Emergencies

Question 1

Define acute limb ischaemia

Answer 1

Previously stable limb has acute (<2 weeks) deterioration in arterial supply

Question 2

Causes of acute limb ischaemia

Answer 2

Embolism - AF, infective endocarditis 
Thrombosis
Dissection 
Trauma
External compression

Question 3

Describe skin changes in acute limb ischaemia

Answer 3

Distal arteries spasm leading to marble white colouration
Over next few hours, spasm subsides and limb fills with deO2 blood so turns mottled
If over 6 hours with compromised blood supply, mottling doesn’t blanch

Question 4

Signs of acute limb ischaemia

Answer 4

Pain
Pallor
Cold
Paraesthesia
Pulseless
Paralysis

Question 5

Management for acute limb ischaemia

Answer 5

Oxygen to maximise tissue oxygenation
IV heparin
Analgesia
Definitive treatment depends on cause e.g catheter embolectomy

Question 6

Complication of treating acute limb ischaemia

Answer 6

Compartment syndrome as oxygen return to ischaemic limb leads to free radical production causing cellular injury and swelling

Question 7

Types of AAA rupture and their prognosis

Answer 7

Intraperitoneal - immediately fatal

Retroperitoneal - high mortality

Question 8

Signs of ruptured AAA

Answer 8

Lower back pain
Hypotension
Vomiting
Pulsatile mass above umbilicus 
Pale, clammy
Weak pulse
Renal colic in >55M

Question 9

Management of AAA rupture

Answer 9

High flow oxygen
Wide bore cannulas in anterior cubital fossa 
Group and cross match
Fluids to maintaining systolic below 100
Catheterise 
Open repair, NOT ENDOVASCULAR GRAFT