Acute limb ischemia

Question 1

6 Ps:

Answer 1

pain (M)
paresthesia then anesthesia (M)
pallor (M)
paralysis (F)
pulselessness (F)
perishing cold (F)

Question 2

Causes:

Answer 2

1) non traumatic
2) traumatic

Question 3

traumatic:

Answer 3

direct injury
indirect injury: compartment syndrome, crushed injuries

Question 4

non traumatic:

Answer 4

MCC: embolism, thrombosis

Question 5

causes of embolism:

Answer 5

AF
post-MI
vegetations
rheumatic heart disease
atrial myxoma
prosthetic heart valve

Question 6

acute emboli affects which part of the body more?

Answer 6

leg >arms
usually artery bifurcation

Question 7

risk factors

Answer 7

smoking
DM
HTN
cholesterol

Question 8

what should be asked in the past medical history?

Answer 8

TIA
Stroke
MI

Question 9

possible examination findings

Answer 9

irregular pulse
valve clicks
murmurs
pulses in affected and contralateral limb

Question 10

if pulse is present in the contralateral limb then the source is

Answer 10

Embolic

Question 11

if pulse is absent in the contralateral limb then the source is

Answer 11

Thrombosis

Question 12

investigations

Answer 12

FBC
U&E
CK
coagulation screen
urine dip (myoglobin)
CXR
ECG
cross match
cardiac/abdomen U/S
if thrombosis -> angiography

Question 13

thrombosis-especial features

Answer 13

previous h/o claudication
muscle wasting
hair loss
ulceration

Question 14

management

Answer 14

1. analgesia - IV morphine
2. IV fluids
3. revascularization
   a. embolectomy
   b. thrombolysis +/- reconstructive surgery

Question 15

revascularization time limit to prevent permanent muscle necrosis and metabolic effects

Answer 15

within 6 hours

Question 16

if >6 hours

Answer 16

amputation
renal failure due to rhabdomyolysis