PVD Flashcards
LERICH SYNDROME WHAT IS IT
BLOCKAGE OF THE ABDOMINAL AORTA BEFORE IT BIFURCATS TO ILIAC VESSELS
signs of leriche syndrome
inability to form an erection
intermittend claudifcation, legs and buttocks
absent femoral pulses
non helaing ulcers, wounds on lower body
numbness in lower half
what are the 6 p’s
- pain
- pallor
- poikilothermia
4/ . pulselessness
5.parestheisa
6.paralyisis
what do the 6 p’s refer too
peripheral vascular disease
what is the purpose of ankle brachial index
to check for restriction of blood flow, e.g PVD like in lerich syndrome
nomral ankle brachial index
around 1 or above (makes ssnes becuase ideally ankle and arm pressure should be thesame so 120/120 is 1
if you have pvd the blood pressure reading of ankle would be..
lower (and hence why you get a decimal as ankle number is lower and yu are divind by a higher number
fromula for index
ankle SBP/arm sbp
what are the vessels of the foot we are interested in in terms of blood flow
there are 2
1. dorslais pedis
2. posterior tibial
where is dorsalis pedis and posterior tibial
dorsum of the foot
meidal aspect of the medial malleulus
apparenly sometimes you dont feel the dorslias pedis its normal but YOU SHOULD ALWAYS BE ABLE TO FEEL POSTERIOR TIBIAL
pvd exam how would you perform it
check radial pulses - same time
brachial artery
external carotid artery - move neck to the side ask to hold in a breath
check femoral, dorsalis pedis, posterior tibial artery
what can we use to give us an idea of blood flow through a vessel
us doppler - non invasive
ct angio - more invasive
How to diagnose a DVT
Definitive would be an ultrasound of the vein ideally within 4hours
What happens if you request a ultrasound for dvt but cannot be done within 4 hours
Then you do a d dimer
Start interim anti coagulation
And request us within 24 hours
Which type of anti coagulation is first line for dvt
DoAC (apiziban, rivoroxibam)
Cut off for wells for DVT
2 or more
If someone has a positive wells for DVT what should you do
- Request an ultrasound within 4 hours
- If positive start anticoaguqltion
(If you don’t see a clot, check again next week as it doesn’t mean necessarily no clot )
Risk factors for DVT
THROmBOSis
Thrombophillia
Hormonal (cocp, pregs)
Obesity
Malignancy
Bone fracture
Smoking
Immobility
Sickness (acute infection’
Dehydration
Post partum 6 weeks
Wells score for DVT
Physical exam cor DVt
Inspection
~ redness
~ swelling
~distended superficial versions
Ulcers (webs of toes , heels)
Palpating
Temp diff
Pitting edema
Distended veins
Pulses - dorsal is pedis and posterior tibia
Calf diameter with tap
Squeez calves for pain
Ideally ask patient to stand helps to tell difference better
How would you advise your patient lifestyle to prevent clots
Reduce smoking (makes plt more sticky )
Alcohol (increases platelets so more likely to clot and also activates plt)
Reduce weight
Active lifestyle
If long haul take plenty rest
