Arterial Injuries - Class 4 Flashcards
arterial ulcers are d/t
arterial insufficiency of large and small vessels
how do arterial ulcers present
gangrene
gangrene
dry, dark, cold and mummified
wet gangrene = infection
when does ulceration occur –> gangrene
when gangrene is sloughed off or debrided
where do arterial ulcers usually occur
toes
interdigital spaces
foot
lateral malleolus
arterial ulcer wound base
dry
deep
pale
arterial ulcers will have
necrotic, lacking granulating tissue
wound edges usually rough and steep
surrounding skin of arterial ulcers
may be cyanotic or gangrenous
demarcation of viable and nonviable tissues
arterial ulcers are
very painful to pt
acute arterial ulcers
thrombosis
chronic arterial ulcers
arteriosclerosis obliterans
arterial insufficiency presents w/
intermittent claudication
pain and pallor on elevation
rubor on dependency
trophic changes of skin
decreased pulses
slow nail growth
predisposing factors of arterial insufficiency
smoking
DM
hyperlipoproteinemia
hypertension
advancing age
those with atherosclerosis –>arterial insufficiency
60-70% of pts have at least 2 RFs
how is arterial insufficiency dx
angiogram
arterial dopler
rubor of dependency
assesses arterial flow by evaluating skin color during elevation and dependency
venous filling time
assesses arterial flow by evaluating time for veins to refill after emptying
capillary refill
assesses patency of the capillaries in small vessel dz
arterial doppler
assesses relative flow of blood
movement of blood cells
–>causes shift in signal frequency which is audible to the examiner
arterial doppler –> normal
sound pulsatile
pulse volume recording
used w/ arterial doppler
visualize waveforms of segmental pressures at different sites of the extremity
pulse volume recording asseses
the site of blockage
ankle/brachial index
detects and quantifies arterial dz
can determine tx course of action
ABI ratio
systolic pressure of posterior tibial artery to brachial artery
< 0.5 ABI
tissue necrosis
0.5-0.8 ABI
ischemic rest pain
0.8-1.0 ABI
minimal sxs
> 1.0 ABI
no arterial occlusive dz
medical therapy for arterial insufficiency
reducing RFS for dz and resultant MI, stroke and vascular death
improving sxs
improving sxs
stop smoking
control of DM
anti-platelet therapy
trental –> reduces blood viscosity
pletal
walking exercise program
indications for surgical therapy –> arterial insufficiency
progressive and limiting intermittent claudication
rest pain
gangrene
conservative management
bed rest (for acute occlusion)
limb protection is paramount
decreased –> NWB when ambulating if ulcerative
local wound care
skin protection
reflexive vasodilation
light exercise
bed rest
avoid excessive muscular activity
HOB raised slightly for increased perfusion to feet
local wound care
determine ABI
sharps, enzymatic debridement if indicated
moisture wound dressings (hydrogels)
cultures –> antibiotics if infected
skin protection
w/ petrolatum bases moisturizers
light exercise
preulcerative pt
surgical management
vascular studies
imaging
cultures
surgery
vascular studies
dopplers
ABI
angiogram
MRA
tcPO2
imaging
xrays
CT scans
bone scans
MRIs
surgery
angioplasties/stents
bypass surgeries
serial debridement
amputations
