Exam 2 CARDIOTHORACIC/VASCULAR EMERGENCIES Flashcards by Wendy Pitts

Aneurysm is?

Abn vessel dilation

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Dissection is?

Tear in intima of vessel wall

Blood into media -> splits creating false channel

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Artherosclerotic Aneurysm U located?

Preceding sxs?

U a/w?

abdominally

U none before rupture

Comorbidities: CAD, PVD, COPD, DM, Renal fail

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AAA diagnostics? (2)

US for dx and follow (always do US for abd complaint)

CT/MRI for plan

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AAA intervention determination?

< 5.5, not enlarging, asympt =
US Q 6-12 mo

> 5.5, rapid expansion or sympt =
intervention

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AAA presentation? (6)

Abd pain
P Flank/Back pain
Pulsatile abd mass
Tender
HypoTN
Hemodynamic instability

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Ruptured or Sympt AAA management?

ABCs
2 large bore IVs
Type/Cross 10u PRBC
Pain mgmt
BP @ 80-100
US
To OR

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TRIAD of Aortic Dissection- CONSTELLATION

Abrupt onset of thoracic or abdominal PAIN w/a sharp, tearing quality
mediastinal &/or aortic WIDENING on chest radiograph
HTN +/- discrepant BP or pulse (absence of a proximal extremity)

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Aortic Dissection (AD) U located?

Risk factors? (4)

thoracic

age
HTN
CT dz
Preggos

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AD presentation? (7)

EMERGENCY
Chest pain
Back pain b/w shoulder blades
Neuro ∆s
Distal ischemia (limb, gut, kidney)
Acute cardiac failure (aortic regurg, ischemia)
HypoTN
Shock w/ rupture

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AD preceding signs/sxs? (6)

HTN
Discrepant BP b/w extremities
Widen mediastinum
Pleural capping
Pleural effusion
Hoarseness

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AD Type A?

In ascending aorta
Most C
Emergent surgery for all
High mortality

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AD Type A complications?

Aortic rupture
Tamponade
Acute aortic regurg
Acute coronary ischemia

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AD Type B Uncomplicated?

Not involving ascending aorta
No rupture or ischemia
Surgical or endovascular tx

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AD Type B Complicated or Failed Mgmt sxs?

Persistent pain
Progress to dissection
Marfans

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AD imaging? (3)

Spiral CT = standard of care
MRI
TEE

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AD initial mgmt? (3)

1) ↓ SBP < 100
2) ↓ LV dP/dT (contractility)
3) Pain mgmt

w/ β-block then vasodilator (Nipride)

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Thoracic Aortic Aneurysm invasive tx:

Ascending and/or Arch?

Descending?

asc = Sternotomy w/ surgical repair, P aortic valve

des = Thoractomy w/ surgical repair or endovasc graft

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Thoracic Aorta injury: Transection caused by?

U from rapid deceleration

???? slide 30

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Thoracic Aortic injury: Transection diagnosis?

Mishaped mediastinum
Blurred aortic knob
Wide mediastinum
2nd rib fracture
Pleural effusion
Apical capping

CXR then Spiral CT

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Thoracic Aortic injury: Transection mgmt?

Open or endocardial repair

High risk of paraplegia

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Blunt cardiac injury: Cardiac Rupture?

U pulmonary hilum

Blunt cardiac injury: Myocardial Contusion?

similar sxs to MI (pain, N/V, SOB, arryh)
P Rv or RA infarct or rupture

Serial ECG/telem
Serial enz
ECHO
watch for 48 hrs

Traumatic Diaphragmatic Hernia?

