Acute Limb Threat Flashcards
Define acute limb ischaemia.
sudden loss of blood supply to a limb - occlusion of native artery or bypass graft
What is the essential thing to distinguish between in acute limb ischaemia?
acute ischaemia vs acute on chronic ischaemia
Name some causes of sudden occlusion?
embolism, athero-embolism, arterial dissection, trauma, extrinsic compression
What are the clinical features of acute limb ischaemia? (6 Ps)
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
What needs to be checked when talking a history/examination of acute limb ischaemia?
No prior history of claudication
Known cause for embolism (mostly cardiac)
Full complement of contra-lateral pulses
What does a ‘woody’ compartment indicate in a calf/muscle?
muscle necrosis
What does blanching mottling indicated in a limb?
capillaries have refilled with stagnated deoxygenated blood -> mottled appearance (purple-ish)
= ischaemia is partially reversible
What does a non-blanching limb indicate?
irreversible ischaemia
arteries distal to occlusion have filled with propagated thrombus with rupture of capillaries
Is a limb salvageable once paraesthesia/paralysis sets in?
only if prompt re-vascularisation
What happens if you transfuse a patient blood if they have had acute limb ischaemia >12hrs?
kills the patient since perfusion attempt has circulated all the bad stuff from the dead tissue
How would you manage an acute limb ischaemia?
ABC resuscitation and investigation.
FBC, U&E, CK, Coag ± troponin
Anti-coagulate
Why could an underlying malignancy be the cause of acute limb ischaemia?
(adenocarcinoma) patient will be pro-thrombotic
Which tests would you do in management of acute limb ischaemia?
ECG - MI, dysarrhythmia
CXR - underlying malignancy
Arterial imaging (only if not certain it is due to an embolus) - CT/catheter angiogram
What are the methods of clearing/dissolving a clot?
Embolectomy - clearing out clot
Fasciotomy - to avoid compartment syndrome
Thrombolysis
What is the triad of diabetic foot sepsis?
tissue ulceration
necrosis
gangrene