atrial disease of the limbs

Question 1

what is the disease process the same as

Answer 1

coronary and carotid atherosclerotic disease

Question 2

what are the risk factors

Answer 2

male
age
smoking

hypercholesterolemia
hypertension
diabetes

Question 3

what are the classifications of limb ischemia

Answer 3

stage 1 - asymptomatic

stage 2 (a and b) - claudication’s

stage 3 - resting pain

stage 4 - necrosis

Question 4

when is it critical lib ischemia

Answer 4

stage 3,4

Question 5

what are the sings of chronic ischaemia to look at

Answer 5

ulceration
pallor
hair loss

Question 6

what are the sings of chronic ischemia to feel

Answer 6

temperature

capillary refill time

Question 7

what do you auscultate

Answer 7

hand held dopler

dorsal pedis and posterior tibial pulses

Question 8

what imaging can you use

Answer 8

CT angiogram

MR angiogram

Question 9

what is the management of peripheral arterial disease like

Answer 9

managed the same ways as with CAD

Question 10

what are people with PAD more susceptible to

Answer 10

developing or dying from coronary artery disease

Question 11

what actually is the conservative management of PLD

Answer 11

antiplatelet therapy
statins

BP control
smoking cessation
diabetic control

Question 12

what are the revascularisation options for peripheral arterial disease

Answer 12

open surgery

endovascular intervention

Question 13

what are the open surgery options

Answer 13

bypass and or endarterectomy

Question 14

what are the endovascular interventions

Answer 14

balloon angioplasty

stent placement

atherectomy

Question 15

what dies surgical bypass require

Answer 15

inflow

a conduit (synthetic or a vein from leg/arm)

outflow

Question 16

what causes Acute limb ischaemia

Answer 16

an arterial embolus, MI, AF or proximal thrombosis

Question 17

what is proximal atherosclerosis is not often a cause

Answer 17

DVT and PE

Question 18

what are the 6 Ps of clinical presentation of acute limb ischemia

Answer 18

pain

pallor

pulse deficit

paraesthesia (tingling sensation)

paralysis

poikilothermia (cold)

COMPARE TO OTHER LIMB

Question 19

what is compartment syndrome

Answer 19

a condition resulting from increased pressure within a confined body space like the leg

Question 20

when does muscle ischaemia become irreversible

Answer 20

after 6-8 hours

Question 21

what does compartment syndrome cause

Answer 21

inflammation
oedema
venous obstruction

rise in creatine kinase
risk of renal failure

Question 22

what is the management of compartment syndrome

Answer 22

if limb is salvageable then either embolectomy, thrombectomy, bypass

if not palliate or amputate

Question 23

what is the % break down of embolus to thrombus for acute limb ischemia

Answer 23

30% embolic

60% thrombosis

Question 24

what is the peri-operative mortality of acute limb ischaemia

Answer 24

22%

Question 25

what % of diabetic patients develop a foot ulcer

Answer 25

25%

Question 26

what % of Diabetic foot ulcers become infected and what % require amputation

Answer 26

50% become infected

20% require amputation

Question 27

what is the pathophysiology of diabetic foot ulcers

Answer 27

microvascular peripheral artery disease
peripheral neuropathy
minor trauma

Question 28

how are diabetic foot ulcers prevents

Answer 28

always wear shoes

check pressure points on

feet regularly

effective glycaemic control

Question 29

what is the management of diabetic foot ulcers

Answer 29

prevention

diligent wound care

infection - antibiotics

possible amputation

revascularisation - very distal disease

Question 30

what wound care would you used for diabetic foot ulcers

Answer 30

dressing

debridement

negative pressure sound closures

skin grafts