascular Extremity Trauma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-. Last Update: April 19, 2023. Review status: REVIEWED against the source listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Hard signs of a vascular injury (per WTA) are a growing hematoma, a bruit, a thrill, external bleeding, no pulse, pallor, numbness or tingling, paralysis, or pain [bleeding · bruit · hematoma · numbness · pallor · paralysis · tingling] - EAST defines hard signs more narrowly as pulsatile bleeding, a thrill, a missing pulse, a bruit, or an expanding hematoma [bleeding · bruit · hematoma] - A single soft sign carries roughly a 10% chance of vascular injury, and two or more soft signs raise that to about 25% SIGNS - what you find (4) - Feeling equal pulses on both sides is reassuring against a significant arterial injury, though further testing is still needed to be sure - A mangled limb involves damage to at least 3 of 4 structures - blood vessels, soft tissue, bone, and nerves - In one small study, a Mangled Extremity Severity Score above 7 predicted a 100% amputation rate, though larger studies since have not confirmed such scoring tools work well - A pulse exam can still feel normal in 5 to 15% of patients who actually have a vascular injury TESTS (9) - In one series, every penetrating-injury patient with hard signs turned out to have a major vascular injury at surgery, supporting exam-based triage to the operating room - EAST guidance calls for restoring blood flow within 6 hours to give the limb the best chance of survival - Among patients with only soft signs, the actual rate of arterial injury runs from about 3% to 25% - A limb pressure index of 0.9 means no further imaging is needed, since both sensitivity and specificity exceed 95% at that point - If the injured limb's pressure index reads 0.1 or lower against the other side, further imaging is required - In one study, a pressure index under 0.90 was 87% sensitive and 97% specific for a torn artery versus formal arteriography, rising to 95% and 97% when checked against clinical outcome - CT arteriography is backed by the highest tier of EAST evidence as the imaging test of choice, despite drawbacks like poor arterial contrast filling and streak artifact - How close a wound sits to an artery does not by itself justify formal arteriography, since exam alone gives much the same information - Duplex ultrasound has a reported specificity around 95%, but its sensitivity swings widely, from 50% up to 100% IF NOT THIS - what else fits (2) - Five patterns of arterial injury are described: a full wall defect causing bleeding or a false aneurysm, an inner-layer (intimal) injury, an arteriovenous fistula, a complete tear, or spasm - Blunt trauma tends to cause an inner-layer injury, while penetrating trauma more often causes a wall defect, complete tear, or arteriovenous fistula Source StatPearls "Vascular Extremity Trauma" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE) [1st line] Adult Covers injuries to blood vessels (laceration, blunt trauma); significant vascular injury needs emergency surgical referral, while the GP's practical contribution is first aid, pressure control, tetanus prophylaxis, and analgesia while arranging transfer. - Refer, with advice Peds Children follow the same pathway: recognise and refer. No primary-care medicine is implied. Source No dose - referral pathway, no medicine given in primary care Why Covers injuries to blood vessels (laceration, blunt trauma); significant vascular injury needs emergency surgical referral, while the GP's practical contribution is first aid, pressure control, tetanus prophylaxis, and analgesia while arranging transfer. Caution Uncontrolled bleeding, an expanding haematoma, absent or weak pulses distal to the injury, or signs of shock are surgical emergencies. No medicine is prescribed for this in primary care - this entry is for recognition and referral. Anything given is decided by the service it is referred to. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)