Acute Limb Threat Flashcards

1
Q

Define acute limb ischaemia.

A

sudden loss of blood supply to a limb - occlusion of native artery or bypass graft

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2
Q

What is the essential thing to distinguish between in acute limb ischaemia?

A

acute ischaemia vs acute on chronic ischaemia

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3
Q

Name some causes of sudden occlusion?

A

embolism, athero-embolism, arterial dissection, trauma, extrinsic compression

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4
Q

What are the clinical features of acute limb ischaemia? (6 Ps)

A
Pain - excruciating pain as some as blockage forms
Pallor - sheet white
Pulseless - distal to block
Perishingly cold
Paraesthesia - tingling sensation
Paralysis - if left too long
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5
Q

What needs to be checked when talking a history/examination of acute limb ischaemia?

A

No prior history of claudication
Known cause for embolism (mostly cardiac)
Full complement of contra-lateral pulses

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6
Q

What does a ‘woody’ compartment indicate in a calf/muscle?

A

muscle necrosis

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7
Q

What does blanching mottling indicated in a limb?

A

capillaries have refilled with stagnated deoxygenated blood -> mottled appearance (purple-ish)
= ischaemia is partially reversible

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8
Q

What does a non-blanching limb indicate?

A

irreversible ischaemia

arteries distal to occlusion have filled with propagated thrombus with rupture of capillaries

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9
Q

Is a limb salvageable once paraesthesia/paralysis sets in?

A

only if prompt re-vascularisation

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10
Q

What happens if you transfuse a patient blood if they have had acute limb ischaemia >12hrs?

A

kills the patient since perfusion attempt has circulated all the bad stuff from the dead tissue

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11
Q

How would you manage an acute limb ischaemia?

A

ABC resuscitation and investigation.
FBC, U&E, CK, Coag ± troponin
Anti-coagulate

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12
Q

Why could an underlying malignancy be the cause of acute limb ischaemia?

A

(adenocarcinoma) patient will be pro-thrombotic

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13
Q

Which tests would you do in management of acute limb ischaemia?

A

ECG - MI, dysarrhythmia
CXR - underlying malignancy
Arterial imaging (only if not certain it is due to an embolus) - CT/catheter angiogram

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14
Q

What are the methods of clearing/dissolving a clot?

A

Embolectomy - clearing out clot
Fasciotomy - to avoid compartment syndrome
Thrombolysis

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15
Q

What is the triad of diabetic foot sepsis?

A

tissue ulceration
necrosis
gangrene

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16
Q

Where do neuro-ischaemic ulcers occur?

A

areas of raised pressure i.e. under metatarsal heads

17
Q

Where might the source of sepsis be in diabetic foot sepsis?

A

simple puncture wound
infection from nail plate/inter-digital space
from a neuro-ischaemic ulcer

18
Q

Why is infection a big problem if in the foot?

A

intrinsic digit muscles are contained in rigid compartments; if infection gets into these compartments; pus can’t escape, raised pressure impairs capillary flow; infection and tissue damage builds up quickly and become septic

19
Q

What are the foot compartments bound by?

A

plantar fascia
metatarsal bones
interosseous fascia

20
Q

What would be the clinical findings in diabetic foot sepsis?

A
pyrexia
tachyapnoea
tachycardia
confusion
Kussmauls breathing
21
Q

Which appearance of an affected digit is diagnostic of osteomyelitis?

A

swollen affected digit - sausage-like

22
Q

Why would a swollen forefoot feel ‘boggy’?

A

due to the abscess underneath

23
Q

What is crepitus and where would you find it?

A

gas in soft tissues of foot - gas released from forming organisms

24
Q

Where would you feel for the dorsals pedis pulse?

A

anterior surface of foot, between 1st and 2nd metatarsal bones;
lateral to the extensor hallucis longus

25
Q

Where would you feel for the popliteal artery?

A

deep within the popliteal fossa - compress against posterior of distal femur with knee slightly flexed

26
Q

Where would you feel for the femoral artery?

A

patient lying flat - place finger directly above pubic ramas, halfway between the pubic tubercle and the anterior superior iliac spine (ASIS)

27
Q

Broad or narrow spectrum antibiotics for diabetic foot sepsis? Why?

A

broad spectrum - to cover for the poly-microbial nature of the infection