Vascular Emergencies Flashcards

1
Q

3 ways in which peripheral vascular trauma may occur?

A

penetrating wounds
blunt trauma
invasive procedures

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2
Q

examples of penetrating wounds?

A

stab
gunshot
IV drug abuse

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3
Q

examples of blunt trauma?

A

bone fracture
joint displacement
contusion

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4
Q

examples of invasive procedures which can cause peripheral vascular trauma?

A

balloon angioplasty
cardiac catheterisation
arteriography

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5
Q

hard signs of arterial injury?

A

external arterial bleeding- pulses of blood
rapidly expanding haematoma- may be visualised on USS
palpable thrill, audible bruit
obvious acute limb ischaemia- pale, cold, pain, pulsless, paraesthesia, paralysis, and this is not corrected by reduction of dislocation or realignment of fracture.

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6
Q

what is required in ptnts with hard signs of arterial injury e.g. external bleeding, haematoma, obvious acute limb ischaemia?

A

surgery!

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7
Q

soft signs of arterial injury?

A

diminshed unilateral pulse
small non-pulsatile haematoma
history of bleeding at scene
proximity of penetrating wound or blunt trauma to major artery

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8
Q

how might ptnts with soft signs of arterial injury be assessed?

A

serial examination*
duplex USS
arteriography

ask vascular surgeon if in doubt!

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9
Q

how long can a limb survive before extensive tissue necrosis occurs in complete acute ischaemia, making a limb unsaveable?

A

6 hours

primary amputation may be required in severely traumatised limb

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10
Q

how should fluid resucitation take place if peripheral vascular trauma?

A

adequate IV access lines, not placed in affected limb or extremities that would lead fluid directly into potential areas of tamponade or venous injury.

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11
Q

which veins should not be used for IV fluid resuscitation in peripheral vascular trauma?

A

great saphenous
cephalic
as these may be needed for repair

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12
Q

why might diagnostic studies be needed in a vascular emergency?

A

localise vascular injury to plan an operative approach
avoid unnecessary op
document presence of surgical lesion

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13
Q

which limb fractures have a higher incidence of assoc. vascular injury?

A

supracondylar fracture of humerus in children
knee dislocation
high tibial ‘bumper fracture’

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14
Q

what generally takes higher importance over limb trauma?

A

severe head injuries and life-threatening haemorrhage from chest or abdomen

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15
Q

how can arterial trauma be accurately identified in stable ptnts following chest trauma?

A

CT scan

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16
Q

what clinical signs suggest a RP bleed following femoral artery catheterisation?

A

Hypotension or drop in Hb following femoral artery catheterisation procedure
Patient may complain of lower back pain
Quite often there is no associated haematoma at groin puncture site
Patient may have iliac fossa mass/tenderness

Ptnt will need resuscitation-replace blood loss

17
Q

what is exsanguination?

A

losing blood to a degree which is sufficient to cause death

18
Q

Most important 1st step to management of any ptnt in this setting?

A

ABCDE
airways- chin lift or jaw thrust to open, protect C spine, endotracheal tube may be used if obstruction
breathing-inspect, palpate, percuss and auscultate chest
circulation- compression- use hand, to control bleeding, IV lines
disability- AVPU, GCS
environmental control+exposure- undress ptnt, keep them warm.

19
Q

compartments of the leg?

A

anterior
lateral
posterior- superficial and deep

20
Q

compartment syndrome more common in young or old?

A

young- more muscle mass- increase pressure in compartment

21
Q

non-arterial causes of an acute limb pain of sudden onset?

A

venous thrombosis

SC compression or infarction

22
Q

causes of acute arterial limb ischaemia?

A

arterial embolus e.g. post MI or due to AF
thrombosis on an atheromatous plaque- ptnt may have already experienced IC or rest pain
thrombosis of an aneurysm
arterial dissection- aortic- severe chest and /back pain, other pulses e.g. L subclavian absent.
traumatic disuption
external compression e.g. a cervical rib

23
Q

symptom triad in ruptured AAA?

A

collapsed
shock- hypotension, tachycardia, cold, clammy
sudden onset back/abdom. pain

24
Q

DDs for ruptured AAA?

A
MI
acute pancreatitis
perforated duodenal ulcer
ureteric colic
aortic dissection
25
Q

emergency management of ruptured AAA?

A

need vascular surgeon and experienced anaesthetist, warn theatre
ECG, take blood for amylase, Hb, crossmatch (may eventually need 10-40U!!), urinary catheter
2 large IVIs. Treat shock with ORh-ve blood, but keep systolic BP 100mmHg or less
take ptnt straight to theatre
give prophylactic antibiotics- cefuroxime 1.5g and metronidazole 500mg IV
surgery- aorta clamped above leak, Dacron graft inserted- replace ruptured aorta