14 - vascular emergencies Flashcards
stanford classification of aortic dissections
class A - ascending class B - more distal
3 normal aging risk factors
- age
- male
- HT
4 predispositons to weak wall
- preg
- fam Hx
- previous repair
- CT disorders
2 increased stresses to wall
- cocaine
2. congenticla bicuspid valve
3 chest pain red flags
- with neuro features
- migrating to abdomen
- with ischemic Sx
4 signs on physical
- HT
- pulse differential at different sites
- BP diff >10 in 2 arms
- murmuer of aortic insuff
main investgations
CXR - widened mediastinum
CT with contrast
Transeso US - best if patient unstable
2 principles behind mgmt
- pain control
2. prevet more tearing
how to manage
rate and BP control
-BB - labetalol
- nitroprusside
then surgery
risk factors for AAA (8)
common (5-10% of men over 65)
- HT
- over 50
- male
- PVD
- fam Hx
- smoking
- diabetes
- CT disease
Sx of ruptures AAA
sudden onset back or flank pain
- speed of onset important
- syncope
-
4 diagnoses that should think about AAA
- renal colic
- unexplained HypoT or syncope
- MSK back pain
- previosu repair of AAA
imaging for AAA
- US is best - outside diameter of 3 cm
2. CT is 100% accurate
mgmt of AAA
folllow for serial ultrasound or repair
mgmt of AAA rupture
prep for surgery
- 2 IVs
- crossmatch
importance of arterial occlusion
serious - can require amputation
risk factors for arterial emoblism 3
- MI
- a fib
- valve stenosis/replacement
2 risks for thrombosis
- occlusion of previosu stent or graft
2. PVD
5 other sources of emboli
- AAA
- cancer mets
- recent surgery
- bact, endocardidits
- IV drug use
6 Ps on Hx
- pain
- pallor
- parathesia
- pulseless
- polar - cool to touch
- paralysis
investigations for occlusions
mostly clinical
- can use US and CT angio
mgmt of occlusion
- IV heparin
- vascular consult
