AMK vascular Flashcards
PAD tx
Tx: Atorvastatin 80mg + Clopidogrel 75mg
acute limb ischaemia - discloruation, right leg pain, at rest, pins and needles adn no pulses what ix performed first to aid dx
bedside handheld doppler
tx for acute limb ischaemia
paracetamol, codeiene, IV heparin and vascular review
tx for acute limb ischaemia
paracetamol, codeiene, IV heparin and vascular review
critical limb ischaemia ABPI
0.3
sx of PAD
walking impariments and pain in bum and thighs relieved by rest
hair loss
pale
arterial ulcers
weak/absent pulses
poorly healing wounds
pain in bum where is stenosis
iliac stensois
pain in thigh
femoral stenosis
surgical PAD repair
under 10cm - endovacualr repair
over 10cm - endarectoym or bypass or amputuation
acute limb ischmaeia - do patietns have features of PAD
yes in contralateral leg
critical limb ischameia sx
night pain - relieved by hanging leg out side of bed
resting pain for over 2 weesk
ulceration
gangrene
absnet pulses
ocld limb
dependant ribour
numbness
ABPI below 0.5
superifical thrombophelibits tx - had a clot in it whereas varicose does not
NSAID
chronic venous insuffiencey sc
brusting pain after stnading
puritis
odeema
skin changes
superficial thrombophelibits - inflamed skin around throbmus
haemosiderin skin stain - hb leaking
atrophie blaunche - pathces of smooth porclain white scar tissue on skin surrounded by hyperpigemntation
lipodermatosclerosis 0 hardenign adn tightening os the skin adn beneath the skin - chronic skin inflammation.
venous eczema - dry and itchy flaky and scaly red cracked skin
need compresson stocking first - change every 3 motbhs
what ulcers are worse at night and pucnhed out with well defined borders and that is worse on elevating and improved by lowering the leg
artieral
burgers disease men - raynaud like with pain worse at night in finger tips , vessels like corkscrew what is the best tx
stop smoking
AAA 3-4.4 in 6 motnhs
urgent EVAR
ruptuered AAA - svere abdo pain to back adn groin , hypotensive and tachy collapse
tx
Transfer directly to theatre without imaging!!
Bloods
G&S + Cross matching
Tx:
High flow oxygen + BP control + FLUID RESUS
Haemodynamically stable ⇒ CT angiogram
Haemodynamically unstable ⇒ EVAR
aortic dissection mx
IV labetolol and IV morphine
Stanford Classification
A – Ascending aorta + Arch of aorta
B – Descending aorta
DeBakey Classification
I – Ascending aorta + Arch of aorta + Descending aorta
II – Ascending aorta
IIIa – Descending thoracic
IIIb – Descending thoracic + abdominal aorta
tear in tunica intima
radio radial delay
CT angio
surgical TX of aortic dissection
type A - Beta-blocker/Non-dihydropyridine CCB + Opioid + Open surgery (midline sternotomy)
Type B ⇒ Beta-blocker/Non-dihydropyridine CCB + Opioid + Endovascular repair (if evidence of end organ damage)
