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Final Notes > FN: Acute Limb Ischaemia > Flashcards

FN: Acute Limb Ischaemia Flashcards

1
Q

Acute definition

A
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2
Q

Acute definition

A
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3
Q

Acute on chronic

A

Worsening symptoms and signs

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4
Q

Chronic

A

Ischaemia stable for >14d

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5
Q

Severity

A

Incomplete: limb not threatened
Complete: lib threatened - loss of limb unless intervention w/i/6hrs
Irreversible: requires amputation

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6
Q

Causes

A 
Thrombosis in situ
Embolism
Graft/stent occlusion
Trauma
Aortic dissection
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7
Q

Thrombosis in situ (60%)

A

A previously stenosed vessel with plaque rupture

Usually incomplete ischaemia

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8
Q

Embolism (30%)

A
  1. 80% form LA to AF
  2. Valve disease
  3. iatrogenic form angioplasty/surgery
  4. Cholesterol in long bone fracture
  5. Paradoxical (venous via PFO)
  6. typically lodge at femoral bifurcation
  7. Often complete ischaemia
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9
Q

Presentation:6Ps

A 
Pale
Pulseless
Perishingly cold
Painful
Parasthesia
Paralysis
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10
Q 
Emobolus
Onset
Severity
Embolic source
Caludication Hx
Contralat pulses
Dx
Rx
A 
Sudden
Profound ischaemia
Present - often AF
Absent
Present
Clinical
Embolectomy + Warfarin
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11
Q

Chronic

A

Ischaemia stable for >14d

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12
Q

Severity

A

Incomplete: limb not threatened
Complete: lib threatened - loss of limb unless intervention w/i/6hrs
Irreversible: requires amputation

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13
Q

Causes

A 
Thrombosis in situ
Embolism
Graft/stent occlusion
Trauma
Aortic dissection
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14
Q

Thrombosis in situ (60%)

A

A previously stenosed vessel with plaque rupture

Usually incomplete ischaemia

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15
Q

Embolism (30%)

A
  1. 80% form LA to AF
  2. Valve disease
  3. iatrogenic form angioplasty/surgery
  4. Cholesterol in long bone fracture
  5. Paradoxical (venous via PFO)
  6. typically lodge at femoral bifurcation
  7. Often complete ischaemia
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16
Q

Presentation:6Ps

A 
Pale
Pulseless
Perishingly cold
Painful
Parasthesia
Paralysis
17
Q 
Thombosis
Onset
Severity
Embolic source
Caludication Hx
Contralat pulses
dx
Rx
A
  1. Hrs-days
  2. Less severe - collaterals
  3. Present
  4. Absent
  5. Angiography
  6. Thrombolysis
    Bypass surgery
18
Q

OTher options

A

Emergency reconstruction

Amputation

19
Q

Investigations

A

Bloods: FBC, U+E, INR, G+S, CK
ECG
Imaging: CXR, Duplex doppler

20
Q

General Mx

A

In an acutely ischaemic limb discuss immediately with a senior as tim eis crucial
NBM
Rehydration: IV fluids
analgesia: morphine + metoclopramide
Abx: e.g. augmentin if sgns of infection
Unfractionated heparin IVI: prevent extension

21
Q

Complete occlusion Mx

A

Yes: uregent surgery: embolectomy or bypass
No: agiogram + observe for deterioration

22
Q

Angiography

A

Not performed if there is complete occlusion as it introduces delay: take straight to theatre

If incomplete occlusion, pre-op angio wil guide any distal bypass

23
Q

Embolus management

A

Embolectomy
thrombolysis
Other otpions

24
Q

Embolectomy

A

LA or GA
Wire fed through embolus
Fogarty catheter fed ocer the top
Balloon inflated and caether withdraw, reomving the embolsim
Send embolis for histo (exclude atrial myxoma)
Adequacy confirmed by on-table angiography

25
Q

thrombolysis

A

Consider if embolectomy unsuccessful

e.g. local injectino of TPA

26
Q

OTher options

A

Emergency reconstruction

Amputation

27
Q

Post-embolectomy

A
  1. Anticoagulate: heparin IVI - warfarin

ID embolic source: ECG, echo, US aorta, fem and pop

28
Q

Complication spost-embolectomy

A

Reperfusion injury

  1. Local swelling - compartment syndrome
  2. Acidosis and arrhythmia secondary to potassium increased
  3. ARDS
  4. GI oedema: endotoxic shock

Chronic pain syndromes

29
Q

thombosis Mx

A

Emergency reconstruction if complete occlusions
angiography _ angioplasty
Thrombolysis
Amputation

Final Notes (196 decks)

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