vascular amk teach Flashcards
man struggle to walk - painful calfs. absent pedal pulses , previous MI and smoker what medication should he be prescribed
clopidogrel 75mg and atorvastatin 80mg - PAD long term
with lifestyle changes and exercise training
srugically
71 male, 1 day right leg pain to foot and sicolorution, pins and needles. Pale right foot that is cold and painful to touch . no pedal pulses. Ischmeic heart disease, COPD and DM and smoker.
what diagnosis should be performed first?
bedside handheld doppler - acute limb ischaemia - 6ps - to find the clot
6Ps of acute limb ischaemia
pain
pallor
pulselessness
parathesia
persihingly cold
79man pain in left leg - come on last 2 hours - leg pale on examination. unable to move and tender. pedal pulses absent in left foot. AF and less active now, smoker.
inital MX given likely dx
paracetamol, codeine , IV heparin and vascular review
- acute limb ischaemia
a 73yr old heavy smoker with foot ulceration and rest pain. Areas of gangrene and pulses impalpable what is following ABPI most associated with clinical findings
0.3
1.2- diabetes
1.2-0.9 - normal
0.9-0.5 claudication
below 0.5 acute limb ischaemia
what is PAD
narrowing of the arteries supplying the limbs and the periphery reducing the blood supply to these areas
intermittent claudication
sx of ischaemia in a limb occuring during exertion adn releived by rest - typically a crmapy , achy pain in the calf thigh or buttock msucles associated with msucle fatigue when walking beyond a certain intensity
aucte limb ischaemia - rapid onset ischaemia in limb, thromubus blockign arterial supply
criticla limb ischami - en stage
inadqeuated healing
night pain
bum
iliac artery blockage
PAD IX
full cvs risk assessment and ABPI
duplex USS site severitt adn seize
how long does ALL need correcting
4-6hrs
pateints have features of PAD in one limb what in the other
absent pulses on contralateral leg
ALL ix
handheld arterial doppler
brown legs adn dry skin adn calf larger than knee- most risk of
venous ulcer
superficial thrombophelibitis
NSAID before comrpession stockings
hwo often do you chnage comrpession stockings
3 months to change them and this is defintive treatment
features of chronic venous insfufiency
superical thrombophelbitis
haemosiderin skin stain
atrophie blaunche
lipodermatosclerosis
venosu exzema. - bilateral - cellultis not
features of chronic venous insfufiency
superical thrombophelbitis
haemosiderin skin stain
atrophie blaunche
lipodermatosclerosis
venosu exzema. - bilateral - cellultis not
corkscrew vessels - buerges disesase what is more important intervention
and non-artherscelrotic ( rules out PAD)
smoking cessation
what is beuerges disease
infalmmaotry ondtion causes thrombus foramtion in small and medicum vessels in distal arterial system
typical patient men ages 25-35 and strong association with smoking so when stop it goes
under 50 and no artherscleotic risk factors
painful blue discoluration of the fingertips or tips of toes and pain worse at night - may progress
cockscrew collateral on arterial duplex
AAA 2.5 cm mx
discharge patient
anuersym more than 6.5 do patients stop drive
yes
and inform DVLa if over 6
aortic dissection tx
IV labetalol , IV morphoen adn EVAR
aortic dissection ix
CT angiogram
ECG - schameia
CXR - widened mediastinum
echo
ortic dissection mx
type a - beta blocker -or non-d CCB and a opio
