Vasc Emergency

Question 1

Periph vasc trauma

Answer 1

Causes- penet wound, blunt trauma, invasive proced
Fluid resus- site away from inj, preserve saph and cephalic V
Limb vasc inj mx- surg repair in 6hr, chest or abdo haemorr takes priority, aputat maybe req

Question 2

Arterial inj hard signs

Req immed surg

Answer 2

Ext bleed
Rapid expanding haematoma
Palpable thrill, audible bruit
Acute limb isch

Question 3

arterial inj soft signs
Req serial exam, duplex or arteriography
If doubt then ask vasc surg

Answer 3

Hx of bleed at scene
Trauma close to maj A
Dimin unilat pulse
Small non pulsatile haematoma
Neurogenic defect

Question 4

Fracs causing vasc inj

Answer 4

Supraepicond frac in kids
High tibial frac
Knee disloc

Question 5

Chest vasc trauma

Answer 5

Risk tension pneumothorax or tamponade
Do chest CT
Comm inv desc thoracic aorta at isthmus, decel inj.
Tx- stent graft

Question 6

retroperit bleed

Answer 6

Pelvic frac or surg, spont eg warf, post angiogram/plasty
Femoral punc above ing lig is a cause
Signs- hypot, low Hb after femoral A catheter. Lower back pain. IF mass/tenderness.
Mx- resus, help, urgent CT, surg or radio interven.

Question 7

acute limb isch

Answer 7

Prev stable, reduc A supply, rest pain or other feats over 2wk.
Nec in 6hr if compl isch.
Px- marble white then in few hrs deO blood causes blue mottle. Limb salvagable if mottle blanches.
RF- HD, trauma, sclerosis RFs
Ix- GS, bloods, ECG, help
Mx- O2, IV hep, analgesia, fluids, cardiac tx, embolectomy

Question 8

causes of acute limb isch

Answer 8

Embol- AF, plaque, proximal anaeur, vegetations
Embol feats- sudd onset, known source, no prev claudication, norm pulses in other limb.
Thromb- sclerosis, graft closure, bleed condit, poplit aneur
Other- dissec, trauma, ext comp

Question 9

6Ps

Answer 9

Pain
Pallor
Pulseless
Parasthesia
Paralysis
Cold

Question 10

After revasc

Answer 10

ReO causes O radicals and cell inj and oedema
This risks compartm synd and musc nec, esp if isch over 6hr
Also rhadbo and k rel

Question 11

Most comm aneur rupt

Answer 11

Infra renal aorta

Question 12

Rupture types

Answer 12

Intra perit- immed death, abdo cav 23L capac, CO 5L

Retro- event rupt

Question 13

AAA px

Answer 13

Abdo pain and NV
Abdo and back pain with collapse
Renal colic f over 55yo
Classic triad- abdo/back pain, pulsing mass, low BP
Pallor, clammy, weak pulse

Question 14

AAA diffs

Answer 14

MI
PE
Acute Pancreatitis

Question 15

AAA mx

Answer 15

O2
Bloods
Fluid, maint systolic 100
Catheter
Comtact surg- open repair or stent graft