U Male and L sided

Resp distress
↓ Breath Sounds
BS in chest
Abd pain
Paradox resp

Tx w/ transabdominal repair

Penetrating Chest Trauma signs/sxs? (5)

``` Hemoptysis Pneumothor SQ emphysema (air in skin on chest/neck) Mediastinal emphysema Beck's Triad ```

Penetrating Chest Trauma work-up?

Helical CT Echo Angiography

Penetrating Chest Trauma: Emergent L Thoracotomy when?

Hemodyn unstable | Witnessed arrest despite resuscitation

Esoph Rupture/Boerhaave Synd location? Presentation? (6)

L postlateral distal esoph ``` Retrosternal/Up abd pain Tachy Dyspnea Fever Odynophagia Hamman's Sign (crunching, rasping sound synchronous w/ heart beating against air-filled tissues) ```

Boerhaave Synd diagnostics? (3) Tx? (4)

CXR = free air in mediastinum CT Esophogram w/ gastrograffin FATAL if not caught (still high mortality) ABCs Fluids ABX Surgery

PeriMyocardial Infarct Emergencies include? (3)

Acute VSD (Ventricular Septal Defect) Acute Mitral Regurg Acute Mesenteric Ischemia

Acute VSD (C) a/w? Exam finding? (3)

Transmural Anterolat MI 2-5 days post Harsh, holosystolic murmur +/- thrill ↓ hemodynamics

Acute VSD study? Tx?

Echo w/ color flow Thrombolytics URGENT SURG REPAIR

Acute Mitral Regurg caused by?

Papillary mm rupture in acute MI U postmedial ~13 hrs post

Acute Mitral Regurg exam findings? Tx?

Acute pulmonary edema Pansystolic murmur, apex to axilla ↓ afterload U surgery necessary

Acute Mesenteric Ischemia caused by Arterial Embolism?

C 2° to cardiac thromboembolism (Afib) | U location is SMA, IMA least

Acute Mesenteric Ischemia caused by Arterial Thrombus?

U from progression of preexist atherosclerosis | C involvement of 2 vessels following dehydration, hypercoag state

Acute Mesenteric Ischemia caused by Non-occlusive events: Types of causes?

Severe/Prolonged vasoconstrict Low CO α-agonists, digoxin, ergots, cocaine

Acute Mesenteric Ischemia exam findings? If SMA involvement?

Early dx critical (< 12 hrs) Severe abd pain w/o many abd findings, N/V/D and ileus (P) + guaiac TRIAD of SMA embolism: GI emptying Abd pain Underlying cardiac dz

Acute Mesenteric Ischemia labs? (3)

``` CBC = Leukocytosis D-Dimer = ↑ LDH = ↑ ``` All are non-specific

Acute Mesenteric Ischemia management? (6)

``` ABC Cardiac monitor O2 IV access/fluids Abx Pain mgmt ```

Acute Mesenteric Ischemia imaging?

Multi-detector CT | Angiography

Acute Mesenteric Ischemia tx?

Papaverine Infusion Embolectomy Intraarterial Thrombolysis Bypass or Reimplant

Aorto-Iliac Occlusive Dz is?

EMERGENCY Saddle embolism at bifurcation OR In-situ thrombosis of already dz'd segment

Aorto-Iliac Occlusive Dz presentation?

Neuro deficit including paralysis, | Absent femoral pulses

Aorto-Iliac Occlusive Dz tx?

Quick imaging | Surgery

Acute Arterial Obstruction is?

EMERGENCY | Sudden stop of blood to extremity

Acute Arterial Obstruction cause by? (4)

Embolism U from heart or aorta Thrombus in situ from trauma or ↓ flow Hypercoag state External compression of artery

Acute Arterial Obstruction from Embolism U result of? (5)

``` Afib LV thrombus Cardiac myxoma (benign tumor) Valve dz Plaque, fat, air ```

Acute Arterial Obstruction from In-situ Thrombus result of? (5)

``` Catheter Stent/graft Popliteal aneur Hypercoag or low flow states Arterial dissection ```

6 P's of Acute Obstruction?

``` Pain Pallor Paresthesia Paralysis Pokilothermia Pulselessness ```

Acute Arterial Obstruction tx?

``` Emergency surg Heparin Thrombolytics Thrombus removal Embolectomy or Bypass ```

Compartment Syndrome C after what? 6 Ps of Compartment Synd?

Reperfusion of ischemic limb (U) calf ``` Pain out of proportion Pain w/ passive stretch Paresthesia Paralysis Pokilothermia Pulselessness ```

Compartment Syndrome diagnosed how? Untreated w/i 8hrs P results in?

Clinically P pressure measurement > 25 mmHg Permanent nn damage Limb loss Death

Compartment Syndrome tx?

Fasciotomy