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Acute limb Ischaemia Flashcards

1
Q

What are the 6 P’s of acute limb ischaemia?

A
  1. Pain
  2. Pallor
  3. Paraesthesiae
  4. Paralysis
  5. Perishing cold
  6. Pulseless
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2
Q

Where can emboli arise from which can cause acute limb ischaemia?

A
  • Heart - AF, Mitral stenosis, mural thrombus from MI
  • Aneurysms - femoral, popliteal
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3
Q

What are thrombotic causes of acute limb ischaemia?

A
  • Popliteal aneurysms
  • Blood disorders - polycythaemia vera, thrombocytopenia, leukaemia
  • Nephrotic syndrome
  • HHS - diabetes
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4
Q

What is an acute-on chronic occlusion?

A

An essential distributing artery that was previously narrowed by atherosclerosis becomes obstructed by secondary thrombosis or by rupture of an atherosclerotic plaque

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5
Q

What are the risks of not treating an acutely ischaemic limb immediately?

A
  • Muscle necrosis
  • Reperfusion injury
  • Compartment syndrome
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6
Q

What does fixed skin mottling indicate?

A

Irreversible necrotic damage - often accompanied by skin blistering

Limb loss is inevitable in this context

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7
Q

How would you manage someone with acute limb ischaemia and you had determined an embolus was the cause?

A
  • IV heparin - 5000 units
  • Analgesia
  • Determine if limb is salvagable
    • ​VIABLE - DSA and revascularisation
    • THREATENED - PCD thrombolysis or THROMBOEMBOLECTOMY within 6 hours
    • NON-VIABLE - Amputation
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8
Q

How would you investigate someone with suspected acute limb ischaemia?

A
  • ECG
  • CXR
  • Routine bloods
  • Crossmatch
  • Angiography - if you have time
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9
Q

How would you manage someone with an acutely ischaemic limb which you had determined a thrombus to be the cause of?

A
  • IV heparin - 5000 units
  • Analgesia
  • Angiograpy first, then determine limb viability
    • VIABLE - DSA and revascularisation
    • THREATENED - PCD thrombolysis or THROMBOEMBOLECTOMY within 6 hours
    • NON-VIABLE - Amputation
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10
Q

Where do the majority of emboli originate for acute limb ischaemia?

A

Heart - 90%

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11
Q

What is the most common site for obstruction in acute limb ischaemia?

A

Femoropopliteal obstruction

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12
Q

What is the general progression of pain in acute limb ischaemia?

A

Just pain -> Severe pain with sensory + motor changes -> No Pain, anaesthetic limb and paralysis

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13
Q

What are the best intial tests for someone with acute limb ischaemia?

A

Arterial and venous doppler

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14
Q

What is the confirmatory test for acute limb ischaemia?

A

DSA +/- ECHO if embolism suspected

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15
Q

What are features of a viable acutely ischaemic limb?

A
  • No sensory loss
  • No muscle weakness
  • Mild to moderate pain
  • Audible arterial doppler signal
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16
Q

What are features of a threatened acutely ischaemic limb?

A
  • Minimal sensation
  • Mild to moderate muscle weakness
  • Severe pain
  • No arterial doppler flow
17
Q

What are features of a nonviable acutely ischaemic limb?

A
  • Anaesthetic limb
  • Paralysis
  • No pain
  • No arterial doppler flow
18
Q

What is the definition of acute limb ischaemia?

A

Inadequate arterial blood supply to a limb over hours or days

19
Q

What is the pathophysiological process behind acute limb ischaemia?

A
  • Embolism - thrombus in the heart or other proximal site as point of origin
  • Thormbosis - atherosclerotic plaque, aneurysm, aortic dissection
20
Q

What is the ischaemic tolerance of skin, after which irreversible tissue damage occurs?

A

12 hours

21
Q

What is the ischaemic tolerance of musculature, after which irreversible damage starts to occur?

A

6-8 hours

22
Q

What would be the difference in terms of onset of acute limb ishaemia for a thrombus vs an embolus?

A
  • Embolism is acute onset, with medical history of CVS disease
  • Thrombus is subacute, with history of artherosclerotic disease (e.g. angina, MI)

Vascular (11 decks)

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