Surgery-CV Flashcards
The 4 Hard signs in extremity vascular trauma? Tx?
- Observed Pulsatile bleeding
- Presence of bruit/thrill over injury
- Expanding hematoma
- Signs of distal ischemia
Tx: Surgical exploration also for hemodynamic instability
The 4 Soft signs in extremity vascular trauma
- History of hemorrhage
- Diminished pulses
- Bony injury
- Neurologic abnormality
3 Diagnostic for Soft signs in extremity vascular trauma
- Injured extremity index
- CT scan or conventional angiography
- Duplex Doppler US
Postop pt with PCWP elevated, Low CI, decreased 02 sat, low BP, Tachy & tachypnea, Perioperative period with no chest pain. Dx?
cardiogenic shock due to MI.
Pt with perioperative MI often lack cp due to postoperative pain control (morphine)
The most sensitive finding for blunt aortic injury is
Mediastinal widening on CXRAY
Bilateral hip, thigh and buttock claudication
Absent/diminished femoral pulse
Impotence
Dx?
Leriche syndrome
Arterial occlusion at the bifurcation of the aorta into the common iliac arteries (aortoiliac occlusion) is suggestive of
Leriche syndrome
It is more sensitive and specific than arterial ultrasound of lower extremities for the initial diagnosis of PAD
Ankle-brachial index (ABI)
> or = to 1.30 suggestive of calcified and uncompressible vessels
A late and rare complication of surgical repair of an aneurysm of the intrarenal aorta where the duodenum erodes into the proximal part of the aortic graft is?
Aortoenteric fistula
early complication of operation on the abd aorta like AAA? pt symptoms
bowel ischemia and infarction;
Progressive abd pain and bloody diarrhea
Risk of reperfusion of a limb following arterio-occusive ischemia for longer than 4-6 hours can lead to
interacellular and interstitial edema
recent cardiac catherterization, anticoagulation with heparin, sudden onset of hypotension, tachy, flack neck veins and , back pain is? NSIM? Tx?
- retropertitoneal hematoma due to bleeding from arterial access site.
- CT scan of the abd and pelvis without contrast
- Supportive with bed rest, intensive monitoring and IV & blood transfusion
How do you treat a post cardiac surgery mediastinits complication from wound contamination as evidence by fever, cp, leukocytosis and mediastinal widening on CXRAY?
Drainage, surgical debridement and prolonged antibiotic therapy
The 2 classic chest x-ray abnormalities for aortic injury in high-energy blunt trauma are
Widened mediastinum & Left-sided hemothorax
A typical chest x-ray finding in acute cardiac tamponade is
a normal cardiac silhouette without tension pneumothorax
Pt presents with JVD, Tachy, Hypotension
