Acute arterial occlusion Emboli

Question 1

symptoms of Acute Arterial Occlusion

Answer 1

Abrupt attack of excruciating pain
Numbness, coldness, tingling
After 6 hrs muscle undergo intensive contractures and swell
After 10 hrs skin have irreversible changes

Question 2

6 P’s of ischemia secondary to acute arterial occlusion

Answer 2

Pulsessness
pain
pallor
paresthesias (sensation of tingling, tickling, prickling, pricking, or burning of a person's skin )
poikliothermia
palor

Question 3

What do you find on a physical exam of a pt Acute Arterial Occlusion ?

Answer 3

Pallor due to spastic reaction of arterial tree
Over 12 hrs and limb becomes cyanotic and mottled
Stasis
Pulses absent distal to occlusion
Area of temp demarcation
loss of light touch and position sense
Distension of superficial veins

Question 4

Differential diagnosis of Acute Arterial Occlusion ?

Answer 4

Iliofemoral thrombophlebitis

Arterial spams

Question 5

Pathophysiologic factors in Acute Arterial Occlusion

Answer 5

Size of the obstructed artery
Adequacy of collateral circulation 
Extent of occluded lesion
Arteriospasm
Fragmentation of thrombus/Emboli 
Secondary venous thrombosis

Question 6

perfusion in Acute Arterial Occlusion

Answer 6

BLOOD BECOMES STAGNANT IN EXTREMITY

• Increase oxygen free radicals
• Damage to surrounding tissues and causes necrosis
• systemic circulation becomes overload with lactate , K, myoglobin and toxins
• Urine is overloaded with alkaline products
• Leads to CV depression and renal failure

Question 7

examples of O2 free radicals

Answer 7

xantine oxidase
H2O2
O2(superoxide)
OH ( hyroxyl radical)

Question 8

surgical treatment for Acute Arterial Occlusion ?

Answer 8

• Embolectomy
• Bypass or graft
• Thrombolysis

Question 9

Acute Emboli

Answer 9

HIgh mortality rate

Question 10

Acute Thrombotic occlusion

Answer 10

High limb loss rate

Question 11

Embolo after acute MI

Answer 11

40% mortality rate

Question 12

Emboli with atrial fib

Answer 12

9%

Question 13

Embolus can be

Answer 13

Thrombus
Fat
Air 
Vegetation
Atheromatous material

Question 14

pathogenesis of embolus

Answer 14

Fracture
Trauma
Surgery
Aniography
Anticoagulants
Cardian catheterization
Angioplasty

Question 15

Embolus affect

Answer 15

arteries and veins

Question 16

Embolus can be

Answer 16

Macroemboli

Microemboli

Question 17

Clinical findings for Embolus on skin

Answer 17

painful violaceous digits

Blue toe syndrome

Question 18

Clinical findings for Embolus on kidney

Answer 18

Renal HTN

Renal failure

Question 19

Clinical findings for Embolus on CNS

Answer 19

TIA (A transient ischemic attack )

CVA (Cerebrovascular accident )

Question 20

Clinical findings for Embolus on cardiac?

Answer 20

MI

Ischemia

Question 21

Clinical findings for Embolus on GI

Answer 21

abdominal bleed

Question 22

Clinical findings for Embolus on pulmonary

Answer 22

Loss of air exchange

Question 23

Blue toe syndrome

Answer 23

shower of microemboli

Breakdown of proximal plaques (travel to digits)

Question 24

Blue toe syndrome

Answer 24

CAVE MAN
Cardiac catheterization
Atrial Fibrillation
Valve disease
Endocarditis
Myocardial infarct / Mural thrombus
Aneurysm/A-V fistula
Nothing

Question 25

Embolus treatment

Answer 25

Modify risk factors Remove source of emboli Surgical replacement of involved segment (Amputation)

Question 26

Virchow's triad

Answer 26

venous stasis Endothelial injury Hypercoagulable state

Question 27

PE formation?

Answer 27

Blood clot forms (usually in deep veins of the leg) Break loose Floats upstream Lodges in pulmonary artery

Question 28

Predisposition for PE

Answer 28

genetic risk factors Factor V leiden Factor II mutation Deficiency in antithrombin, protein C or Protein S

Question 29

PE diagnosis

Answer 29

Not easy | requires a high clinical index of suspicion and diagnostic testing to confirm diagnosis

Question 30

symptoms of PE

Answer 30

- Unexplained sudden SOB - Dyspnea - CP that worsens with coughing or deep respirations - lightheadedness - sense of anxiety - hemoptysis - Increased RR >20 beats/min

Question 31

what is the first symptom in 25% of people who have PE

Answer 31

Sudden death

Question 32

initial PE testing

Answer 32

Q/V scan Helical CT D-dimer (fibrin degradation product) Aniogram

Question 33

PE results in mismatch of Q/V scan due to

Answer 33

areas of lung is ventilated but not perfused

Question 34

Medical management for PE

Answer 34

Respiratory support Hemodynamic support Empiric anticoagulation

Question 35

Surgical management for PE

Answer 35

Thrombolytic therapy IVC filter Embolectomy

Question 36

Embolectomy

Answer 36

Catheter | Surgical

Question 37

Catheter

Answer 37

Rotational Suction Thrombus fragmentation