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PVD > Acute arterial occlusion Emboli > Flashcards

Acute arterial occlusion Emboli Flashcards

1
Q

symptoms of Acute Arterial Occlusion

A

Abrupt attack of excruciating pain
Numbness, coldness, tingling
After 6 hrs muscle undergo intensive contractures and swell
After 10 hrs skin have irreversible changes

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2
Q

6 P’s of ischemia secondary to acute arterial occlusion

A 
Pulsessness
pain
pallor
paresthesias (sensation of tingling, tickling, prickling, pricking, or burning of a person's skin )
poikliothermia
palor
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3
Q

What do you find on a physical exam of a pt Acute Arterial Occlusion ?

A

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

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4
Q

Differential diagnosis of Acute Arterial Occlusion ?

A

Iliofemoral thrombophlebitis

Arterial spams

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5
Q

Pathophysiologic factors in Acute Arterial Occlusion

A 
Size of the obstructed artery
Adequacy of collateral circulation 
Extent of occluded lesion
Arteriospasm
Fragmentation of thrombus/Emboli 
Secondary venous thrombosis
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6
Q

perfusion in Acute Arterial Occlusion

A

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
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7
Q

examples of O2 free radicals

A

xantine oxidase
H2O2
O2(superoxide)
OH ( hyroxyl radical)

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8
Q

surgical treatment for Acute Arterial Occlusion ?

A
  • Embolectomy
  • Bypass or graft
  • Thrombolysis
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9
Q

Acute Emboli

A

HIgh mortality rate

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10
Q

Acute Thrombotic occlusion

A

High limb loss rate

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11
Q

Embolo after acute MI

A

40% mortality rate

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12
Q

Emboli with atrial fib

A

9%

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13
Q

Embolus can be

A 
Thrombus
Fat
Air 
Vegetation
Atheromatous material
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14
Q

pathogenesis of embolus

A 
Fracture
Trauma
Surgery
Aniography
Anticoagulants
Cardian catheterization
Angioplasty
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15
Q

Embolus affect

A

arteries and veins

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16
Q

Embolus can be

A

Macroemboli

Microemboli

17
Q

Clinical findings for Embolus on skin

A

painful violaceous digits

Blue toe syndrome

18
Q

Clinical findings for Embolus on kidney

A

Renal HTN

Renal failure

19
Q

Clinical findings for Embolus on CNS

A

TIA (A transient ischemic attack )

CVA (Cerebrovascular accident )

20
Q

Clinical findings for Embolus on cardiac?

A

MI

Ischemia

21
Q

Clinical findings for Embolus on GI

A

abdominal bleed

22
Q

Clinical findings for Embolus on pulmonary

A

Loss of air exchange

23
Q

Blue toe syndrome

A

shower of microemboli

Breakdown of proximal plaques (travel to digits)

24
Q

Blue toe syndrome

A 
CAVE MAN
Cardiac catheterization
Atrial Fibrillation
Valve disease
Endocarditis
Myocardial infarct / Mural thrombus
Aneurysm/A-V fistula
Nothing
25
Q

Embolus treatment

A

Modify risk factors
Remove source of emboli
Surgical replacement of involved segment (Amputation)

26
Q

Virchow’s triad

A

venous stasis
Endothelial injury
Hypercoagulable state

27
Q

PE formation?

A

Blood clot forms (usually in deep veins of the leg)
Break loose
Floats upstream
Lodges in pulmonary artery

28
Q

Predisposition for PE

A

genetic risk factors
Factor V leiden
Factor II mutation
Deficiency in antithrombin, protein C or Protein S

29
Q

PE diagnosis

A

Not easy

requires a high clinical index of suspicion and diagnostic testing to confirm diagnosis

30
Q

symptoms of PE

A
  • Unexplained sudden SOB
  • Dyspnea
  • CP that worsens with coughing or deep respirations
  • lightheadedness
  • sense of anxiety
  • hemoptysis
  • Increased RR >20 beats/min
31
Q

what is the first symptom in 25% of people who have PE

A

Sudden death

32
Q

initial PE testing

A

Q/V scan
Helical CT
D-dimer (fibrin degradation product)
Aniogram

33
Q

PE results in mismatch of Q/V scan due to

A

areas of lung is ventilated but not perfused

34
Q

Medical management for PE

A

Respiratory support
Hemodynamic support
Empiric anticoagulation

35
Q

Surgical management for PE

A

Thrombolytic therapy
IVC filter
Embolectomy

36
Q

Embolectomy

A

Catheter

Surgical

37
Q

Catheter

A

Rotational
Suction
Thrombus fragmentation

PVD (5 decks)

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