S7C64 - Occulsive Arterial Disease

Question 1

Tissue Ischemia

Answer 1

-peripheral nerves and skeletal muscle are particularly affected by ischemia –> death w/in 6h at room temperature if anoxic

Question 2

Reperfusion Injury

Answer 2

• presence of myoglobinemia, renal failure, peripheral muscle infarction
• labs: hyperkalemia, myoglobinemia, metabolic acidosis, elevated CK
• 1/3 of deaths from occlusive arterial dz is secondary to metabolic complications from revascularization

Question 3

Clot formation post MI

Answer 3

-usually occurs areound 14d (range of 3-28d)

Question 4

6 Ps of limb ischemia

Answer 4

• pain
• pallor
• paralysis
• pulselessness
• paresthesias
• polar (for cold) / poikilothermia
• hypoesthesia or hyperesthesia and muscle weakness are early findings
• 2-point discrimination, vibratory sensation and proprioception usually go before deep sensation

Question 5

Claudication

Answer 5

-cramping pain or ache or fatigue that is brought on by exercise and relieved by rest, reproducible, resolves w/in 2-5min of rest and reoccurs at consisten walking distances

Question 6

Neurogenic claudication

Answer 6

-typically worse with an erect posture and responds variably to exercise, otherwise it is similar to vascular claudication

Question 7

Venous claudication

Answer 7

• DVT with phlegmasia cerulea dolens (painful blue inflammation) or phlegmasia alba dolens (milk leg) can be confused with obstructivearterial dz
• cerulea dolens: very swoleen cyanotic leg from venous engorgement, massive iliofemoral thrombosis, leads to high compartment pressures and venous gangrene
• alba dolens: assoc with pregnancy, massive iliofemoral thrombosis, pale leg from arterial spasm with diminished PPP, transient and followed by venous engorgement

Question 8

Physical exam for obstructive chronic arterial dz

Answer 8

• shiny hyperpigmented skin, hair loss, ulceratin, thickened nails, muscle atrophy, vascular bruits, poor pulses
• venous insufficiency has ulcers on medial malleoli, arterial ulcers occur on foot and toes and are more painful
• ABI - ratio of SBP with cuff above malleolus to the highest brachial pressure in either arm, chronic arterial dz has an AVI of 1.3 = noncompressible

Question 9

Investigations for arterial obstructive dz

Answer 9

• basic labs
• ECG
• coags
• trops (has an ACS led to an embolic event)
• CK

-U/S good for obsructions above the calf

Question 10

ED treatment for acute limb ischemia

Answer 10

• heparin 80 units/kg bolus followed by 18 units/kg/h infusion
• ASA
• positioning
• pain control
• protect from temperature extremes

-refer to vascular - surgery