Acute arterial occlusion Emboli Flashcards
symptoms of Acute Arterial Occlusion
Abrupt attack of excruciating pain
Numbness, coldness, tingling
After 6 hrs muscle undergo intensive contractures and swell
After 10 hrs skin have irreversible changes
6 P’s of ischemia secondary to acute arterial occlusion
Pulsessness pain pallor paresthesias (sensation of tingling, tickling, prickling, pricking, or burning of a person's skin ) poikliothermia palor
What do you find on a physical exam of a pt Acute Arterial Occlusion ?
Pallor due to spastic reaction of arterial tree
Over 12 hrs and limb becomes cyanotic and mottled
Stasis
Pulses absent distal to occlusion
Area of temp demarcation
loss of light touch and position sense
Distension of superficial veins
Differential diagnosis of Acute Arterial Occlusion ?
Iliofemoral thrombophlebitis
Arterial spams
Pathophysiologic factors in Acute Arterial Occlusion
Size of the obstructed artery Adequacy of collateral circulation Extent of occluded lesion Arteriospasm Fragmentation of thrombus/Emboli Secondary venous thrombosis
perfusion in Acute Arterial Occlusion
BLOOD BECOMES STAGNANT IN EXTREMITY
- Increase oxygen free radicals
- Damage to surrounding tissues and causes necrosis
- systemic circulation becomes overload with lactate , K, myoglobin and toxins
- Urine is overloaded with alkaline products
- Leads to CV depression and renal failure
examples of O2 free radicals
xantine oxidase
H2O2
O2(superoxide)
OH ( hyroxyl radical)
surgical treatment for Acute Arterial Occlusion ?
- Embolectomy
- Bypass or graft
- Thrombolysis
Acute Emboli
HIgh mortality rate
Acute Thrombotic occlusion
High limb loss rate
Embolo after acute MI
40% mortality rate
Emboli with atrial fib
9%
Embolus can be
Thrombus Fat Air Vegetation Atheromatous material
pathogenesis of embolus
Fracture Trauma Surgery Aniography Anticoagulants Cardian catheterization Angioplasty
Embolus affect
arteries and veins
Embolus can be
Macroemboli
Microemboli
Clinical findings for Embolus on skin
painful violaceous digits
Blue toe syndrome
Clinical findings for Embolus on kidney
Renal HTN
Renal failure
Clinical findings for Embolus on CNS
TIA (A transient ischemic attack )
CVA (Cerebrovascular accident )
Clinical findings for Embolus on cardiac?
MI
Ischemia
Clinical findings for Embolus on GI
abdominal bleed
Clinical findings for Embolus on pulmonary
Loss of air exchange
Blue toe syndrome
shower of microemboli
Breakdown of proximal plaques (travel to digits)
Blue toe syndrome
CAVE MAN Cardiac catheterization Atrial Fibrillation Valve disease Endocarditis Myocardial infarct / Mural thrombus Aneurysm/A-V fistula Nothing
Embolus treatment
Modify risk factors
Remove source of emboli
Surgical replacement of involved segment (Amputation)
Virchow’s triad
venous stasis
Endothelial injury
Hypercoagulable state
PE formation?
Blood clot forms (usually in deep veins of the leg)
Break loose
Floats upstream
Lodges in pulmonary artery
Predisposition for PE
genetic risk factors
Factor V leiden
Factor II mutation
Deficiency in antithrombin, protein C or Protein S
PE diagnosis
Not easy
requires a high clinical index of suspicion and diagnostic testing to confirm diagnosis
symptoms of PE
- Unexplained sudden SOB
- Dyspnea
- CP that worsens with coughing or deep respirations
- lightheadedness
- sense of anxiety
- hemoptysis
- Increased RR >20 beats/min
what is the first symptom in 25% of people who have PE
Sudden death
initial PE testing
Q/V scan
Helical CT
D-dimer (fibrin degradation product)
Aniogram
PE results in mismatch of Q/V scan due to
areas of lung is ventilated but not perfused
Medical management for PE
Respiratory support
Hemodynamic support
Empiric anticoagulation
Surgical management for PE
Thrombolytic therapy
IVC filter
Embolectomy
Embolectomy
Catheter
Surgical
Catheter
Rotational
Suction
Thrombus fragmentation
