Acute Vascular Emergencies Flashcards
(21 cards)
ruptured AAA
aortic diameter >3cm
risk factors include aged >60, smoking, fhx, male.
loss of elastin and smooth muscle in the aortic wall associated with elevated MMP
symptoms: back pain and abdominal pain, flank pain and testicular pain, collapse and LOC, shock- pallor, HP , low BP, sweating.
tender expansile swelling
differentials- MI, stroke, hypoglycaemia
investigations for ruptured AAA
(if stable hx and examination)
if unstable bedside: vitals (HR, RR, BP) ECG oxygen large bore venflon hartmanns if hypotension
urinary catheter
urgent CT
inform vascular reg or consultant
bloods: FBC, U+E, creatinine, glucose, clotting screen ABG XM 6-8nuts? warn blood bank- FFP and platelts
AAA scoring systems to operate
Hardman Glasgow aneurysm score V POSSUM APACHE II *open operative treatment *endovascular repair (EVAR) (ask about this on placement)
complications- death, multi organ failure, haemorrhage, embolism, thrombosis, graft infection
acute limb ischaemia
acute or acute on chronic
embolic causes: AF, MI, AAA, popliteal aneurysm
thrombotic- atherosclerosis
signs and symptoms:
sudden onset of painful, cold white foot
six p’s= pulseless, paralysis, paraesthesia (nerve ischaemia 1-2hrs), pain, pallor, perishingly cold
acute limb ischaemia- assesment and investigations
A-E
full history and examination
bloods: fbc, u+e, creatinine, cs, glucose, ABG, group and save, troponin, CK
oxygen ECG ABPI* analgesia nil by mouth
IV cannula , heparin bolus, infusion, fluids
immediate senior review.
angiogram dependent
acute limb ischaemia management
embolectomy and fasciotomy
brachial embolectomy
mesenteric ischaemia causes
acute / chronic
if acute- occlusive or non occlusive mechanism leading to hypoperfusion of one or more of the mesenteric vessels and therefore loss of blood supply to the bowel (1/3 of CO goes to the midgut)
mechanism- thrombotic or emboli, hypoperfused state, iatrogenic (angioplasty)
RF- age, smoking, IHD, HT, diabetes, AF, CCF, hypercoagulable state
mesenteric ischaemia symptoms
severe or non-severe non localised abdominal pain with little tenderness. possible history of chronic pain with weight loss, peritonitis, sepsis.
HR high and BP low
mesenteric ischaemia investigations
full history and exam
plain AXR and erect CXR
bloods- FBC, U+E, creatinine, culture and sensitivity, group and save, ABG, lactate, CK, amylase, LFT
diagnosis can be difficult and delayed
tx: o2, IV fluids, abx, catheter, NGT, IV heparin
AXR shows portal venous gas, pneumatosis, thumbprinting and free air
mesenteric ischaemia treatment
supportive restore flow resect any nonviable tissue supportive care catheter directed thrombolysis
vascular trauma
penetrating- stab, gunshot, impaling
blunt- crush, acceleration deceleration, fracture dislocation
A-E
aortic dissection pathophysiology
tear in the media of the aortic walldue to micrifbril and elastin degedation in the media. true and false lumen*
risk factors hypertension congenitally deformed connective tissue disorders pregnancy
aortic dissection symptoms and signs
sudden death severe and sudden chest pain or back pain (ripping/tearing) hypertension hypotension high index of suspicioun pulse deficit in arms, loss of distal pulses paralysis murmur ischaemia of any organs
aortic dissection investigations
ECG CXR CT angiogram bloods- FBC, U+E, LFT, CS, G+E echo (transoesophageal echo0
aortic dissection management
type A stanford (ascending aorta) replace the aortic root
type B (not involving the ascending aorta) medical management to reduce stress on aortic wall (IV vasodilators and beta blockers)
endovascular - acute dissection with branch vessels ischaemic
fenestration and stent
venous bleeding
causes: blunt or penetrating trauma, iatrogenic trauma (e.g misplaced central line) complication of anticoagulation (spontaneous/compounding factor)
complications of anticoagulation- spontaenous/compounding factor
abdominal venous pressures
oesophageal varices
venous obsturction
normal blood volume for 70kg man
5000ml (5L)
estimated blood volume (ml)= weight (kg) x 75 (ml)
classes of shock/haemorrhage
CLASS I
class I
HR <100, BP normal, conscious normal/anxious, UO >30ml/hr
blood loss % vol <15% (750mls)
CLASS II
HR 100-120 BP normal mildly anxious UO 20-30ml/hr blood loss % volume 15-30% (750-1500ml)
CLASS III
HR >120 BP decreased confused urine output 5-15 ml/hr blood loss % (volume) 1500-2000 ml
CLASS IV
HR >140 decreased BP lethargic UO= anuric blood loss in % 40% >2000ml
