Ch 7/8 Vascular Issues & Other

Question 1

7 P’s of PAD

Answer 1

1. Pain
2. Pallor
3. Paresthesia
4. Paralysis
5. Pulseless
6. Poor temperature
7. Poor healing

Question 2

Homan’s Sign

Answer 2

VTE
Pain in calf with abrupt dorsiflexion of the foot while the knee is flexed at 90 degrees

Question 3

Plt <150,000

Answer 3

Thrombocytopenia. The body can form platelet plugs until the platelet count is about 100,000 uL.
Causes:
- Sepsis - phagocytosis of platelets by macrophages
- DIC
- Inflammation

Question 4

Tx HIT

Answer 4

• Long term anticoagulation with Coumadin
• Use direct thrombin inhibitors (DTIs):
  
  • Bivalirduin (Angiomax) - PTT 1.5 -2.5 baseline - renal adjustments are necessary
  • Argatroban (Acova) - cleared by liver. PTT 1.5-3x baseline value, not to exceed 100 seconds

Question 5

Reverse Coumadin (Warfain)
Reverse Heparin
Reverse Dabigatran (Pradaxa)
Reverse Rivaroxaban (Xarelto)
Reverse Apixaban (Eliquis)

Answer 5

Vitamin K (Phytonadione)
2.5 - 5 mg PO / 1-2.5 mv IV slowly over an hour. INR within 8-12 hours

Normally used with K-centra (Prothrombin Complex Concentrate)

Heparin Reverse: Protamine
Reverse Dabigatran (Pradaxa): Praxbind (idarucizumab)
Reverse Rivaroxaban (Xarelto): Andexxa
Reverse Apixaban (Eliquis): Andexxa

Question 6

PT 11-13.5
INR 0.8-1.1

Answer 6

Normal

Question 7

Normal aPTT & therapeutic ACT

Answer 7

aPTT 25-38
ACT 300-350 seconds ; discontinue sheaths when ACT <150