Acute limb ischaemia Flashcards Preview

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Flashcards in Acute limb ischaemia Deck (27)
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1

What is Acute limb ischaemia?

  • Sudden decrease in limb perfusion
  • <14 day onset
    • Threatens viability of the ilmb
  • Associated with the 6 P's 

2

Causes of Acute limb ischaemia?

  • Thrombosis 
  • Embolisation
  • Trauma
    • (including compartment syndrome)

3

What are the symptoms and signs of Acute limb ischaemia?

  • 6Ps
    • Pale, pulseless, painful
    • Paralysed, paraesthetic, perishing with cold
  • Emboli tend to originate from the heart:
    • AF, mural thrombosis

4

Describe how a potential acute limb ischaemia might be investigated?

  • Bloods
    • Serum lactate:
      • assesses level of ischaemia
    • Thrombophilia screen
  • ABPI
    • =<0.9
  • Doppler US 
  • CT arteriogram
    • Can provide location information for operative approach

5

Differentials for Acute limb ischaemia?

  • Acute DVT
  • Critical chronic limb ischaemia
  • Spinal cord/ peripheral nerve compression 

6

Describe the management of acute limb ischaemia?

  • Revascularisation within 6hr 
  • Heparin bolus then infusion
  • Analgesia with paracetamol and opioid 
  • Assess revascularisation vs amputation 
  • Revascularisation options:
    • Bypass surgery
    • Local thrombolysis with tPA
    • Embolectomy via Fogarty catheter
    • Angioplasty for thrombosis

7

What are the possible complications after surgery to fix acute limb ischaemia?

  • Compartment syndrome 
  • Reperfusion injury
    • Release of substances from damaged cells:
      • K+ => hyperkalaemia
      • H+ => acidosis
      • Myoglobin => AKI

8

Outcomes of Acute limb ischaemia?

9

Describe irreversible limb ischaemia?

  • Mottled, non-blanching appearance
  • Hard, woody muscles 

10

Gold standard investigation for acute limb ischaemia?

CT angiography 

11

What level does the aorta pass through the diaphragm?

T12 

12

What level does the aorta bifurcate?

L4 

13

Signs of a non-viable limb?

  • Tissue loss
  • Nerve damage
  • Sensory loss

14

Complications of Peripheral arterial disease?

  • Leg/foot ulcers
  • Gangrene
  • Permanent limb weakness/numbness

15

Describe the differences between acute, acute-on-chronic and chronic limb ischaemia?

  • Acute
    • Ischaemia <14 days
  • Acute-on-chronic
    • Worsening symptoms <14 days
  • Chronic
    • Ischaemia stable for >14 days 

16

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of severity?

  • Embolus
    • Complete ischaemia (no collaterals)
  • Thrombosis
    • Incomplete ischaemia (collaterals)

17

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of onset?

  • Embolus
    • Seconds or minutes
  • Thrombosis
    • Hours or days 

18

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of embolic source?

  • Embolus
    • Usually AF
  • Thrombosis
    • Absent 

19

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of previous claudication?

  • Embolus
    • Absent
  • Thrombosis
    • Present 

20

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of palpation of the artery?

  • Embolus
    • Soft, tender
  • Thrombosis
    • Hard, calcified 

21

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of bruits?

  • Embolus
    • Absent
  • Thrombosis
    • Present 

22

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of diagnosis?

  • Embolus
    • Clinical
  • Thrombosis
    • Angiography 

23

Describe the difference between an embolus and thrombosis cause of Acute limb ischaemia in terms of management?

  • Embolus
    • Embolectomy, warfarin
  • Thrombosis
    • Medical, bypass, thrombolysis

24

What is the most important symptom in Acute limb ischaemia?

  • Paralysis
    • Indicates that the limb is threatened

25

Describe Thoracic outlet syndrome?

  • Pressure on subclavian artery from cervical rib or abnormal soft tissue band
  • Can lead to post-stenotic dilation linned with thrombosis
    • Predisposition to occlusion or embolisation
  • Diagnosed with duplex US

26

Treatment for Thoracic outlet syndrome?

  • Thrombolysis
  • Thrombectomy/embolectomy
  • Excision of cervical rib 

27

Contraindications for a heparin bolus in acute limb ischaemia?

  • Trauma
  • Suspected aortic dissection