24 - Blue Toe Syndrome Case Study Flashcards
What is blue toe syndrome?
Blue toe syndrome is a situation of atherothrombotic microembolism causing transient focal ischemia, occasionally with minor apparent tissue loss, but without diffuse forefoot ischemia
The sudden development of a cyanotic digit or lesion of the feet may be the result of atheroembolic decrease or a numer of medical conditions
What are the common symptoms of blue toe syndrome?
- Myalgia and muscle tenderness
- Cutaneous lesions (ulcers and necrosis)
- Lacelike pattern of blue0red mottling with normal skin
- Palpable purpura
- Temperature changes
- Cyanosis
- Absent capillary fill time (CFT)
What is intermittent claudication (a common symptom)
Intermittent claudication - when the patient can walk about a half mile or so before they begin to feel pain in their legs or their legs feel tired
Claudication = cramping in leg due to atherosclerosis during exercise
What are the different clinical tests you can do to confirm whether or not a patient has blue toe syndrome?
Non-invasive vascular evaluation
Plethysmography (detects changes in blood volume)
Doppler ultrasound
Transcutaneous oxygen
Invasive diagnostic studies (arteriogram)
What are three non-invasive vascular tests that you can do?
ABI (ankle/brachial index)
PVR (pulse volume recording)
Toe blood pressures
What is an ABI test?
A quick non-invasive way to check your risk for peripheral artery disease (PAD)
ABI compares your blood pressure measured at your ankle with your blood pressure measured at your arm
How do you interpret an ABI test?
A low ABI number can indivate narrowing or blockage of the arteris in your legs, increasing your risk of circulatory problems and possibly causing heart disease or stroke
Ankle pressure / brachial pressure
(low) / (high) = a small number
What is a PVR?
A PVR study is a non-invasive vascular test in which blood pressure cuffs and a hand-held doppler are used to obtain information about arterial blood flow in the arms and legs
What are toe blood pressures?
Digital cuffs are used to measure the blood pressure on the toes to determine the level or risk the patient is at for blue toe syndrome
How do you interpret toe blood pressures?
- Low risk = above 0.6
- Moderate risk = above 0.4
- High risk = above 0.2
- Severe risk = below 0.2
What is plethysmography?
Measuring and recording changes in volume over a short period of time
A plethysmograph is an instrument for measuring changes in volume within an organ or whole body (usually resulting from fluctuations in the amount of blood or air it contains)
How do you read a plethysmograph?
It looks like squigly lines kind of like an ECG… You read the waveform and tetermine the level of obstruction in the bloodflow you are evaluating
What does a normal plethsymography waveform look like?
“Mountainous form”
Steep upslope
Sharp peak
Distinct dicrotic notch
What does a mild obstruction look like on a plethsymography?
Less of a steep upslope
Less of a distinct peak
Loss of a dicrotic notch (one peak, not two)
What does a moderate obstruction look like on a plethysmography?
“Delayed upslope
Rounded peak
Loss of a dicrotic notch “