ED LE and testes (super fast reading) Flashcards
what ABI is indicative of peripheral arterial disease
<.9
what significantly increases risk of developing PAD
tobacco use
What timeframe is dangerous for limb ischemia 2/2 acute arterial occlusion? what can happen
4-6 hrs
can cause irreversible changes in peripheral nerves and skeletal muscle tissue
what are the most frequently diseased arteries for limb ischemia
- femoralpoliteal
- tibial
- aortoiliac
- brachiocephalic
what are the MC sites of arterial embolism
- common femoral artery
- common popliteal artery
what are the six P’s
pain
pallor
paresthesia
poikilothermia
paralysis
pulselessness
what is the earliest symptom of acute arterial occlusion? how can this sympotm worsen?
pain!!!
worsens with elevation of the limb
what is claudication and how common is it in PVD
- cramping pain/ache or tiredness in ischemic limb
- only present in 20-30% of patients
what is the MCC of acute arterial occlusions?
thomboembolic disease
what history would strongly suggest that an embolus is present and is the cause of limb ischemia
a history of an abrupt ischemic event in a pt with afib or recent MI
what are the diagnostic modalities used to evaluate limb ischemia/acute arterial occlusion?
- handheld doppler (assures presence/absence of bloodflow to limb)
- duplex US (sensitivity of 85% for obstructions!)
- ABI (>.9 = PAD. >.41 is CRITICAL!!!)
- arteriogram (Gold standard for finding obstruction in limb ischemia)
what is the treatment for acute arterial occlusion
- fluid resuscitation and pain meds
- get EKG and consider echo to look for embolus associated conditions
- unfrac heparin
- vascular surgeon consult.
- Admission!!!
If a patient has PAD with no comorbidities and iscemia with no critical threat to the limb (ABI>.4) what is the treatment
DC on ASA 81mg with loading dose of 325mg prior to DC
idk if we need this but might be good.
what is the classic presentation of a LE DVT
calf or leg pain
redness
swelling
tenderness
warmth
present in fewer than 50% of patients
In what setting do UE DVTs often occur
indwelling catheters! presents the same as LE
what two PE findings are predictive but not specific or sensitive for DVT
- 2cm difference in lower leg circumference
- Homans sign - pain in the calf with forced dorsiflexion of the foot
what is phlegmasia cerulea dolens and what is its presentation
- uncommon but severe presentation of DVT
- extremely swollen and cyanotic limb d/t high grade obstruction that elevates compartment pressure