<p> Blunt Thoracic Aortic Injury</p><p>A. For patients with very suspicious chest radiograph with hypertension OR diagnosis of BTAI on helical chest CT or angiogram:</p><p>Start Antihypertension regimen:</p><p>1. Infuse esmolol bolus then maintenance rate for a goal BP (syst) 100-120 mmHg, heart rate <100</p><p>2. Add second agent such as Nitroprusside if BP (syst) still elevated despite esmolol</p><p>B. Treat ongoing life-threatening hemorrhage from other injuries prior to treatment of BTAI (unless patient actively bleeding from aorta).</p><p>C. Treat coagulopathy if present.</p><p>D. Once diagnosis of BTAI established consult Cardiac Surgery and evaluate the following to determine early or delayed repair.</p><p>Reasons for delayed repair:</p><p>1. Pa02/Fi02 ratio less than 150</p><p>2. CNS injuries which should be delayed: a. massive contusion b. evidence of shift on Head CT c. large areas of intracerebral blood d. high ICP (consistently >20) e. need for systemic heparinization for full bypass felt to be contraindicated by Neurosurgery.</p><p>3. Ongoing major transfusion requirement or coagulopathy</p><p>4. Massive, open, contaminated wounds or burn where likelihood of wound sepsis is high.</p><p>E. If patient to be delayed for longer than 48 hours:</p><p>1. Continue beta-blocker therapy, convert to long-acting agent (labetalol or atenolol)</p><p>2. Add secondary long acting antihypertensives as necessary</p><p>3. BP (syst) may be liberalized at 7 days to 150-160 mmHg</p><p>4. Physical therapy may begin at day 5</p><p>F. Any additional concerns or problems should be discussed at the attending level between the TB and Cardiac surgeons.</p>