Acute Limb Ischaemia Flashcards
define acute limb ischaemia
sudden decrease in limb perfusion causing a threat to limb viability
causes of acute limb ischaemia
embolism atheroembolism arterial dissection flap trauma extrinsic compression
embolic causes of acute limb ischaemia
cardiac AF MI valvular disease acute thrombosis of popliteal aneurysm
atheroembolic causes of acute limb ischaemia
thrombus on atherosclerotic plaques
distant cause
presentation of acute limb ischaemia
6P’s
- pain
- pallor
- pulseless
- perishingly cold
- paraesthesia
- paralysis
pain in acute limb ischaemia
severe
sudden onset
resistant to analgesia
woody compartment (muscle necrosis- irreversible)
pallor in acute limb ischaemia
re-fill with stagnated deoxygenated blood giving a mottled appearance due to occlusions occuring
non-blanching mottling is irreverisble ischaemia
when is a limb not salvageable?
fixed mottling non-blanching compartment tender/red paralysis >12 hours
signs that indicate partly reversible ischaemia
blanching mottling
4-12 hours
signs in a salvageable foot
white foot
painful
sensorimotor deficit
0-4 hours
management of acute limb ischaemia
- anticoagulation with LMWH
- anaesthetic (if anticoagulated patient cannot have regional)
- surgery
surgical options if limb salvageable
embolectomy
thrombolysis
fasciotomies
surgical options if limb unsalvageable
palliation
amputation
what is an embolectomy?
surgical removal of embolus from inside of the artery using an inflatable balloon (Fogarty balloon) to pull the clot back
what is are fasciotomies?
when the limb is successfully reperfused it can cause massive oedema in fascial compartments which need pressure release
